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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: O2 Therapy Devices:Adult & -Low flow - Nasal cannula Answer: 1.Delivered FIO2: 24%-45% 2.Flow: 1-6 L/M Question: O2 Devices:Adult & Pediatric-Low flow -Simple mask Answer: 1.Delivered FIO2: 40%-50% 2.Flow: 6-10 L/M Question: O2 Therapy Devices:Adult & Pediatric-Low flow -Partial Mask Answer: 1.Delivered FIO2:60%-65% 2.Flow: 6-10 L/M 4. no one way . Question: O2 Therapy Devices:Adult & Pediatric-High flow-Venturi Mask/Air-entrainment Answer: 1.DeliveredFIO2: 24%-55% 2. Works by mixing 100% O2 and room air. 3. Precise FIO2 delivery. 4. When FIO2 increases entraintment port is Decreased. 5. When FIO2 decreases the internal diameter of gas decreases. Question: O2 Therapy :Adult & Pediatric-High flow- Non-breather Mask (NRB) Answer: 1.Delivered FIO2: 21-100% 2. It is a high flow device and keeps the reservoir bag from collapsing if the flow rate is High. 3. Used in cases. 4. it has one way valve that prevents from rebreathing CO2. Question: O2 Therapy Devices:Adult & Pediatric-High flow- In a non-breather Mask (NRB)-Why isa face seal ? Answer: 1. Face seal is important because reservoir collapse slightly on each inhalation. A)If bag does not collapse - mask should be tightened and a better seal should be obtained. B)If bag collapses NBR valve may be stuck then - replace with a new mask. Question: O2 Therapy Devices:Adult & -High flow- Aerosol Mask Answer: 1. Trach collar - fits , easy to tolerate- used when T-pieceis inconvinient for the pt. due to pt. movement. 2. Aerosol mask-is only good for high flow system- otherwise air entrainment is too great and FIO2 will be decreased significantly. Question: O2 Devices:Adult & Pediatric-High flow- Brigg's adapter (T-tube, T-piece) Answer: 1.Used to deliever aerosol. 2.requires a high flow supply/a pre-mixed gas. 3.Attaches @the end of an ET tube/trach tube. 4.Must see aerosol production during both inspiration&expiration, if cant see the flow the aerosol then Increase the flow. Question: O2 Therapy Devices: define Air-entrainment Answer: These devices mix O2 and air to an exact FIO2. Question: O2 Therapy Devices: of Air-entrainment device- Answer: 1. Venturi mask. 2. Large volume nebulizers (LVN). 3. Small IPPB macines. 4. Some pressure . Question: O2 Devices: Complications of Air-entrainment device Answer: 1. flow or back pressure- causes an increasein FIO2. 2. Occluded entraintment port - causes increase in FIO2. Question: O2 Therapy Devices: Air-entrainment -What all cases does FIO2 Increases? Answer: 1. when puff of aerosol coming from the tubing of a LVB set @ FIO2 28%. 2. The very last part of the delivered breath from a Bird IPPB . 3. A king in the aerosol tubing coming from a LVB. --> All these cases FIO2 increases. Question: O2 Therapy Devices: Air-entrainment - Air/O2 mixture Ratios Answer: 24%- 25:1 28%-10:1 30%-8:1 35%-5:1 40%-3:1 & 60%-1:1 Question: O2 Therapy Devices: Air-entrainment - Calculate Total Flow- if O2%=28%, O2 flow meter setting=6 L/min. ? Answer: if O2%=28%, O2 flow setting=6 L/min. Ratio for 28%=10:1. Now add the ratio parts (10+1)=11. Then multiply by the flow (11 x 6L) = TOTAL FLOW = 66L/min. Question: O2 Therapy Devices: O2 therapy device Answer: O2 Tent. This is used for both pediatric & Neonatal. 1.Useful when humidity/Aerosol environment is desired 2.Highest FIO2=40-50%. 3.Flow Rate=12Lpm to CO2. High fluid can cause fluid retention in pt.should monitor input-output pt. weight. Question: O2 Devices:Neonatal O2 therapy- O2 Tent Answer: 1. FIO2 is highest @ bottom 100% O2 is heavier than other gases. 2. If FIO2 near pt. face is difficult to keep consistant may need to ensure the plastic walls are tucked into the bed wall. Question: O2 Therapy Devices:Neonatal O2 - O2 hoodAnswer: It is placed over infant's head. Flow=7-14Lpm can deliver upto 100% O2, with an O2 . It comes w/ temp. probe. If hot infant become apneic. If cool causes increase in O2 consumption. It is loud inside hood causes hearing loss-use a blender than LVN Question: O2 Therapy :Neonatal O2 therapy- Incubator Answer: 1. Only for neonates. 2. , whole-body environment 3. precise control over environment including FI02. 4. Red-flag warning sign when suing FIO2 100%. Question: O2 Therapy Devices:Neonatal O2 - hazards of Incubator Answer: 1)Skin Burns 2) Hearing damage-very loud noise 3)Electrical Question: O2 Therapy Devices:Neonatal O2 - Radiant Warmer Answer: 1)it is open to room air 2)Not a good environment for O2 . 3. must be combined with an O2 delivery device. 4) allows RT to have access to the infant to provide care. 5. useful in controlling temp.& helpful in decreasing insensible water loss. Question: O2 Conserving Devices:Reservoir Answer: 1. It is like a regular cannula except with a small reservoir under the nasal prongs or as a reservoir inline, chest level. 2)it allows O2 be set @ a lower flow rate. Question: O2 Conserving : Transtracheal Oxygen Catheter (TTO2) Answer: 1. It is implanted thin catheter inserted thru the tracheal wall(b/w the 2nd & 3rd tracheal rings). Trachea acts a reservoir so flow may be reduce by as much as. 1/2. Question: O2 Conserving Devices: Oxygen Catheter (TTO2)-Hazards Answer: 1)Bronchospasm 2)Trauma to the including bleeding 3) Risk of infection at insertion site. 4) Pneumothroax & subcutaneous emphysema upon erroneous insertion 5)Poor cleaning technique 6) Catheter may be obstructed. Question: O2 Conserving Devices: Transtracheal Oxygen Catheter (TTO2)- What do we do if TT02 is ? Answer: Catheter may be obstructed need to flush with saline- 1st provide O2 by cannula. Then troubleshoot & find a remedy. Question: O2 Conserving : Pulse-Dose O2 delivery Answer: It is Combined w/ specialized nasal-cannula.Humidification not required.50PSI gas source is required. System senses inhaltion,delivers pulse of O2. capable to switch to flow-uses continous mode when a problem is suspected. Used @homecare setting Question: O2 Devices: Gas Containers & Bulk Delivery Systems: Cylinders-Procedure Answer: 1)Crack Valve open before mounting regulator.2)PISS regulator is used for E . 3)ASSS regulator is used for H Cylinder. 4)Point any glass or plastic-faced regluators away from persons while opening valve- could burst and cause harm. Question: O2 Conserving Devices: Gas Containers & Bulk Systems: Cylinders - Troubleshooting Answer: 1)Hissing leak sound - Tighten all connection. 2)No apparent flow-check flow a calibrated flow sensing device Question: O2 Conserving Devices: Gas Containers & Bulk Delivery : Cylinders- Time Factors Answer: E Cylinder = .3 H = 3.00 G= 2.41, small tanks are good care for home care patients needing mobility and as backup supply in case of concentrator failure. Do not tanks in hot place - like trunk of car Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders Flow Formula Answer: Tank Duration(in mins.) = (Tank x Tank Factor) / Liter Flow Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Bulk O2 system-1) Cylinder Answer: it requires 2 separate banks of tanks for Primary & Reserve.(several H tanks are mounted to manifold.) Question: O2 Conserving Devices: Gas & Bulk Delivery Systems: Cylinders- Bulk O2 system- 2)Bulk Liquid O2 Answer: Able to store mass quantity in small space compare to tanks. Requires a backup system. Ex. H tanks. Requires a Convestion Unit. Some units are so small & to carry than E tanks & last longer. Question: O2 Conserving Devices: Gas Containers & Bulk Delivery : Cylinders -O2 concentrator(molecular sieve device Answer: Requires electricity only. It produces 6L/min. Extracts O2 from room air. Must change filters & check flow . Must ensure appropriate electrical load capacity of the home.Tank/a backup source of O2 is recommended. It is a device used for homecare. Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders -Troubleshooting of O2 (molecular sieve device Answer: Flow & Check Circuit breaker or fuse. Question: O2 Devices: O2 Enhancing system: CPAP Answer: It increases surface area of the alveolar capillary . Prevents soft tissues from collapsing & obstructing the airway. It facilitates use of FIO2 to accomplish the same PaO2. It can be given w/ a face mask /Nasal mask/throug an artificial airway Question: O2 Conserving Devices: O2 system: Nasal CPAP Answer: Very Useful w/ infants easy & quick modality. Creates a huge leak if is crying. Use oral pacifier to prevent crying & keep mouth closed. It involves a nasal prongs, like a cannula. Question: O2 Devices: O2 Enhancing system: PEEP Answer: Works like a CPAP except used in conjunction w/ backup ventilatory rate ( mechanical ) Question: O2 Conserving Devices: O2 Enhancing system: Mechanisms to PEEP/CPAP Answer: 1) Wate 2) Exhalation Valve 3) Spring disk 4) Venturi Question: O2 Conserving : O2 Enhancing system: Troubleshooting of PEEP & CPAP Answer: 1) Low Pressure = leak/insufficent flow to the sytem then increase flow. 2) High pressure = obstruction, bad CPAP/PEEP valve. Replace/Flow may be set too Question: O2 Conserving Devices: O2 Blending Answer: 1.Air O2 can accurately blend Air &O2 to exact %. Blenders will mix & deliver gas @ 50PSI 3. When using a blender & an Air-entrainment device(LVN), must set the nebulizer @100%. Question: Humidification & Aerosol : Passover Humidifier Answer: Gains humidity from a body of water thru evaporation as gas passes over its surface. It is not very effective. Not appropriate when using w/ mechanical vent. Or with pts. Where the natural upper Airway is by passed. Question: Humidification & Delivery : Bubble Humidifier Answer: The gas bubbles produce more surface area to pick up humidity. It is than passover humidifier. Efficency depends upon water level. It involves an inlet tube w/ pop off alarm. If inlet tube is clogged pop off alarm wont funtion. Question: Humidification & Aerosol Delivery : How does Bubble function can be checked? Answer: By occluding line on gasoutlet causing back pressure. If no pop-off alarm-system has a leak - tighten bottle/replace system if problem presists. If Pop-off alarm sounds w/out occlusion-check kink in the tube or for an such as H20 in the tube Question: Humidification & Aerosol Delivery :what happends in a Bubble Humidifier if the down tube clogged? Answer: Pop-off will not , but flow meter will read zero (compensated flow zero). Question: Humidification & Delivery : Heated Cascade Humidifier Answer: Most efficient device @ creating . It is commonly used w/ meachical ventilation & w/ intubated pts. It must be heated to achieve any efficiency. It can produce particles which is undesirable because it increases risk of nosocomial infection. Question: Humidification & Aerosol Delivery : Wick Answer: It is efficient by expanding surface are for evaporation and humidification. It can accomplish 100% body's humidification needs. It does not produce particles so no nosocomial infections. Some of the most common wick devices are-Concha and -paykel. Question: Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- name Answer: Nose Question: Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- like what? Answer: Sponge Filter- traps heat & moisture that comes from the during expiration & delivers it back to the patient during inspiration. Question: Humidification & Aerosol Delivery : Heat Exchanger (HME)- Where is it placed? Answer: placed WYE and the patient on a mechanical ventilator circuit. Question: Humidification & Aerosol Delivery : Heat Exchanger (HME) - Is it considered as a deadspace? Answer: Yes. It will the PCO2 to rise (1-2 torr) Question: Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- Does it cause ventilator pressure? Answer: Yes it will increased Pressure. Question: Humidification & Delivery : Heat moisture Exchanger (HME)- should be Remove before an in-line Aerosol or MDI therapy? Answer: Yes we must remove a MDI therapy Question: & Aerosol Delivery : Heat moisture Exchanger (HME)-It is best used for ? Answer: term humidification eg. during transport. Question: Humidification & Delivery : Heat moisture Exchanger (HME)- How do you dispose? Answer: Never attempt to or rinse out an HME Question: Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- What do we do if HME is on a patient?Answer: It is best to switch to a cascade/wick type . If those are not available then replace w/ a new HME. Question: Humidification & Aerosol Delivery : Jet Answer: It is a handheld or small volume neb. Reservoir sizes are different. Each devices produces different dispositions of particle sizes. It uses high gases to create particle sizes 2-10microns. Question: Humidification & Delivery : Reservoir Jet Nebulizer Answer: It uses the Jet Neb. Concept but combined w/ Large vol. reservoir. It is to deliver Aerosolized sol. w/ 1-2 Lpm flow. It is used for large doses of medications. Ability to meet humidity deficit of body is dependent upon the use of a heating source Question: Humidification & Aerosol Delivery :Small aerosol generator(SPAG) Answer: It is used to treat RSV or bronchiolitis by Ribavirin(Virazole). Produces particle size - 1.3 microns. Problems related to crysallization of the drug which can build up in circuits & clog output (tubing,etc) Question: Humidification & Delivery :Hydrodynamic Nebulizer Answer: 1. Very effective nebulizer but not popular 2. Example nebulizer is the hydrosphere. 3. Able to meet the humidity deficit but can cause fluid . Question: Humidification & Aerosol Delivery : Nebulizer Answer: Creats particles by an electrical device. Provides the most particle output but promotes fluid overload. Vibrating device is known as piezoelectric disc(clean w/ Acetic acid). Frequency of vibration cannot be set. Must have ground plug available Question: & Aerosol Delivery : How does Mist increase in Ultrasonic Nebulizer? Answer: 1. blower 2. Ensuring adequate fluind in reservoir. 3. Incresing amplitude of vibration . Question: Humidification & Aerosol Delivery : Hazards of Ultrasonic Nebulizer(Vibrating Device- disc)? Answer: Cannot place a bronchodilator in the reservoir as the vibration can disrupt the structure. FLUID OVERLOAD. Transient Dyspnea due to swelling of secretions(aerosol causes swelling of secretions). Question: Humidification & Delivery : Centrifugal Nebulizers Answer: 1. Least effective at producing uniform particle sizes. 2. Not recommended for use . 3. with high frequency of contamination. Question: & Aerosol Delivery : Metered Dose Inhaler's (MDI) Answer: 1. It is portable. In mechanical ventilation -placed on side of the circuit & b/w Y & pt. Gives uniform dosage&particle size requires pt. cooperation.Aerosol produced by pressurizing a gas or liquid in a closed canister. Spacer is recommended Question: & Aerosol Delivery : Why is spacer recommended for Metered Dose Inhaler's (MDI) Answer: It minimize particles that are large by allowing them to attach to wall of chamber. Requires less time coordination w/dose, pt. can squeeze&inhale. Pt. is to take several breaths to get all the particles.High inspiratory flow rate is not for pt. Question: What is the vast majority Mechanical used ? Answer: Positive Pressure Devices- they are classified according to how they are powered and how and expiratory cycles are initiated and terminated Question: Ventilators: Define Volume-Cycled Ventilators Answer: 1) It will continue inspiration until a preset volume of gas is delivered. 2)It ignores the amount of pressure/time it takes to deliver the . Question: Mechanical : What limit does Volume-Cycled Ventilators incorporate? Answer: 1)Pressue limit. Excessive pressure is harmful to pt. it causes Barotrauma. 2)i.e, inpiratory continues until a preset vol. is given UNLESS a predetermined pressure limit is reached 1st. 3)such vents. are called Vol.-cycled,Pressure-limited devices. Question: Ventilators: Volume-Cycled Ventilators-3 examples Answer: 1) Puritan-Bennett 7200 2) PB 840 3)Bear Question: Ventilators: Define Pressure-Cycled Ventilators Answer: It will continue until a preset pressure is reached. 2) These machines will delivered the same pressure on every breathe regardless of the volume. Question: Mechanical Ventilators: What is the reason when Pressure-Cycled incorporate minimum volume alarms? Answer: The main reason for these types of ventilators is that as lung compliance & resistance changes, volume is sacrificed. Question: Mechanical Ventilators: How does Pressure-Cycled powered? Answer: Electrically or by gas . Question: Mechanical Ventilators: In Pressure-Cycled Ventilators in pressure will result in what? Answer: an in volume. Question: Mechanical Ventilators: In Pressure-Cycled Ventilators what happens at higher levels of ? Answer: Theres is a diminishing return of . Question: Mechanical Ventilators: Pressure-Cycled Ventilators - 2 Answer: Bird Mark and Bennett PRII are . Question: Mechanical Ventilators: What treatments are given with a Pressure-Cycled ? Answer: IPPB Question: Mechanical Ventilators: What limit does Pressure-Cycled Ventilators ? Answer: Pressure-Cycled are often pressure limited. Question: Mechanical Ventilators: In Pressure-Cycled what happens when flow increases? Answer: flow will decrease inpiratory time(Reverse is also true). Question: Mechanical : In Pressure-Cycled Ventilators what needle shows us smooth rise to Pressure? Answer: a Monometer needle. If it does not show a rise then Increase the Flow Rate. Question: Ventilators: In Pressure-Cycled Ventilators Air-mix on? Answer: Air mix knob is pulled out. Gas is mixed in a venturi device. FIO2 varies from 40-80%. The chamber surrounding the venturi device will excess O2 from 1st breath & will then entrain that O2 on the next breath which causes increase in FIO2. Question: Mechanical Ventilators: In Pressure-Cycled Air-mix OFF? Answer: Air mix knob is in. FIO2=100% pure source gas. Since there is no air entrainment total achievable flow rate is less. When switching from air entrainment to 100% source gas must immediately increase the flow to compensate. Question: Ventilators: In Pressure-Cycled Ventilators what is Rate Control(Expiratory time control)? Answer: can set a time limit on the expiratory phase, thus indirectly allowing manipulation of rate. Question: Mechanical : In Pressure-Cycled Ventilators what is pressure control(the part that controls the pressure - NOT the ventilatory mode? Answer: Vol. is indirectly increased by increasing pressure. If cant reach a pressure indicates a leak -check for leaks starting @pt. (mask, lip seal). Examine for connections&holes. An increase in back pressure (coughing)causes pressure limit&will reduce Question: Mechanical Ventilators: In Pressure-Cycled what is Sensitive Control? Answer: Lower set # -easier for pt. to initiate cycled . Higher #s cause an increase in pt. effort. If macine is rapidly-cycling, sensitivity may be set too low(too sensitive). If machine cycles w/o pt. effort - too sensitive. If so turn dial to higher #s. Question: Mechanical Ventilators: In Pressure-Cycled what is the characterestics of Bennett PRII? Answer: 1.Output Flow=15 Lpm. Neb. Has 2 controls- expriatory&inspiratory nebulization. Neb. Gas source-100% regardless of air dilution on/off 3.Terminal flow control for leaks but reduce flow & works thru air entrainment. Question: Mechanical Ventilators: In Pressure-Cycled Ventilators-In PRII rate control & Pressure control allows what? Answer: Rate control-allows time cycle. Pressure control will pressures upto 50cm H2O Question: Mechanical Ventilators: In Pressure-Cycled Ventilators In Bennett PRII what is Air dilution ON/OFF /achieve? Answer: Air dilution ON-Allows FIO2 OFF 40-80%. Air OFF-achieves 100% O2. Question: Mechanical Ventilators: In Pressure-Cycled - In Bennett PRII what happens to the Bennett valve? Answer: Bennett Valve is flow limited & will close if < 1 Lpm is detected. Question: Mechanical Ventilators: In -Cycled Ventilators what is the characterestics of AP4 & AP5 ? Answer: It is electrically powered. It only has pressure& nebulizer control. It can deliver room air. It is good for COPD Pts. It volume & FIO2 when different controls are manipulated. Question: Ventilators: Define Time-Cycled Ventilators Answer: Inspiration continues for a number of seconds. And usually incorporates a specified pressure regardless of volume delivered. Thus a time-cycled vent. Will require a set inspiratory time & pressure. Question: Ventilators: Time-Cycled Ventilators are often used for? Answer: Infants Question: Mechanical Ventilators: In Time-Cycled Ventilator what does it incorporates to guard against exposure to excessive pressures & consequent ? Answer: It a Pressure Pop-off valve Question: Mechanical : In Time-Cycled Ventilators what is set indirectly to set an expiratory time? Answer: Rate maybe set indirectly by expiratory time. Question: Ventilators: Define Bilevel Ventilators? Answer: 1. Bilevel means that positive pressure is applied during both inspiratory and phases. 2. Breaths are flow triggered and also WOB is decreased. Question: Mechanical Ventilators: In Bilevel Ventilators what does it requier? Answer: and expiratory pressure settings. Question: Mechanical Ventilators: In Ventilators what must be higher than expiratory pressures? Answer: Inspiratory must be higher than expiratory pressure. Question: Mechanical Ventilators: In Bilevel Ventilators what is the ventilatory pressure and give eg.? Answer: The actual ventilatory pressure = (Inspiratory pressure - Expiratory pressure) Eg. Inspiratory Pressure = 15 and Expiratory pressure = 8 cm H2O therefore 15-8 = 7 cmH2O. Question: Mechanical Ventilators: Bilevel Ventilators can be used for what all ? Answer: It can be used for 1. Non-invasive ventilation 2. does not need intubation. BUT, only for that requier some assistance ww/ ventilation and NOT for those who require full ventilator support. Question: Mechanical Ventilators: In Bilevel what is an Inspiratory pressure and expiratory pressure called? Answer: Inspiratory pressure - IPAP and expiratory - EPAP Question: Mechanical Ventilators: In Bilevel what is the brand name and the therapy name? Answer: Brand name - and Therapy name - Bilevel therapy Question: Mechanical Ventilators: Bilevel Ventilators is not a good for what patients? Answer: It is not good for pt. requiring High levels of ventilatory because most machines are only capable of 20-25 cmH2O Question: Ventilators: Home-use Ventilators Answer: 1. These are electricall powered vent & maybe vol./pressured cycled. 2. If pt. requires vent. More thatn 50% then a back up ven is needed. 3. Family education on CPR & vent. Operations is required. 4. Common Home . Are - PLV100, L6 etc. Question: Ventilators: Transport Ventilators Answer: 1. Suitable for a period of time only 2.easy to carry. 3. It is fluidically 4. Problems in vent. Vol. & rate occurs when gas supply gets low. Not good for weaning,long term/home vent. Needs physical assesment skills during use. Only operated by RT Question: Mechanical Ventilators: Pressure Ventilators Answer: 1. Do not require invasive devices. 2. More natural than PPV. 3. Less negative effects to PPV. 4. Involves a large suction device attached to the chest wall. 5. Requires a vaccum source. Question: Mechanical Ventilators: what in Negative Pressure Ventilator work when it is applied to the chest wall? Answer: It causes the diaphragm to lower and ventilation to occur. Since diaphragm has its limits of excursion, high levels of vaccum will have return on volume. Question: Mechanical Ventilators: In what does the Negative Pressure Ventilator ventilates and what is Rate and tidal volume controlled by? Answer: Negative pressure ventilation is Time-cycled. Rate is controlled by - time of inspiration. Tidal volume is controlled by - of pressure applied. Question: Mechanical Ventilators: In a Negative Pressure Ventilators what occur to get a good seal? Answer: Leak b/w the and the device. Question: Mechanical Ventilators: In Preoperational Tests what all needs to be done in a ventilator before connecting to a ?Answer: 1) Check return Tidal Volume 2) if Tidal Volume is less than delivered look for a leak & examine connection points in the . 3) also ensure alarms are working. Eg. High & Low volume or pressure. Question: Artificial Airways: Types-ET tubes Answer: It can be inserted throught the oral/nasal . Question: Airways: Airway Types- Oral ET tubes route?Answer: Oral route insertion is dacilitated by the use of a Laryngoscope an . Question: Airways: Airway Types-Nasal ET tubes route?Answer: Nasal route is performed using a forceps. Question: Artificial Airways: Airway Types-what are the ET tubes graduated cm ? Answer: 1. Oral intubation - 20-24 cm @ the lips(low 20's) 2. intubation - 25-29 cm @ the naris (High 20's) Question: Artificial Airways: Airway -what about ET tubes cuffs? Answer: Tubes may or may not have a cuff depends on the size. Tubes below 6 andless usually do not have . Question: Airways: Airway Types-what are Tracheostomytubes? Answer: Long term of reducing airway resistance. Question: Artificial : Airway Types-different configurations of a Tracheostomy tubes Answer: 1. Fenestrated 2. Jackson tube. 3. Bivona foam cuff. Question: Artificial Airways: Airway Types- what is a Tracheostomy tubes? Answer: A hole in the outercannula.Helps in talking&weaning.Inserts for resuscitation.It caps tube closed&1st deflate cuff-remove innercannula&cap the tube.deflate while talking, remove innecannula& capping.Best for pts. partially dependent on a vent Question: Airways: Airway Types- what is Jackson Tracheostomy tubes?Answer: 1. Used for home care and Long term pt. 2. No cuff (cannot mech. ) 3. Tube is made of silver. Question: Artificial Airways: Airway Types- what is a bivona foam tube cuff?Answer: 1. Also Kamen-wilkinson. 2. The cuff is oassively full means leave pilot open to amnient air to keep cuff expanded. 3. To deflate/inflate or insertion/ removal of a cuff use a syringe. Question: Artificial Airways: Airway Types-what is the with a Tracheostomy tubes? Answer: Subcutaneous Emphysema-occurs when tube is dislodged&adding air to subcutaneous layers of skin. It feels like crackling when palpating air. Remedy by adjusting tube back to the trachea. This happens while pt. is being moved for a bath or so. Question: Artificial Airways: Airway Types- Double-lumen ET Answer: 1. Tube has 2 cuffs w/the opening of one lumen @ the end of the tube and another opening b/w the 2 cuffs. 2. One lumen(distal) will the lung side in which it is inserted. The other lumen (proximal) will ventilate the other lung side. Question: Artificial : Airway Types- what is Double-lumen ET tube good for and with? Answer: Good for Independent lung ventilation with 1. Bronchopleural fistulas. 2. surger to areas of the lung (lobectomy, esophageal resection.) Question: Artificial : Airway Types-Laryngeal Mask AirwayAnswer: 1. short ET w/an inflatable mask(cuff)@the end.Cuff part is inserted in the deflated mode in the above the trachea&then inflated. It facilitates good breathing.Not to use w/PPV causes gastric innsufflation.Pt. cooperation needed for LMA removal Question: Artificial Airways: Airway Types- Answer: 1. Dual lumen tube w/ 2 cuffs. 2.Used for quick intubation 3. Tube is intended to insert in Esophagus, Proximal opening in the tube gives access to the lungs. 4. It can be inserted blindly. 5.Larges cuff as an anchor against hard palate. Question: Artificial : Airway Types-Oral airway Answer: 1. Usually plastic do not enter the trachea keeps airway open even if pt. is biting. 2. Proper size is distance b/w angle of jaw &tip of chin. 3. 180 Degrees from it final position then twisted into place. 4. Should not secure w/ a tape. Question: Artificial : Airway Types- Nasal airway Answer: 1. Also called Nasal trumphet. 2.Sizes - a. Outer of the airway should match inside diameter of outer naris. B.lenth should be equal todistance b/w the earlobe & the nasal septum. When too long pt. coughs - change to short tube after insertion Question: Artificial Airways: Airway Types- Define ? Answer: Airways may or may not come w/inflatable . This varies according the tube's size, application and function. Question: Artificial Airways: Airway - 2 Types of cuffs?Answer: 1.Large volume,Low pressure-minimizes pressure on the wall of trachea&avoids impedance of capillary blood flow& reduces the incidence of tracheal tissue damage.2. Low volume,High pressure-used on tubes that incorporate . (combitubes & lumenn tubes) Question: Artificial Airways: Airway Types- What is a cuff ?Answer: 1.Cuff Normal is 20 mmHg. Higher than 20 mmHg could impede blood-flow&promote tissue . It can be monitored using a pressure manometer. If NO pressure-check connections then add air&observe a pressure rise. If NO pressure rise - then replace the tube Question: Artificial Airways: Airway Types- What is Minimum Technique ? Answer: MOV - adding & removing air from the cuff while ausculting over the neck. Enough air is added to stop the of air passing around the cuff. Question: Artificial Airways: Airway Types- What is leak Technique ?Answer: MLT - It is performed like the MOV. Enough air is subtracted from the cuff to a very small leak at the top of inspiration. Question: Artificial Airways: Airway Types- Insertion - Larngoscope? Answer: It attaches to varies sizes, usually contains batteries to power a light on the blade. Question: Airways: Airway Types- Insertion equpiment- 2 types of Larngoscope BladesAnswer: 1. blade(straight blade)- a. Fits under epiglottis. B. only used for infants. 2. Macintosh blade (curved blade)- fits into the vallecula. Question: Artificial Airways: Types- Insertion equpiment- what are the Larngoscope lights? Answer: 1. Light should turn on when blade is snapped into place. 2. If it does not turn on then a. First tighten the bulb b. try a blade. C. change handle/handle batteries. Question: Artificial Airways: Airway Types- Insertion equpiment- what are the sizes of a larngoscope? Answer: 1. Adult- size 3. 2. Pediatric- size 2 3. Full-term infant- size 1. 4. Pre-term - size 0 Question: Artificial Airways: Airway - Insertion equpiment- What are other intubation assisting tools?- Stylet? Answer: 1. ONLY fot Oral intubation. 2. it into the ET tube to help shape it and ease insertion. Question: Artificial Airways: Airway Types- Insertion equpiment- What are intubation assisting tools?- Magill forceps Answer: 1.ONLY for nasal intubation. 2. into the mouth to direct tip of a nasally inserted ET tube into the trachea 3.If asked to gather equipment for an ORAL intubation - DO NOT include magill forceps. If performing nasal intubation do not include stylet Question: Artificial : Airway Types- What are the ET tubes sizes? Answer: 1. Adult- use the 1st number of the pts. Wght. In kg. eg. Pt 72 kg then use - 7 ET tube. If 84 kg then use 8 ET tube. 2.Pre-term infant- size 2 3.Full term infant - size 3. Question: Pulmonary Assessment Equipments: Define Blood gas Answer: Used to make measurement of PCO2, PO2 an pH. Question: Pulmonary Assessment Equipments: Types of Blood gas analyzers Answer: 1. pH - sanz electrode. 2. PCO2 - Servinghaus . 3. PO2 - Clark electrode. Question: Pulmonary Assessment Equipments: of Blood gas analyzers Answer: 1. Low pH - 6.84 High pH solution - 7.38 2. PCO2 calibration - 5% CO2 gas. 3. Low PO2 calibration - 0% O2. High PO2 calibration - 12%/20% O2. Question: Pulmonary Assessment Equipments: How many hours does a QC should be run? Answer: 8 hrs. Question: Pulmonary Assessment Equipments: Blood gas quality control - 3 solutions for a QC material? Answer: 1. acidodic. 2. and 3. Alkalotic materials. Question: Pulmonary Assessment Equipments: of graphical information on a QC device? Answer: 1. In control 2. Also in control 3. Trend 4. 5. Random error. 6. Not in control. Question: Assessment Equipments: what is a CO-Oximeter? Answer: 1. It determines the amount of CO in the blood. 2. Acceptable range - 1-3% (smokers b/w - 5-15%) 3. Above 20% - CO poisoning requires treatment. 100% O2, Hyperbaric therapy etc. 4. Since analyzed in the , data is a spot check value. Question: Pulmonary Assessment : What is a Pulse-Oximeter? Answer: 1. It is a non-invasive way to measure O2 saturation. 2. It determines saturation by examining light wave lengths transmitted the finger/ ear lobe etc. Question: Pulmonary Assessment Equipments: When is a -Oximeter show low accuracy or poor function? Answer: 1. High ambient light. 2. Finger nail polish. 3. Very low BP&perfusion (shock) 5.Erythema. -If suden fall is indicated SaO2 is noted-then suspect a problem w/ the probe 1 st - DO NOT the flow/ other intervention decision based on that data alone Question: Pulmonary Equipments: What is a Capnography (PECO2/PetCO2)? Answer: Measures CO2 from expired gas.It is not invasive. Uses infra-red technology. Varies about 10mmHg w/ arterial CO2(reads lower).If reading low/0 pt. needs vent. support. If capnography has no plateau on the , then think about Airway resistance-COPD Question: Pulmonary Assessment : What is Inflection points in a Capnography (PECO2/PetCO2)? Answer: Any part of graph that changes direction is called an inflection point. 1.Normal capnograph. 2. capnograph w/ a dead space - pulmonary embolism. 3. capnograph w/ poor /ventilatory failure. Question: Pulmonary Assessment : What is Pulmonary Function Testing (PFT)? Answer: Collins water-sealed spirometer is the most effective w/meausrements of flow and . Question: Pulmonary Equipments: What is an O2 analyzer? Answer: 1. Used to measure FIO2. 2. requires calibration. 3. Should be used any time a in FIO2 is made. Question: Pulmonary Equipments: What are the types of electrodes? Answer: 1. 2. galvanic fuel cell Question: Assessment Equipments: what is a polargraphic? Answer: 1. It requires battery and a n electrolyte solution. 2. If analyzer don’t read 100% - then change battery. 3. If analyzer don’t read and battries are good - then electrolyte solution. ex: clark electrode. Question: Pulmonary Assessment Equipments: What is a fuel cell? Answer: Its a cell batery & is good & common.If not working-it could be fuel cell is consumed so change cell.DON'T solution/battery bcoz CELL is the battery.It is affected by high pressures changes in altitude, H20 on the electrode. PAP causes high reading Question: Pulmonary Resuscitation : Desired characterstics? Answer: 1. self-inflating. 2. NBR valve. 3. Adjustable relief on pediatric models, fixed 25cmH2O on adult models. 4. Internal diameter connector of 15mm,outer diameter22mm. 5.Reservoir to maximize FIO2. 6.Shapeable, transparent& inflatable mask. Question: Pulmonary Resuscitation : Troubleshooting Answer: If bag collapses easily when squeezed & no chest rise replace bag & If bag is to squeeze, ensure pt. valve isnt stuck, check if the problem is low pulmonary compliance. If bag is suspected faulty replace bag dont fix the problem unless no option Question: Pulmonary Resuscitation : Mouth-to-valve mask Answer: 1. serves as a barrier b/w pt. and provider. 2. Cross contamination from pt.s expelled air is prevented through a one-way valve. 3. Superior to mouth-to-mouth . Question: Pulmonary Resuscitation Equipments: Demand (Pneumatically powered) Answer: 1. Deliever 100% FIO2. 2. by manual button & negative inspiratory pressure produced by the pt. 3. Not sensitive to changes in lung compliance-risks a pneumothorax. 4. Too powerful for infants. 5. Associated w/ gastric insufflation. Question: Suctioning Equipment: Suctioning Catheter- system suction catheter Answer: 1. is an eg. For closed suction device. 2. allows repeated used of the catheter-bags keep catheter sterile. 2. No discontinuance of FIO2/mechanical ventilations. 3. Useful when pt. is on high PEEP levels (no break in PEEP). Question: Suctioning Equipment: Suctioning Catheter- Catheter Answer: 1. Must maintain sterile technique when using. 2. one-time use only. (no ) Question: Equipment: Suctioning Catheter- Coude Tip Catheter Answer: 1. Tip of catheter is bent slightly to facilitate entrance and suction of the left mainstem bronchous. 2. Can be to direct into either bronchus. 3. requires sterile technique. Question: Suctioning Equipment: Catheter Size- Answer: 1. Nasal/Oral suctioning- 20 inches. 2. Tracheostomy - 15 inches. Question: Equipment: Catheter Size- Diameter Answer: 1. not exceed 1/2 of the internal diameter of the ET/Trach tube. Question: Suctioning Equipment: Catheter Size- in French Units Answer: 1. 1mm/ID of ET/Trach tube = 3 French. Ex. If Id = 6.0 mm, shouldnt exceed 3.0mm i.e. 3.0mm*3 = 9 French catheter. 2.If catheter comes in 8-10 french & catheter needs to be 9 (choose smaller of 2 (8 fr.) 3. 10 & 12 Fr. Most common for adults. Question: Equipment: Suction Pressure- Answer: 1. : 100-120 mmHg. 2. Pediatrics: 80-100 mmHg 3. Infant: 60-80 mmHg. Question: Equipment: If suction not adequate what do we do? Answer: 1. check connections 2. check collection - change if full. Question: Suctioning Equipment: suction Devices Answer: 1. In-line specimen trap (luken's trap) 2. Tonsil suction devices- a. Know as a yankauer(brand) b. also know as oral device. C. Useful in suctioning mouth and throat. Question: Cleaning- Define Disinfection?Answer: pathogenic organisms. Question: Equipment : Disinfection- Steam autoclave Answer: 1. No . 2. Involves placement in packages prior to prodcedure. Question: Equipment Cleaning: Disinfection- Answer: 1. Done with pre-washing and hot-water soak. 2. Best to use with used on patients with infectious disease such as hepatitis. Question: Equipment Cleaning: - Alcohol Answer: 1. and isopropyl are effective. 2. 70-90% concentrations. Question: Cleaning:Define Sterilization? Answer: Kill all living Question: Equipment : Sterilization- Irradiation Answer: 1. Uses radioactive gamma rays. 2. DO NOT irradiation with ethylene oxide (ETO). Question: Equipment Cleaning: Sterilization- Answer: 1. Destroys equipment. 2. for disposable items. Question: Equipment : Sterilization- Ethylene Oxide (ETO) Answer: 1. Gas 2. Good for devices that have electrical components. Question: Equipment Cleaning: Sterilization- (Alkaline Gluteraldehyde) Answer: 1. Liquid. 2. Not good for components. 3. Will kill all bacteri in 10 mins. 4. Will kill everything in 10 hrs. 5. Tuberculocidal in 20 mins. 6. Works by using a caustic (alkaline) pH (7.5-8.5) Question: Equipment Cleaning: Sterilization- Sonacide (Acid ) Answer: 1. Kills bacteria in 10 . 2. Kills everything in 1 hr. 3. Uses acidic pH (2.5-3.5) Question: equipment consideration: Answer: 1.Bronchoscope - Cidex ( gluteraldehyde) 2. IPPB machine - ETO Question: control: Answer: 1.disposable method of determining survived a sterilization/disinfection procedure such as pasteurization. 2. If viable (able to live) spores are found, then equipments requires re-sterilized. Question: Infeection Control: a therapist have to use what ? Answer: Always use at Universal precautions. Question: Infeection Control: How do we an equipment? Answer: In a plastic bio-hazard bag. |
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