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Flight Paramedic Certification Study set > Ventilator management > Flashcards

Ventilator management Flashcards

1
Q

What is tidal Volume?

A

VT

Air that patient breathes in during a normal minute

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2
Q

What is Inspiratory Reserve Volume?

A

IRV

Amount of air forcefully inhaled in addition to normal breath

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3
Q

What is expiratory reserve volume?

A

Amount of air forcefully exhaled after a normal breath

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4
Q

What is the equation for vital capacity? (VC)

A

VT+IRV+ERV= VC

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5
Q

What is residual volume?

A

RV

Amount of air left in respiratory tract after forceful exhalation

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6
Q

What is total lung capacity? (TLC)

A

IRV+VT+ERV+RV= TLC

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7
Q

What is dead space?

A

Surface of airway that are not involved in gas exchange
Gas exchange only occurs in the alveoli
Dead space formula: 2 ml/kg

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8
Q

Where are the central chemo receptors located?

A

medulla and pons

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9
Q

What is the brain chemo receptor called? Response?

A

Central
This is a slow responding system
Response is driven by CO2 and H+ levels in the CSF

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10
Q

Where are the peripheral chemo receptors located?

A

In aortic arch and carotid bodies

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11
Q

What is the heart chemo receptors called? Response?

A

Peripheral
Body’s pulse Ox
Response driven by O2, CO2 and H+

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12
Q

What are some conditions of Hypoxic respiratory Failure?

A

ARDS, pneumonia, CHF, Asthma

Anything that inhibits getting O2

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13
Q

How do you treat hypoxic respiratory failure?

A

By increasing FIO2 and PEEP. VT and Rate will have minimal impact.

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14
Q

What causes hypercarbia respiratory failure?

A

Damage to pons or upper medulla (stroke/trauma)

Inability to remove CO2

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15
Q

How do you treat hypercarbia respiratory failure?

A

Fix by increasing VT and RR

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16
Q

What are some breathing patterns? (5)

A

Kussmaul, Cheyne-Stokes, Apneustic, Attaxic, Biots

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17
Q

Describe Cheyne-Stokes breathing pattern?

A

This is hypoperfusion of the brain
Caused by drugs, stroke, sleep apnea or heart failure
Described as a gradual deeper or faster respiration pattern followed by a period of apnea

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18
Q

Describe Kussmaul Respirations?

A

This is caused by diabetic ketoacidosis, cancers or kidney/liver failure
Deep rapid respirations

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19
Q

Describe Apneustic respirations?

A

Deep gasping inspirations

Associated with decerebrate posturing

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20
Q

Describe Attaxic respirations?

A

Complete irresgularity of breathing with irregular pauses and increase periods of apnea.
Caused by damage to the medulla secondary to trauma or stroke.

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21
Q

Describe Biots respirations?

A

Deep regular respirations with periods of apnea.

Caused by damage to the medulla secondary to CVA or trauma or pressure on the medulla secondary to brainstem herniation.

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22
Q

What is the normal Tidal Volume?

A

4-8 cc/kg IBW

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23
Q

How do you calculate Minute Volume? (VE)

A

RxVT Should be 4-8 L/min

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24
Q

What is the average FIO2?

A

0.21-1.0

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25
Q

What is PIP? What is the normal value?

A

Pressure to inflate the lung

<35

26
Q

What is the PPlat? What is the normal value?

A

Plateau Pressure
Pressure to small airways and alveoli
<30

27
Q

What does lung compliance mean?

A

The stretchiness of the lung

28
Q

What does low compliance mean?

A

Stiff lung and needing higher pressure

29
Q

What does high lung compliance mean?

A

Less stiff lung and needing lower pressure

30
Q

What are the three different breaths that can be delivered on a vent?

A 
Controlled breaths (cannot take own breath)
Assisted Breaths (deliver full breaths)
Support spontaneous breaths (some support but not full support)
31
Q

Which setting on the vent can cause Auto peep or stacked breaths?

A

Volume control setting

ASV, ACV, CMV

32
Q

What does volume control effect?

33
Q

Pressure assist control is where a preset pressure is delivered. What else do you have to monitor?

A

Volume

Volume can change with each breath

34
Q

What is SIMV mode?

A

Capable of delivering all three vent breaths

Synchronized intermittent mandatory ventilation

35
Q

What is important to remember with COPD/Emphysema patient’s?

A

Set RR lower

36
Q

How can you obtain what the PPLAT is?

A

End inspiratory hold maneuver Goal is <30

On our vent exhaled tidal volume divided by CSTAT + peep

37
Q

What does high PPLAT and PIP reflect?

A

Decreased Lung compliance and Lung disease
-ARDS, pulmonary contusion, Pulmonary edema, Pleural effusion, tension pneumo, circumferential chest burn, massive ascites, compartment syndrome, pneumonia.

38
Q

What is the normal difference between your PIP and PPLAT?

39
Q

What does Increases PIP and unchanged PPLAT reflect?

A

Increased airway resistance

-ETT occlusion, secretions/mucous, bronchospasm, kinked line

40
Q

What does DOPES stand for?

A

Dislodged (low pressure), obstructed (high pressure), pneumothorax (high pressure), equipment, stacked breaths (high pressure)

41
Q

What is Patient/vent desynchrony?

A

Respiratory demands not being met
Caused by inadequate sedation or pain control
Evidence of Curare cleft on ETCO2 (patient making an attempt to breath)

42
Q

What is VQ ratio

A

Determined by nuclear study

Relation to ventilation and perfusion

43
Q

What does high or low VQ reflect

A

Low VQ reflects respiratory failure, Low PaO2, high PaCO2

High reflects something like a PE

44
Q

What is a normal V/Q ratio?

A

0.8 or 4/5

45
Q

What pulmonary diseases show a flattened diaphragm on Chest X-Ray

A

COPD and Asthma

46
Q

What is the treatment for Asthma?

A 
Increase I:E ration to 1:4
Zero peep
Consider Bi-Pap
High flow O2
Bronchodilators
EPI, Mag , steroids, IV fluids and or Ketamine
Manual exhalation
47
Q

What are some signs and symptoms of COPD?

A

Barrel chest (blue bloater) and Pink frothy sputum from emphysema.

48
Q

What is a pleural effusion?

A

Fluid in pleural space that gravitates to most dependent area

49
Q

What does a chest X-Ray show in pneumonia?

A

Pleural effusions, lobar consolidations, patchy infiltrate’s

Right middle lobe is the most common site for consolidation

50
Q

What does ARDS stand for?

A

Acute respiratory distress syndrome

51
Q

What is ARDS?

A

Collection of fluid in lung’s air sacs depriving the organ’s of O2

52
Q

What does the chest X-ray show on an ARDS patient?

A

Ground glass appearance, patchy infiltrates, bilateral diffuse infiltrates

53
Q

What are some treatments for ARDS Patient’s?

A

Increase peep and FIO2 (peep >10)
Low Tidal volume (4cc/kg)
Increase RR (ensure adequate MV)

54
Q

Where are the central chemoreceptors located?

A

Medulla and Pons

55
Q

What is the gold standard for monitoring ventilation?

A

Capnography

56
Q

What 2 factors influence oxygenation?

A

Peep and FIO2

57
Q

What 2 factors influence ventilation?

A

Respiratory rate and tidal volume

58
Q

PPLAT should be maintained less than ?

59
Q

PIP should be maintained less than ?

60
Q

What is the IBW calculation for both male and female?

A

Males: 50 kg + 2.3 kg for each inch over 5 ft
Females: 45.5 kg + 2.3 kg for each inch over 5 ft

61
Q

How many minutes should you wait for serial ABG’s when making vent changes?

A

15 minutes

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