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Mechanical Vent 1
Mechanical Vent Units 1 & 2- SPC
| Question | Answer |
|---|---|
| Indications | When a procedure should be done |
| Contraindications | Reasons a procedure should not be done |
| Hazards | Something that could happen during a procedure |
| Indications for artificial airways | SAVO -suctioning -aspiration -ventilation -obstruction |
| Indications of oral airways | Maintain patient airway on Unconscious patient, helps keep tongue off back of throat |
| Indications for Nasopharyngeal airways | Facilitate suctioning -maintain airway in conscious patients |
| Contraindications for oral airways | Do not use with conscious patients |
| Hazards of oral Airways | Gagging, fighting away, tongue obstructing airway, epiglottis pushed into laryngeal area, Trauma due to improper insertion. |
| Hazards of Nasal Airways | Aspiration if airway is too small, nasal irritation, bleeding |
| Ventilation | volume of air inspired per minute. 4-5L/min |
| Perfusion | Amt of Blood flow back to lungs. 5L/min |
| Deadspace | Vent w/out perfusion, High VQ, cause by Pulmonary Embolus |
| Shunt | Perfusion w/out vent, Low VQ, cause by Atelectasis, Pneumonia, ARDS |
| PaO2/FIO2 (PF) ratio | < 300 acute lung Injury >300 normal < 200 ARDS- severe de-oxygenation |
| PaO2/PA02 range | norm 0.75 normal range 0.75-0.95 <30 poor o2 transfer and increased shunting. <15 is critical |
| Responsive Hypoxemia | low PO2 goes up with supplemental O2 -due to VQ mismatch |
| Refractory Hypoxemia | PO2 doesn't go up with supplemental O2. -caused by shunting |
| Anatomic Deadspace | Gas volume in the conducting airways |
| Alveolar Deadspace | Gas which does not reach functioning gas exchange units |
| Mechanical Deadspace | Re-breathed gas from mechanical attachments |
| Vd/Vt | (measures deadspace) PaCO2-PECO2 over PaCO2 -30% of each tidal volume breath is deadspace ventilation |
| normal Vd/Vt | 30% normal range 20-40% -Vd/Vt increases in sick people -pulmonary embolus causes high Vd/Vt |
| Lung Compliance | Stretchablity of lung -Normal Cl 200ml/cm H2O or 0.2 L/cm H2O |
| Thoracic Compliance | Stretchability of the Chest Wall - Normal 200ml/cm H2O or 0.2 L/cm H2O |
| Static Compliance | Plat- compliance with no airflow. -altered by changes in lung compliance & thoracic compliance |
| Dynamic Compliance | Peak- compliance during airflow -altered by changes in lung and thoracic compliance. Can Also be altered by changes in Airway Resistance |
| normal compliance values | 0.05 to 0.17 or 50-170ml/cm H2O |
| Factors that alter compliance (lung, thoracic, static, dynamic) | congestion (congestive heart failure, pulmonary edema) atelectasis, fibrosis, pneumonia, emphysema |
| Causes of resistance | Bronchospasm, secretions, obstructions, Small ET and Trach Tubes, High Insp. flow rates, Foreign bodies, Biting on ET tube |
| Airway Resistance calc. | Peak-Plat/Flow (L/Sec) |
| Dynamic Calc | Vt/Peak-Peep |
| Static Calc. | Vt/Plat-Peep |
| 30 is 60, 60 is 90, 40 is 75 | PO2 30=Sat 60, PO2 60= 90 Sat, PO2 40=75 sat (venous blood) |
| reason suction cath is hard to advance | pt biting down, kinked ET tube, Cath. too big |
| Normal PH | 7.35-7.45 |
| Normal PaCO2 | 35-45 mm Hg |
| Normal PaO2 | 80-100 mm Hg |
| normal HCO3 | 22-26 |
| Alveolar minute ventilation (Va) | first calc Vd -Vd= Vt(Vd/Vt) fill for VA= (Vt-Vd)f |
| How to increase minute vent | Increase Tidal Volume or RR |
| Factors that alter thoracic compliance- CW changes outside the lung | kyphoscoliosis, pectus excavatum, ascites, obesity, chest strapping, diaphragmatic impairment |
| factors that affect airway resistance | Smooth, laminar flow & wide/straight airway = decrease resistance Rough turbulent, Narrow/curved = Increase resistance |
| Signs of respiratory distress | Cyanosis, >RR, Increase HR, Increase BP |
| adequate tidal volume | 600ml-800ml adults, 70-300 pediatric, 20-70 infant (needs manometer) |
| how many times to bag pt during code | 10-12 |
| liter flow of ambu | 10-15 adults 5-10 children |
| Nasal airway | lies btwn the base of tongue & post. wall of pharynx |
| LMA | for emergency- cuff rests against the upper esophageal sphincter |
| PMA | Displaces glottis and opening sits above larynx |
| Reflexes | pahryngeal- gag & swallow, laryngeal- laryngospasm, Tracheal- coughing, Carinal- coughing |
| ET tube size | Adult Male 8-9 / 23-24, Adult female 7-8 / 22-23 |
| Rae Tube | Curved- reduces kinks and disconnects. for nasal surgery, ophthalmic, facial, T |
| Endobronchial Tube | double lumen- for thoracic surgery, broncho-spirometry, thoracoscopies, selective lung ventilation, Lung Lavage |
| Combitube | Double lumen |
| Mallinckrodt Hi-Lo | 2nd lumen hooked to suction to remove secretions (decreased infection) |
| Macintosh blade | curved, inserted into vallecula to indirectly lift epiglottis |
| Miller | straight, placed under epiglottis to directly lift |
| Immediate complications ET tube | tooth trauma, laceration of pharynx, esophageal intubation, right mainstem intubation, damage to vocal cords |
| Late complications ET tube | Contamination/infection, cough mechanism reduced, damage to vocal cords, laryngeal or tracheal edema, mucosal damage, tube occluded w/ secretions, loss of ability to talk, loss of dignity, trachoesophageal fistula |
| Tracheostomy indications | bypass upper airway obstruction, reduce anatomic deadspace up to 50%, preventa probs w/ oral and nasal ET tubes, allow pt to swallow |
| tracheostomy complications (immediate) | pneumothorax, bleeding, thyroid injury, subcutaneous emphysema, pt discomfort |
| late tracheostomy complications | hemorrhage, infection, airway obstruction, tracheoesopheal fistula, interference w/ swallowing, stomal stenosis, tracheitis, rupture of the innominate artery |
| cufflator | keep <20 torr or 26 cm h20, >30 ischemia, >20 congestion, >5 edema |
| minimal occluding volume | start w/ leak & end up w/out a leak |
| minimal leak | fill w/o leak & pull until you hear a minimal leak |
| Suction catheter sizing | (Size of airway x 3)/2 ex (8x3)/2 = 12 |
| Coud'e | angled for endobronchial procedures |
| Closed Suction | no sprayback (reduced contamination), soft tip reduces trauma |
| HME | absorbs water vapor from exhaled gas use <96 hrs try to change every 24 |
| Heated humidifier | uses sterile water, helps prevent or loosen thick retained secretions |
| Normal VQ | .8 |
| Cuff inflated | ventilation |
| Cuff deflated | Speech |
Created by:
irishblue82
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