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Mechanical Vent 1

Mechanical Vent Units 1 & 2- SPC

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