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AirMed Regional > Vent Management > Flashcards

Vent Management Flashcards

1
Q

What is the minimum weight the Revel is rated for?

A

5kg

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2
Q

What mode gives a set rate regardless of patient breathing?

A

A\C

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3
Q

What mode gives a set rate, but will give a support breath when a patient takes a breath?

A

SIMV

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4
Q

When in AC mode, does the Pressure Support setting light up for use?

A

No…no support breaths are given in AC mode.

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5
Q

When in SIMV, does the Pressure Support (PS) setting light up for use?

A

Yes…the patient can initiate a support breath.

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6
Q

What is another term for BiPAP?

A

CPAP + PS

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7
Q

What modes must a pplat be checked in?

A

Volume

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8
Q

What can a pplat greater than a PIP indicate?

A

Air trapping…check EtCo2 waveform and patient

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9
Q

What is the maximum pressure PRVC will allow a patient breath to reach?

A

5 below the high pressure alarm limit.

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10
Q

What does the alarm “Volume Limited” mean?

A

When in PRVC mode, you have reached the maximum allowed pressure before your targeted volume was met. For example, a TV of 500 was set and your high pressure alarm is 40. While trying to administer a breath of 500ml, the pressure hit 35 before the entire volume was administered and the breath was terminated, thus it is volume limited.

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11
Q

What kind of mask must you use with the NIPPV mode on Revel?

A

A non-vented mask

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12
Q

If nebulizing a medication for a mechanically ventilated patient, at which time should you change the Bias Flow to 10? When using a secondary oxygen source or when nebulizing through the vent?

A

Only when nebulizing through the vent. The extra flow is needed to nebulize the medication. With a secondary source, the flow is being provided outside of the vent.

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13
Q

What mode does the vent have to be in to nebulize through the vent?

A

A/C, Volume

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14
Q

A patient you are transporting is requiring high PEEPs, what alarm do you anticipate needing to adjust?

A

High PEEP alarm. Defaults to 12 and will alarm if the measured PEEP reaches this. Change by going to the extended menus, alarm config, then High PEEP.

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15
Q

When transporting a patient in the NIPPV mode, you begin receiving a blower demand exceeded (Blwr Demand) alarm. How do you troubleshoot?

A

The ventilator will stop delivering any flow during this alarm. Check the mask seal to ensure it is snug and a non-vented mask. Be prepared to remove circuit and manually ventilate as necessary if it is not quickly resolved.

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16
Q

Upon receiving a SVHP Relief alarm, what actions should you quickly take?

A

SVHP Relief is the Safety Valve High Pressure Relief alarm. An airway pressure of >110 has been detected. The vent cycles to exhalation and the red safety valve just above where the inhalation limb attaches to the vent, opens up. No flow is administered. Commonly a sense line issue and must check the sense lines for kinks or occlusions (fluid). May have to replace the circuit.

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17
Q

Your mechanically ventilated patient is hypoxic. What 2 vent parameters should you be considering changing to increase oxygenation?

A

FiO2 and/or PEEP

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18
Q

Adequate ventilation can simply be assessed by ….?

A

chest rise and fall and EtCO2

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19
Q

You are called to a facility to transport a 1 year old with a trach receiving BiPAP. When you arrive bedside, the RT and the patient’s mother explains that the patient does not like to receive ventilated breaths. You prepare the ventilator by turning it on, choosing pediatric setting and NIPPV mode. You enter the appropriate IPAP and EPAP.

What should you enter for the rate?

A

0

This rate is commonly mistaken to be the backup rate. It is actually a set rate to be delivered to the patient. To ensure the patient is not receiving a vent triggered breath, look at the Breath Mode and CPAP+PS should be selected. If A/C is selected, the patient is receiving the set Breath Rate.

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20
Q

When ventilating a patient with NIPPV, they complain that the breath is too forceful. How can you adjust the vent to make them more comfortable?

A

Change the Rise Time. Settings are from 1-9. Change in the direction towards 9 to slow how quickly the breath is delivered and towards 1 to speed it up. Sometimes only one change is needed (ex: a setting of 4 changed to 5). For each level changed, the breath is 33% slower or faster than the previous level.

Also evaluate whether you’re giving a vent triggered breath (A/C mode) that could be making the patient uncomfortable.

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21
Q

NIPPV ventilation can use a lot of oxygen, especially if there’s difficulty obtaining a mask seal (NG tube placed, etc.). What is the best way to prepare to conserve oxygen?

A

Utilize low pressure O2 source. The ventilator has a mixer that will use ambient air and the low pressure O2 to conserve oxygen.

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22
Q

You arrive bedside in a facility and are preparing your ventilator. You find a hole/leak in your high pressure hose. This patient does not have super sick lungs and is not requiring a “dialed in” FiO2. What other option do you have to provide oxygen?

A

Low pressure O2 source.

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23
Q

How do you know how many LPM to administer when utilizing low pressure O2 source?

A

There is a chart on page 5-15 of the Revel Vent Manual (Bias Flow 5 is default). Save this chart somewhere. Determine the patient’s minute ventilation and the needed FiO2, then follow the appropriate line on the chart to see where to set the regulator for LPM flow.

24
Q

How do you set up the low pressure O2 source?

A

Take off the high pressure hose from the vent and put a “tree” in its place. Use oxygen supply tubing to connect that “tree” to the oxygen source. Scroll down on the vent O2 setting below 21% to “LPS”. Set the regulator on the oxygen source to the desired LPM.

25
Q

What is Controlled Minute Ventilation (CMV)?

A

The patient gets a set rate and is not allowed to trigger a breath. This is not a mode on the Revel but may be seen in hospitals. This differs from A/C in that Assist Control does give a set rate, but will also allow the patient to take a breath.

26
Q

What is a complication of setting up your vent for a PRVC type and allowing it to initiate breaths before the circuit is attached to the patient?

A

PRVC works by adjusting each breath based on the previous breath. It will only increase or decrease the pressure deliver by 3 for each breath until it reaches the targeted volume. If the initial breath is not a patient breath, then the vent takes that much longer to get to the targeted volume. Suggestion, start the patient in volume mode, attach the circuit, then switch to PRVC.

27
Q

What is a physiological normal PEEP?

A

3-5

28
Q

You step into an ambulance to find a patient intubated and being ventilated via BVM. What is a quick way to improve this patient’s oxygenation and lung status?

A

Throw on a PEEP valve!

29
Q

You notice that the vent is auto triggering breaths at an unwanted rate. More than likely due to vibrations or other movements. What is the solution?

A

Change the sensitivity. It defaults as a flow trigger with a sensitivity of 2. This means the circuit can move and cause a flow change of only 2 liters and the vent will think the patient is trying to breathe and deliver a breath. If you turn that sensitivity up, it will require much more flow movement in the circuit to trigger a breath. Other option is to change to a pressure trigger by turning the Sensitivity all the way down to “P”. The patient then has to draw negative pressure (-3) on the circuit to trigger a breath. The circuit can move all it wants and will not trigger in pressure trigger.

30
Q

You’re ventilating a patient in NIPPV mode when you notice they are tachypneic and appear to be uncomfortable. What setting can you change to help make them more comfortable?

A

Change the Flow Term to 40% to allow the patient to cycle to exhalation and initiate the next breath much faster. 40% is the highest allowable setting.

31
Q

What is the difference in Pressure Support and Pressure Control?

A

Pressure Support is a pressure breath given to support a patient’s breath. Only utilized in SIMV or CPAP+PS modes.

Pressure Control is a pressure breath delivered (controlled) by the ventilator.

32
Q

When ventilating in NIPPV, you are not delivering a set rate to the patient, how long will the patient be apneic before apnea alarm initiates and provides ventilations?

A

20 seconds

33
Q

When ventilating in NIPPV with settings of CPAP+PS, Pressure, IPAP 16 and EPAP 8, you notice the apnea alarm initiates and begins providing back up breaths. What happens when you clear this alarm?

A

The vent will stop delivering breaths and allows the patient to be provided support breaths only. If the patient has truly gone apneic, clearing this alarm will stop the vent from breathing for them. Either disconnect them and provide manual BVM ventilations, or switch the vent mode from CPAP+PS to A/C and a set rate will initiate.

34
Q

What other ventilator terms can IPAP sometimes be synonymous with?

A

PIP, total inspiratory pressure, etc

35
Q

What other ventilator term can EPAP be synonymous with?

A

PEEP

36
Q

Your patient is acidotic and tachypneic. You decide RSI is necessary. What must you consider when deciding on vent settings?

A

How best to match the patient’s minute ventilation prior to RSI.

37
Q

What is Auto PEEP?

A

Air trapping

38
Q

How can you check the auto PEEP on the vent?

A

Perform an E-hold. Much like an I-Hold to assess the Pplat. Select Maneuvers, Scroll to E-Hold, Press maneuvers again to make the light start flashing, then press and hold to perform the E-hold. An auto-PEEP value will be displayed. Helpful in stiff lungers

39
Q

How can you help improve a patient who is air trapping?

A

Bronchodilators and steroids.

Lengthen exhalation time by decreasing the rate or by increasing the inspiratory time.
Goal of 1:3 or 1:4 I:E

Increase PEEP to 75%-80% of the Auto-PEEP.

40
Q

You are called to transport an 8 year old patient that weighs 15kgs. You notice when you get bedside that the patient has a rare disease in which the legs did not develop normally, are very small, and do not function. The rest of the patient’s body did develop normally. Due to the patient’s acute state, you have to RSI. Using the 4-8ml/kg range, what would be the appropriate tidal volume?

A

100-200ml

The answer is not 60-120 because the patient’s lungs developed for a normal sized 8 year old which would be approximately 25kg. In this case, the tidal volume should be appropriate for the patient’s lung size.

41
Q

You check a pPLAT and it is over 30. What should you do?

A

Decrease the tidal volume until it is less than 30. Do not go below 4ml/kg tidal volume.

42
Q

Why do you not need to check a pplat in pressure mode?

A

The PIP is the same as the pplat in this breath type.

43
Q

When ventilating in the pressure breath type, what measurement should you be assessing?

A

The tidal volume to ensure the patient is receiving adequate (4-6ml/kg) tidal volume.

44
Q

You are ventilating a 100kg patient using A/C pressure and notice the tidal volume is measured at 300ml. How can you correct this?

A

Increase the Pressure Control until the measured tidal volume is within normal limits.

45
Q

You respond to a patient that was pulled from a house fire. EMS intubated them. You arrive in the ambulance, confirm tube placement, attach a PEEP valve, and note the SpO2 to be 100%. In an effort to prevent over oxygenation, what should the FiO2 on the vent be set to?

A

Trick question….These patients from inside a building fire need 100% FiO2 to treat for possible carbon monoxide, cyanide, and other poisonings. Maybe EMS had a CO sensor?

46
Q

What does the pplat (plateau pressure) represent?

A

alveolar pressure

47
Q

What is the peak airway pressure?

A

A combination of airway resistance and alveolar pressure.

48
Q

What do you do when you receive a high airway pressure (high pressure) alarm?

A 
DOPES
D-displaced tube
O-Obstructed tube
P-pneumo
E-equipment problem (circuit, etc)
S-breath Stacking
49
Q

How can a pplat help you understand how to toubleshoot a high pressure alarm?

A

If the airway pressure is high and the pplat is high, then the problem is in the lungs:

  1. maintstem intubation-pull back the tube
  2. atelectasis - percussion or bronchoscopy
  3. Pulmonary edema - diuretics, inotropes, etc
  4. ARDS - lower the TV, increase PEEP
  5. Pneumo - decompress, chest tube

If the airway pressure is high and the pplat is low, then the probelm is in the airway:

  1. kinked ETT - unkink it!
  2. Mucus plug - suction
  3. Bronchospasm - bronchodilators
  4. ETT is too narrow - change it, slow the inspiratory time, or accept the high pressures
50
Q

If a patient is becoming very fatigued, which mode of ventilation is best? A/C or SIMV

A

Answer: A/C
Provides a full breath when the patient initiates it. Requires little effort from the patient.

SIMV only provides a partial support breath when the patient initiates it. Requires more effort from the patient. You can use this mode, but may require higher pressure support breaths to help the patient.

51
Q

How do you calculate dead space?

A

Approximately 1ml per 1cm in height. Average 150-180ml.

52
Q

If the patient’s metabolic state demands a change in the minute ventilation, what is the preferred way to change it?

A

Rate first.

Volume should be maintained between 4-6ml/kg of IBW, no more than 8ml/kg.

53
Q

What is the difference in how a volume breath and pressure breath are actually delivered?

A

A volume breath with an I time of 1.0 sec and a TV of 500 will take the entire 1 second to reach a volume of 500 before terminating the breath.

A pressure breath with an I time of 1.0 sec and a PC of 20 and a PEEP of 5 will deliver a pressure up to 25 and hold that pressure for 1.0 sec before it terminates the breath. How quickly that breath reaches the pressure of 25 is determined by the Rise Time.

54
Q

If a chest x-ray shows white stuff where there should be black stuff (consolidation or infiltration) what might you be preparing to administer more of on the vent?

A

PEEP

55
Q

How much PEEP can be delivered before you MIGHT see a change in hemodynamics?

A

10-12. If blood pressure drops with PEEPs at this level or lower, highly suspect need for fluid resuscitation.

56
Q

What is airway pressure release ventilation (APRV) and what types of patient’s is it used in?

A

APRV is a proprietary name also known as Bi-Vent, and BiLevel vent depending on what the vent manufacturer is.

Essentially, you’re giving a really high CPAP that is needed to improve oxygenation and keep alveoli open for super sick ARDS patients, pulmonary contusions, and bilateral pneumonia. In order to make sure they’re also receiving ventilation, the breath is cycled to release all of the pressure (providing CO2 gas exchange) and then quickly triggered back to the high pressure for oxygenation. Though the Revel does not have this mode, it can be mimicked. Requires a lot of practice to mimic.

AirMed Regional (5 decks)

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