Written Lab Final Flashcards
How long do you do IPPB for?
15-20 minutes (short-term)
What are the clinical goals of IPPB?
- improve lung expansion
- short term vent support
- deliver medications
What are the relative contraindications of IPPB?
- hiccups
- ICP>15mmHg
- active hemoptysis
- untreated active TB
- uncooperative patient
What happens when you increase sensitivity for IPPB?
the magnet is further away so it is easier to trigger a breath
How is IPPB powered?
pneumatically
What will happen if the IPPB is set to be too sensitive?
it will auto-cycle too quickly
What are the indications for IPPB?
- atelectasis
- increased WOB
- hypoventilation
- increased RAW
What are the hazards of IPPB?
- increased RAW
- airtrapping
- bronchospasm
- pneumothorax
- hyperventilation
How do you know if IPPB therapy is effective?
- VT increased by more than 25%
- breath sounds improved
- more effective cough
- ABG improved
How do you set the flow rate?
watching the pressure gauge and talking to the patient
What is the mean airway pressure?
the average of both pressures on exhalation and inhalation
What happens to the alveoli due to IPPB treatment?
increase in size
What do you set pressure at for IPPB
10-15ml/kg body weight and no more than 20 cmH20
How does IPPB start?
when sensitivity between -2 and -5 is triggered
How do you increase pressure with IPPB?
decrease the sensitivity by moving the magnet closer
How do you create volume with IPPB?
increase the pressure
What is an absolute contraindication of IPPB?
untreated tension pneumothorax
How can you tell if a patient is trying to breathe with the IPPB machine?
the manometer will have pressure jumps
What is the physiology of IPPB?
- increase MAP
- increase VT
- decrease WOB
- secretion control
How does IPPB affect inspiration pressure?
pressure becomes positive instead of negative
What will happen if the machine is set too difficult?
the patient won’t be able to trigger a breath and the manometer will swing negative, but nothing will happen
What does IPPB stand for?
intermittent positive pressure breathing
When is a breath terminated with IPPB?
when the predetermined inhalation pressure is reached
How does a pharyngeal airway relieve airway obstruction?
it keeps the base of the tongue away from the posterior wall of the pharynx to prevent the tongue from occluding the airway
What are the steps of proper oral airway insertion?
- remove foreign substances from mouth
- hyperextend the neck and open the patient’s mouth
- insert the airway with the tip pointing toward the roof of the mouth
- observe the passing of the uvula and rotate 180 degrees
How do you measure an endotracheal tube?
measure from the mouth to the jaw
What are the indications for oral pharyngeal airways?
- unconscious patient
- facilitate suctioning
- enhance bag mask ventilation
In terms of endotracheal tube size, what size is better?
larger rather than smaller
What is a berman airway?
hard plastic with grooves down the sides
What are complications of oral airways if the tube is not the right size?
too large: blocks coughing reflex
too small: does not relieve obstruction
What does the bite block do?
keeps from biting the tongue
Why should an oral airway never be taped in place?
in case the patient becomes conscious, the airway should be easily removable
What is a guedel airway?
soft plastic with a lumen down the middle
What are complications of oral airways?
- teeth or lip damage
- gagging
- aspiration
- failure to remove quickly when reflexes return
What are the advantage of nasal airways over oral?
- can be used in both semiconscious and conscious patients
- can be inserted during seizures
- jaw trauma
How do you visually assess placement of a nasal airway?
- examine oropharynx
- flashlight
- tongue depressor
How often should you change the nasal pharyngeal airway?
every 24 hours
How do you measure a nasopharyngeal airway?
tip of the nose to the tragus of the ear
Where should the bevel face during insertion?
midline
What are the complications of nasal pharyngeal airways?
- trauma to the mucosa
- infection
- bleeding
- chemical inflammation
- obstructed with secretions
Why are nasopharyngeal airways helpful with semiconscious patients?
allows the patient to breath and aids frequent suctioning
What do you use to lubricate the airway?
water soluble lubricant
What are the hazards of nasopharyngeal airways?
- intubation of the meninges
- sinusitis
- otitis media
- bleeding
- gastric inflation
What should you use to secure a nasopharyngeal airway?
place a safety pin through the side of the flare
How should you determine which side of the nasal passage is less obstructed?
temporarily occlude each side and see which side has better airflow
What are the nasopharyngeal airway supplies?
- 3 sizes of airways
- water soluble lubricant
Why should you change the nasal pharyngeal airways so often?
- reduce the risk of infection
- increased RAW
How do nasopharyngeal airways facilitate suctioning?
protect the nasal cavity from suctioning and trauma
What are the contraindications of nasal airways?
- nasal trauma
- basilar skull fractures
- deformities of the nose
- coagulation disorders
What are the indications for suctioning?
- retention of secretions
- sputum sample needed
What should you keep suction pressure at?
80-120 mmHg
How long should you suction for?
no more than 15 seconds
What should you do before and after suctioning?
preoxygenate and postoxygenate
What are the hazards of suctioning?
- hypoxemia
- tissue damage
- bleeding
- infection
What mode of ventilation is time triggered, pressure controlled and time cycled?
pressure control
What mode of ventilation is patient triggered, pressure controlled and flow cycled?
pressure support
What mode of ventilation is a combination of mechanical and spontaneous breaths - the mechanical breaths are time/patient triggered, pressure limited and time cycled?
P-SIMV
What mode of ventilation is a combination of periods of control mode and periods of spontaneous breathing?
IMV
What mode of ventilation is patient triggered, flow controlled during inspiration and time cycled?
assist control
What mode of ventilation is a specific (limited) number of assist control breathed interdispersed with spontaneous breathing?
SIMV
How do you calculate static compliance?
VT / (plat-peep)
How do you calculate dynamic compliance?
VT / (peak-peep)
How do you calculate airway resistance?
(peak-plat) / flow
When parts do you need to setup a ventilator?
- exhalation valve
- exhalation valve housing
- circuit (inspiratory and expiratory lines)
- flow sensor
- bacteria filter
- HME or humidifier
- temperature probe
What should you do if a person has a high amount of CO2?
increase the RR or VT
What should you do if a person has a low PaO2?
increase the FiO2
How do you calculate itime?
(VT / flow) x 60
What are the indications for intubation?
- respiratory failure or arrest
- cardiac arrest
- inability to protect airway
- failure to breathe adequately
What are the contraindications for intubation?
- severe airway trauma or obstruction
- cervical spine injury
- mallampati classification of III or IV
What are the hazards of intubation?
- intubation of the esophagus
- damage to teeth or lips
- hypoxia
What is the proper tube size for a male and female?
male: 8-8.5
female: 7-7.5
What should the cass tube pressure be?
no more than 20 cmH2O
What should you always check before intubation?
the cuff
What supplies do you need for intubation?
- laryngoscope handle
- blades
- ET tube
- water soluble lubricant
- syringe
- securing device
- bag valve mask
- suction equipment
- stethoscope
What pressure should the cuff be kept at?
25-35 cmH2O or 20-30 mmHg
What is the term for measured peak inspiratory pressure for every breath, including spontaneous?
Ppeak
What is the term for an inspiratory hold maneuver with a freeze frame?
Pplateau
What is the term for mean airway pressure over an eight breath average?
Pmean
What is the term for positive end expiratory pressure?
PEEP (in cmH2O)
What is the term for minimum pressure seen throughout ventilatory cycle?
Pmin (in cmH2O)
What is the term for unintended positive end expiratory pressure?
autopeep (in cmH2O)
What is the term for airway occlusion pressure?
PO.1 (in cmH2O)
What is the term for a calculated parameter of the respiratory rate divided by VT in liters (rapid shallow breathing index)?
RSB; <105 is GOOD
What is the term for measured exhaled tidal volume, including spontaneous measured at the flow sensor?
VTe (average 4-12L)
What is the term for a measured eight breath average if leak in volume per breath?
Vleak
What is the term for peak inspiratory flow measured per mandatory and spontaneous breaths?
Inspiratory flow (range: 40-80L/min)
What is the term for peak expiratory flow measured in L/min?
Expiratory flow
What is the term for resistance to inspiratory flow caused by endotracheal tube and the patient’s airways during inspiration?
Rinsp (normal 3-6 cmH2O/L/sec)
What is the term for resistance to the expiratory flow caused by endotracheal tube and the patient’s major airways during exhalation?
Rexp
What should you set for a high pressure limit?
10-15 above peak pressure
What should you set for a high minute volume?
<3-5 above observable minute volume
What should you set for a low minute volume?
2 below observable minute volume
What should you set for a low tidal volume?
100-200 below maintained tidal volume
What should you set for a high respiratory rate?
5-10 above observable rate
