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Respiratory Revision > Year 3 > Flashcards

Year 3 Flashcards

0
Q

What are the indications for ventilation?

A 
GCS below 8
RR >30bpm 
PaO2 >8kPa
PaCO2 >6.5kPa
pH <1 L ( normally 3-5L)
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1
Q

What are normal ABGs?

A 
pH = 7.35 - 7.45
Pa02 = 10.7 - 13.3 kPa
PaCO2 = 4.7 - 6.1 kPa
HCO3- = 22 - 26 mmol 
BE = -2 to +2
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2
Q

What does PEEP stand for?

A

Positive end expiratory pressure

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3
Q

What is PEEP?

A

The pressure that exists at the end of expiration that is needed to keep the alveoli splinted open to prevent collapse.
Low = 5cmH2O
Mod = 8-10cmH2O
High = >10cmH2O

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4
Q

What is CPAP/PS?

A

Patients trigger each breath but the machine supports spontaneous breaths and assists inspiration

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5
Q

What does SIMV stand for?

A

Synchronised Intermittent Mandatory Ventilation

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6
Q

What does SIMV do?

A

Usually used when very sedated but does allow for spontaneous breathing

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7
Q

What doesBiPAP stand for?

A

Biphasic positive airway pressure

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8
Q

What does BiPAP do?

A

Alternates between Phigh and Plow at a set rate. A patient can take a spontaneous breath at any point but is only supported at PLow

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9
Q

What does APRV stand for?

A

Airway pressure release ventilation

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10
Q

What does APRV do?

A

Patient is kept at Phigh for longer and then drops to Plow before going straight up to Phigh again. Really good for gaseous exchange

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11
Q

What does PRVC stand for?

A

Pressure regulated volume controlled

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12
Q

What does PRVC do?

A

Set TV with a variable flow rate hence is more natural and so more comfortable for patients

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13
Q

What are the cardiac effects of ventilation?

A

Decreases BP
Decreases VR
Decreases CO

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14
Q

What are the renal effects of ventilation?

A

Decreased urinary output can lead to a acute kidney injury

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15
Q

What are the gastric effects of ventilation?

A

Gastric distension due to air going into the oesophagus

16
Q

What are the neurological effects of ventilation?

A

Decreases cerebral perfusion

Increases ICP

17
Q

What are the airway effects of ventilation?

A

An ETT or trache may mean they can’t cough which can lead to secretion retention

18
Q

What are the sleep effects of ventilation?

A

Sedation and loss of normal sleep-wake cycle

Psychological effects

19
Q

What is barotrauma?

A

Damage to the airways due to high pressures >40cmH2O

20
Q

What is volutrauma?

A

Alveolar trauma due to over distension during over ventilation

21
Q

What is alectrauma?

A

Alveolar collapse if PEEP is too low

22
Q

What are the 4 key aspects of weaning from mechanical ventilation?

A
  • Decrease RR until the patient is in control
  • Decrease pressure support
  • Decrease PEEP
  • Decrease FiO2

Leave 24 hours between each change for recovery

23
Q

What is SIRS?

A

Systemic inflammatory response syndrome.

= tissue injury due to activation of inflammatory system but no underlying infection

24
Q

What is Sepsis?

A

Systemic inflammatory response due to infection e.g. Wounds. It’s SIRS with an infective component

25
Q

What is MOF?

A

Multi Organ Failure. 2+ organ failure. SIRS and sepsis lead to organ failure

26
Q

What are the clinical signs of SIRS/sepsis?

A 
2 + of:
Temp >38 or 100bpm 
Increased RR >20bpm
Decreased PaO2
Decreased systolic BP <90mmHg
27
Q

What is ARDS?

A

Acute/adult respiratory distress syndrome - the pulmonary manifestation of SIRS.
Will occur 1 week after a known worsening of Resp symptoms, show bilateral opacities on a CXR and have oedema that is not explained by heart failure or fluid overload - they need an ECG

28
Q

What happens in the Exudative stage of ARDS?

A

3-7 days
Inflammatory mediators damage alveolar capillary membrane and increase permeability so protein rich fluid leaks into the interstitial space and alveoli - it’s non cardiogenic pulmonary oedema

29
Q

What happens in the Proliferative/Fibrotic stage of ARDS?

A

Inflammatory exudate flood the alveoli and decrease surfactant leading to collapse. The exudate consolidates and leads to fibrosis and decreases gas exchange

30
Q

What is Nitric Oxide?

A

A pulmonary vasodilator

31
Q

What is HFOV (high frequency oscillatory ventilation)?

A

The lungs are held at high pressures and rapid breaths of very small TV are given - CPAP “with a wiggle”. It decreases atelectasis and volutrauma and increases V/Q matching

Respiratory Revision (5 decks)

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