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180 Exam 2
| Question | Answer |
|---|---|
| Pressure support ventilation (PSV) is useful to compensate for the increased work of breathing due to what? | increases exhaled tidal volume to increase pH and decrease CO2. Compensates for airflow resistance to augment spontaneous breathing efforts |
| Airway resistance is an important concept in mechanical ventilation, because when the airway radius is reduced by 50% airflow resistance increases by how much? | Must increase by a factor of 16-fold to maintain the same airflow |
| Lung compliance and emphysema patients | Emphysema is high lung compliance with impaired gas exchange. Exhalation is often incomplete due to the low recoil. Typically leads to CO2 retention, air trapping, destruction of lung tissues, and enlargement of terminal and respiratory bronchioles |
| Dynamic compliance | Vt/(PIP-PEEP) |
| Static compliance | Vt/(Pplat–PEEP) |
| What all is measured with an inspiratory hold | Plat pressure, |
| How to identify increase and decrease of compliance and resistance in volume control ventilation | Pressure volume wave form |
| A decrease of the peak inspiratory pressure–plateau pressure (PIP–P plat) gradient implies what | Airflow resistance decrease |
| A waveform to monitor change in compliance | Pressure volume waveform |
| Ventilatory failure | Occurs when pt’s minute alveolar ventilation can’t keep up with metabolic rate or CO2 production. CO2 production exceeds removal |
| Oxygen failure | Usually found when cardiopulmonary system can’t provide adequate O2 needed for metabolism. Severe hypoxemia due to any condition that lead to persistent cellular and tissue hypoxia |
| early signs of hypoxia | Pallor, nasal flaring, mouth breathing, increased RR, HR, and BP, Decreased PaO2, SpO2, and CaO2 |
| Factors that affect gas diffusion at the alveolar capillary membrane level | Emphysema (loss of surface area), pulmonary fibrosis (thickening of a-c membrane), absolute shunt (capillary blood flow is not matched by alveolar ventilation), relative shunt (capillary perfusion is in excess of alveolar ventilation |
| Causes of refractory hypoxemia | ARDS, Atelectasis, intrapulmonary shunting |
| Hypoventilation results in what? | Increased PaCO2; ventilatory failure, oxygenation failure, cellular and tissue hypoxia, anaerobic metabolism, hypoxic brain, and cardiopulmonary arrest |
| Rapid shallow breathing pattern can cause a VQ mismatch due to what? | Increased WOB, respiratory muscle fatigue, and ventilatory failure |
| If a patient is improving on a vent, what would we expect to see with regards to plateau pressures, compliance, resistance, and Peak pressures | Decrease in PIP, Pplat, and resistance, increase in compliance |
| Factors that will cause a decrease in Pplat and increase in Pplat as well as increase and decrease PIP | Increase in PIP/Pplat: decrease in LC increase in Raw Decrease in PIP/Pplat: increase in LC , decrease in Raw Increase in PIP: Increase in Raw Decrease in PIP: decrease in Raw Increase in Pplat: decrease in LC and Raw Decrease in Pplat: increase in LC/Raw |
| Be able to calculate pulmonary compliance. (calculators are allowed) | Change in volume over change in pressure |
| Passive exhalation | Normal exhale |
| Active exhalation | Use of accessory muscles to force out a breath |
| Boyle's law | Pressure of a fixed mass of gas is inversely proportional to its volume when temperature is constant |
| Poiseuille's law | When the radius of a circle is reduced by 50% the driving pressure must increase by a factor of 16 fold to maintain airflow |
| Indications for mechanical ventilation | apnea, acute ventilatory failure, impending ventilatory failure, severe oxygenation problems |
| Causes of gas exchange abnormalities | Dead space ventilation, diffusion defect, and shunting |
| Cycle variable | Must be measured by the vent and then used as a feedback signal to terminate inspiration. Pressure, time, volume, or flow |
| Trigger variable | When one of the variables reaches a preset value, inspiration begins Pressure, time, volume, or flow |
| Limit variable | Describes the variable that remains constant during inspiration phase. Pressure, volume, or flow |
| Control variables | Variable that is measured and used as feedback to control the vent’s output |
| Pressure control | If pressure remains constant during inspiration when subjected to changes in pt resistance and compliance |
| Volume control | Pressure varies during inspiration when pt’s resistance and compliance change, but the volume delivery remains constant |
| Flow control | Volume delivery remains unchanged when pt resistance and compliance change, but volume is not measured and used to control the vent |
| Time control | When volume and pressure waveforms change during inspiration when subjected to changes in pt’s resistance and compliance |
| Control circuit | Mechanism the vent uses to control its drive mechanism. Determines the characteristics of the vents output |
| Drive mechanism | Method used by the ventilator to convert the input power into vent work |
| Different types of vent input power | Pneumatics, electricity, or combined pneumatic and electric |
| Know when to use the term CPAP and when to use PEEP | CPAP is spontaneous breathing, PEEP is used with mandatory ventilator breaths |
| Time cycling | Time becomes the cycle variable when measured and used to determine the end of breath |
| Flow triggering | Breath triggering when a pt’s inspiration flow meets a flow threshold |
| NAVA | Neurally adjusted ventilation assist uses neurologic signals from pt’s diaphragm contraction to trigger inspiration |
| When can volume become a limit variable | If volume reaches a preset value and remains constant during inspiration phase |
| During inspiration the pressure increases to a preset value and doesn't change until exhalation, the pressure is termed, what | Pressure control/ limit variable |
| Most common baseline variable | PEEP/CPAP |
| Pressure support | Augments spontaneous effort with positive pressure. The patient determines inspiratory flow and tidal volume |
| CSV | All breaths are spontaneous |
| SIMV | Mandatory breaths are delivered at a preset ration, allowing for spontaneous breaths w/in mandatory breaths. Typically pressure or volume controlled breaths |
| VC-CMV | Control variable is volume, and every breath is mandatory |
| PC-CMV | Control variable is pressure, and every breath is mandatory |
| BiPAP | Noninvasive ventilation that combines inspiratory positive airway pressure and expiratory positive airway pressure. Pt imitates and terminates all breaths |
| Spontaneous timed | Mode of BiPAP that allows clinician to set up a back up rate |
| Ventilator mode | A predetermined pattern of ventilation between a patient and a ventilator that may be described by control variable, breath sequence, and targeting scheme |
| PEEP | Positive pressure at the end of expiration used to “recruit” collapsed alveoli and improve oxygenation |
| What determine length of inspiration in volume control | Inspiratory time |
| What determines length of inspiration in pressure control | Flow rate |
| Form of high frequency mechanical ventilation that uses a sliding venturi | High frequency percussive ventilation |
| PAV uses what targeting scheme | Servo-targeting (support provided to the pt is proportional to the pts inspiratory efforts) |
| ASV uses what targeting scheme | Optimal |
| What targeting scheme lets the vent go from pressure to volume and vice versa | Dual |
| When is sniffing position used | During intubation |
| Understand mallampati and mallampati scoring | Employed to assess probable difficulty of intubation. Score range from I-IV, I being easy and IV being difficult |
| MacIntosh | Indirect and curved |
| Miller | Direct and straight |
| Size of ETT corresponds to what | The internal diameter of the tube |
| What should be included in an intubation kit | Laryngoscope handle and blades, ET tubes, Stylets, 10mL syringe, ET ties and holder, Suction, Yankauer, stethoscope, CO2 colormeteric, Oral and nasal airways, Ambu bag and mask, magil forceps |
| Common complications of manual ventilation via BVM | Barotrauma, Gastric inflation, hyperventilation, hypoventilation |
| Familiarize yourself with anatomical landmarks for intubation | Epiglottis and vocal cords |
| Familiarize yourself with nasal intubation | Magill forceps, does not use a stylet |
| Airways common for blind intubation | Combi tube and Kings airway |
| What hand is blade held in and what side of patient mouth is tube inserted into | Blade is held in the left hand, tube in the right |
| Popular medications used for rapid sequence intubation for sedation and for neuromuscular blockade (paralytic) | Morphine, dilaudid, ativan, versed, nurcuron, amidate, ketamine, propofol, succinylcholine |
| When should a water soluble lubricant be used | During intubation or when inserting a nasal pharyngeal airway |
| How to measure appropriate oropharyngeal airway and indications for use | From the corner of the mouth to the angle of the jaw Indications: deeply unconscious patients, absent gag reflex |
| Complication of tracheostomy | Bleeding, damage to trachea, subcutaneous emphysema, pneumothorax, hematoma, misplacement, and displacement |
| After you intubate a patient and they are able to vocalize, what might be the problem | Esophageal intubation |
| Signs of esophageal intubation | SpO2 continues to drop despite 100% BVM, breath sounds absent, no bilateral chest rise, weird sounds in gastric region, CO2 colormetric stays purple, abdominal distension |
| If breath sounds are present only on one side, what might be the issue | Right main stem bronchi intubation |
| Chest xray immediately after intubation is done to confirm what | Correct placement of the ET tube’s depth |
| Signs of successful intubation | Bilateral breath sounds, improved SpO2, yellow CO2 colorimetric, Bilateral chest rise, X-ray showing correct tube placement. |
| Purpose of a Cook catheter | To help with exchanging or replacing an ET tube |
| late signs of hypoxia | Cyanosis, Respiratory arrest, cardiac arrest, decreased RR, HR, BP, PaO2, SpO2, and CaO2. Metabolic or combined acidosis |
Created by:
K.Moskowitz
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