| Question |
Answer |
| Signs of acute respiratory failure (6) |
Dyspnea, Cyanosis, Skin, HR, RR, BP |
| Define Acute respiratory failure (ARF) |
Absent of insufficient respiratory activity resulting in inadequate oxygen uptake and CO2 clearance |
| ARF clinically observed as: |
PaO2 below the predicted normal range; PaCO2 greater than 50 and rising; pH falling below 7.25 |
| Types of ARF (2) |
Lung Failure and Ventilatory pump failure |
| What is lung failure |
vent/perf mismatch, diffusion defects, R-L shunting, alveolar hypoventilation, inadequate FIO2 |
| What is Ventilatory pump failure |
Inability of the body to maintain a normal PaCO2. |
| Ventilaroty pump failure causes |
CNS disorders, neuromuscular disorders, disorders that increase WOB |
| Early signs of Hypoxia or Hypercapnia |
Tachycardia, Dyspnea, Tachypnea, Hypertension |
| Later signs of Hypoxia or Hypercapnia |
PaO2< normal range, PaCO2 > 50, pH < 7.25, Confusion, Lethargy, Convulsions, Hallucinations, Coma |
| Indications of ARF & need for MV (ventilation) |
pH <7.25; PaCO2 55 and rising; Deadspace to VT ratio > 0.6 |
| Indications of ARF & need for MV (Oxygenation) |
PaO2 <70 on FIO2 >.60; P(A-a)O2 >450 on O2; Pa02/PAO2 <0.15; PaO2/FIO2 <200 |
| Standard criteria for instituting MV |
Apnea or absence of breathing, ARF, Impending RF, Refractory Hypoxemia |
| What % of patients do not require slow weaning? |
80% |
| What is weaning |
gradual reduction of ventilatory support from a patient who is clinically improving |
| What are weaning protocols |
A set plan of action to enable the clinician to wean the patient according to established criteria resulting in extubation |
| Modes of weaning from MV |
CPAP; SIMV; T-piece trials; PSV; Closed Loop Modes; MMV; ASV; Bi Level |
| Weaning and extubating parameters |
VC >10; Ve <15; VT >4-6; F <30; MIP -20 or less; WOB <0.8; Dynamic CL >25; VD/VT <0.6 |
| What is the most frequently used study and very reliable predictor of successful extubation |
Rapid Shallow Breathing Indes (RSBI)=f/Vt; Normal range 60-105 |
| Post extubation complications |
Horseness, sore throat, cough, subglottic edema, increased WOB, Airway obstruction, Laryngospasm, Risk of aspiration |
| what are scalers |
Graphs measured over time |
| What are the 3 main types |
Flow VS. Time; Volume VS. Time; Pressure VS Time |
| How many views for Flow VS Time |
5: Rectangular, Sinusoidal, Ascending, Descending, Exponential |
| How many views for Volume VS time |
2: Ascending Ramp or sinusoidal |
| How many views for Pressure VS time |
2: Rectangular or Exponential |
| What is auto PEEP or intrinsic PEEP |
When patient does not fully exhale inspired volume |
| Actions to eliminate auto PEEP |
Suction, bronchodilator, increase expiration time, increase PEEP |
| What does pressure volume loop show? |
Compliance of the lung, looks like a football, the narrower, the more compliant |
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