Ventilators

Question 1

Ventilatory vs perfusion problems

Answer 1

Ventilatory = problem with air movement into the lungs

Perfusion = insufficient oxygenation of pulmonary blood at alveolar level

Both of these occur in patients with abnormal lungs (COPD, asthma attack)

Question 2

What is V/Q mismatch?

Answer 2

total ventilation and perfusion are normal

one lung gets a lot of blood with not much oxygen while the other lung gets less blood but more oxygen

well oxygenated regions can’t compensate for poorly ventilated areas due to the oxyhemoglobin dissociation curve (more Hgb = better oxygenation)

Question 3

Cheyne Stokes

Answer 3

gradual increase and decrease followed by periods of apnea

Question 4

Biot’s pattern

Answer 4

rapid gasps followed by periods of apnea

Question 5

Kussmaul’s respirations

Answer 5

rapid RR with deep breaths

seen with metabolic acidosis and DKA because they are trying to compensate by blowing off excess CO2

Question 6

Hallmark sign of acute respiratory failure

Answer 6

dyspnea

Question 7

Interventions for dyspnea

Answer 7

Priority is airway

O2, reduce anxiety, cluster care, drugs to dilate bronchioles and decrease inflammation

Question 8

Causes of ARDS

Answer 8

sepsis, shock, aspiration, inhalation injury

Question 9

Diagnostics for ARDS

Answer 9

Low PaO2 that doesn’t improve with O2 (refractory hypoxemia)

Whited-out, ground glass chest X-ray

Question 10

Interventions for ARDS

Answer 10

Mechanical ventilation with high PEEP

ET tube or CPAP

Drugs and fluids

Question 11

Important info about ET tubes

Answer 11

Right mainstem: positioned incorrectly in the lung, pull ET tube a little bit

Checking placement: listen to breath sounds, CO2 detector, chest X-ray

If you hear weird noises there may be a leak so make sure the cuff is inflated

Question 12

Assist-control ventilation

Answer 12

Takes over the work of breathing for the patient

Ventilatory pattern is established if pt doesn’t initiate spontaneous breaths

Question 13

Synchronized intermittent mandatory ventilation (SIMV)

Answer 13

Unlike AC, SIMV allows spontaneous breathing at patients own rate and tidal volume between ventilator breaths

Example: PRVC (pressure regulated volume control)

Question 14

Bi-level positive airway pressure (BiPAP)

Answer 14

non-invasive pressure support

Question 15

Extubation

Answer 15

hyper oxygenate, suction, rapidly deflate ET cuff, remove tube at peak inspiration, assess for respiratory distress

Have extra intubation equipment available!

Question 16

Causes of V/Q mismatch

Answer 16

Altered V: COPD, asthma, atelectasis, pulmonary edema, pneumonia, aspiration

Altered Q: PE