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