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Mech Vent and ARDS
Mechanical Ventilation and ARDS
| Question | Answer |
|---|---|
| Bilevel Positive Airway Pressure (Bi-PAP) | noninvasive; patient must breath spontaneously and cooperate; most often for pts with sleep apnea or pulmonary issues; if pt is on it for 4hrs and no change then it will probably not work for them |
| Rapid Sequence Intubation | rapid, concurrent administration of a paralytic agent and a sedative during emergency airway management |
| Who can intubate? | NURSES can not! Respiratory therapists only intubat NICU babies; acute care practitioners are ok to intubate, care flight nurses can intubate if all else fails |
| Hemodynamic stability with Intubation | b/c pt with respiratory failure have been in fight mode, be prepared for the BP to totally bottom out (due to vasodilation), have a liter of saline just in casey you have to bring that BP back up! |
| Suctioning | you can hyperoxygenate but do not hyperventilate; rule of thumb hold breath while suctioning pt so you know when to stop |
| Saline Bullets | pink and usually contain 10ml; they are not used to loosen secreation b/c there is not enough saline to help with loosening; it acutally stimulate carina to initiate cough, also helps prevents rust on catheter |
| Mechanical Ventilation | 21%(room air) is moved into and out of lungs by a mechanical ventilator |
| Indications of Mechanical Ventilation | apnea or impending inability to breathe; acute respiratory failure; severe hypoxia; respiratory muscle fatigue |
| Assist Control | patient receives a set amount of respirations and set volume; if they breath about amoungt of respirations they stil get same amount of volume (so the rest is whatever they can pull from atmosphere); start questioning if pt can be pulled off ventilator |
| Prone Positioning | "recruiting the lungs"; when you prone somebody you float their lungs which recruits air space; if there is no improvement within a few hrs than this will probably not work for the patient |
| Tracheostomy | surgical incision into the trachea to establish an airway that results in a stoma |
| Advantages of a tracheostomy | less risk of long-term damage to airway; increased comfort; patient can eat; increase mobility because tube is more secure |
| Speech with Tracheostomy | passing murror valves allow air to pass over vocal cords which allows speech to occur; usually only able to have this done for 10-15 minutes, b/c pt can only tolerate it for so long |
| Decannulation | when patient can adequately exchange air and expectorate; stoma closed with tape and occlusive dressing; trachs begin to heal within 24-48hrs, they heal from inside, out creating fibrin tissue |
| Acute Respiratory Distress Syndrome | sudden progressive form of acute respiratory failure; alveoli fill with fluid (intravascular fluid) which allows no oxygen exchange |
| Characteristics of ARDS | severe dyspnea/tachypnea; hypoxia/hypoxemia; decreased lung compliance; alveolar collapse; diffuse pulmonary infiltrates |
| Direct Mechanisms (Injury) of ARDS | aspirationg of gastric contents; pneumonia; toxic inhalation; pulmonary contusion or PE; O2 toxicity; near-drowning; radiation |
| Indirect Mechanisms (Injury) of ARDS | *spesis*; trauma; massive transfusion; pancreatitis; drug OD; burns; DIC; shock; something outside the lungs has caused a histamine/cytokine release, which starts to destroy lung tissue |
| Pancreatitis: | the pancreas releases a lot of juices and they flood in everywhere (the diaphragm squeezes up to avoid the juices), causes the lungs to not fully expand which leads to atelectasis in the bases |
| Whose at risk for ARDS? | anyone with a respiratory illness |
| How do you know its ARDS? | Initial Hypoxemia and Respiratory Alkalosis then Respiratory Acidosis; Pulse Ox: body is starting to vasconstrict, and trying to pull all the O2 it can and bring it back to the core; less O2 to the extremities |
Created by:
sydleigh
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