Week 8 - Critical Care and Ventilation Flashcards
What is a central venous pressure catheter (CVP)?
Inserted into subclavian or internal jugular vein to measure fluid volume; indicator of hearts ability to cope with this volume
What are normal ABGs?
PH - 7.35-7.45 PO2 - 10-14 PCO2 - 4.7-6.0 HCO3 - 22-26 BE - +/-2
What is a Swan Ganz catheter?
Pulmonary artery catheter inserted via a central vein through right side of heart into pulmonary artery
Measures CO, SV and ventricular load
What is ICP and CPP? How do you calculate CPP?
ICP = intracranial pressure
CPP = cerebral perfusion pressure
CPP = MAP - ICP
Normal MAP = 90mmHg
What are normal values for ICP and cPP?
ICP = 0-15 mmHg, Critical = >20mmHg CPP = >70mmHg, Critical = <50mmHg
What are three methods of intubation?
Endotracheal tube
Tracheostomy
Nasal ETT
What are potential complications of ventilation?
Barotrauma VQ mismatch CVS instability Discomfort Excess secretions/ infection Absorption atelectasis Gut/ bowel dysfunction Weakened respiratory muscles
Name two different types of ventilation
Pressure controlled
Volume controlled
What settings are there on a ventilator?
Inspiratory pressure or TV RR PEEP FiO2 I:E ratio
What can cause problems with weaning from ventilator?
Increased load, e.g. secretions, hyperinflation
Decreased drive, e.g. sedation
Capacity of pump, e.g. paralysing agents
Consider - anxiety, sensory overload
Name some pros and cons of a tracheostomy?
Pro - increase patient mobility and comfort, decrease anatomical dead space, assist communication
Cons - blocked tube, infection, aspiration risk, psychological problem
How can you improve humidification with a tracheostomy?
Hydration
Nebulisers
Saline installation
Swedish nose/ thermovent
How do you care for a tracheostomy?
Cleaned at least once a day Daily inner tube change/ clean Check every 4h Daily cuff pressures (<25mmHg) Plan tube changes every 28 days Emergency procedures in place
Describe the process of weaning
Mechanical ventilation CPAP Trachy mask Deflate cuff Speaking valve Decannulation cap Decannulation (+/- mini tracheostomy)
Name some criteria for weaning
Primary cause resolved Adequate nutrition and sleep Able to protect airway Spontaneous breathing off ventilator for 24-48 hour O2 <40%
