Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Mechanical Vent tes3
Initiation of Mechanical Ventilation
| Question | Answer |
|---|---|
| Initiating mechanical vent: What mode do you choose? | doesnt matter as long as you can set RR |
| Name 2 Full Support Modes in which you can set RR | Controlled Mandatory Ventilation(CMV), Assist control (A/C) |
| Name 2 Partial Support modes in which you can set RR | Intermitetnt Mandatory Ventilation(IMV), Synchronized intermittent mandatory ventilation(SIMV) |
| Name 1 little to no support mode | CPAP |
| What 2 options on the vent allow you to manage CO2? | RR and Vt |
| What is the initial setting of RR for a new mechanical vent patient? | 8-12 breaths per minute |
| What is the initial setting for VT for a new mechanical vent patient? | 8-12 ml/kg IBW |
| Spontaneous Vt is driven by ___ ____ and not considered on initiation of mechanical vent | pressure support |
| What 2 options on the vent allow you to manage O2 (SaO2)? | FiO2 and PEEP |
| What is the initial FiO2 setting for mechanical vent? | 40% or 100% |
| Which patients FiO2 should be set at 40% on initiation? | non-cardiopulmonary issues |
| Which patients should be started at 100% on initiation? | patients with cardiopulmonary issues |
| What is the FiO2 exception rule? | pt with a known FiO2 on different device (i.e. CPAP or BiPap) should be kept on that FiO2 when put on mechanical vent |
| What is the initial PEEP setting on mechanical vent? | 5-10 cmH2o |
| All patients being set up on mechanical ventilation must have what done? | ABG within 30 minutes of being placed on vent |
| What should the VT alarm be set at? | +/- 100ml exhaled Vt or +/- 10% exhaled Vt |
| What should the RR alarm be set at? | 10-15 bpm above observed |
| What should the minute ventilation alarm be set at? | >10LPM or +/- 1L exhaled VE |
| What should PIP alarmn be set at? | +/- 10-15cwp, but never greater than 50cmH2o |
| What should Plat alarm be set at? | + 10, but never greater than 35cmH2o |
| If PIP and/or Plat are extrememly low, what could be the cause? | leak |
| High PIP indicates what? | Increased Raw |
| High Plat indicates what? | increased Cs |
| Indications for Mechanical Ventilation includE: | Apnea, Acute ventilatory failure, Impending respiratory failure, severe hypoxemia, surgery, prophylactic support for pulm complications |
| What constitutes acute ventilatory failure? | pt contain sustain spontaneous ventilation to provide adequate oxygenation and ventilation, pH<7.25, PaCO2 >50; COPD(decomp resp acidosis with PaCO2 above pt norm) |
| NIF or MIP < __ cmH2o, intubate | 20cmH2o |
| Criteria for impending Respiratory failure: | Vt< 5cc/kg IBW, VC< 10cc/kg IBW, RR>35 or <10, VE> 10LPM, NIF<-20cwp,RSBI>105 |
| What is an absolute contraindication for mechanical vent | untreated tension pneumo |
| What is %Ti | Percentage inspiratory time (ex- 1:2=3, 1/3=33%) |
| What mode of ventilation is used in patients with ARDS? | pressure controlled ventilation |
| Indications for PCV are: | PIP>50, Plat>35, PEEP>15,FiO2 100%, Assist control rate 16/min |
| What are the initial settings for PCV? | FiO2 100%, pressure set at or above Pplat, Vt 6-10ml/kg IBW, I:E 1:2 |
| Why would you initially set tidal volumes lower than 8-12ml/kg IBW? | low compliance(ARDS 6-8ml/kg), Increased compliance, air trapping; or need for reduced lung volumes (pneumonectomy) |
| What can cause Exhaled Vt to be higher that delivered Vt? | circuit compressible volume loss |
| Greater circuit compliance = | greater volume lost per unit pressure |
| Volume lost is not delivered to patient but is what | recorded in exhaled volume measurement (some measure vol at AO, some automatically compensate for compressible vol loss) |
| Volume lost = | compression factor x PIP |
| Corrected Vt = | Set Vt- Vt lost |
| Compressible volume loss is usually only significant in which patients? | neonatal and pediatric d/t low volumes used |
| What type of ventilation only supports spontaneous breathing and is not needed during initial setting of vent? | Pressure support ventilation |
| PSV pressure is set to deliver how much volume? | 5-7ml/kg IBW of spontaneous Vt |
| Estimated VE formula | male 4 x BSA; female 3.5 x BSA |
| BSA formula | [(4 x kg) + 7]/(kg + 90) |
| desired RR= | estimated VE/ desired Vt |
| What 2 things must you monitor when using PEEP? | BP and ABG |
| Why would you increase PEEP? | refractory hypoxemia, FiO2 > 60% |
| What is the most common method of I:E change? | changing the flowrate |
| Increasing flow rate= | decrease Ti, increase Te, increase I:E |
| Decreasing flow rate= | increase Ti, decrease Te, decrease I:E |
| Normal flow rate = | 40-60LPM |
| Ti x Flowrate= | Vt |
| Why is Longer I time 1:1, IRV is used | correct refractory hypoxemia, create auto-PEEP, decrease in compliance |
| Changes in RR affect the length of what? | exhalation |
| What type of flow pattern would you see with IPPB? | square |
| This type of flow pattern enhances gas distribution for patients with airway obstruction but may cause asynchrony? | Accelerating |
| This type of flow pattern creates high PIP and satisfies patient flow demand? | Decelerating |
| This is the most natural type pf flow pattern similar to spontaneous breathing? | Sine |
| Apnea alarm setting is | 15-20 second delay |
| FiO2 alarm set at | +/- 5% set FiO2 |
| Complications of mechanical vent include | Barotrauma/Volutrauma, decrease in CO, BP; pulmonary infection, Tracheal damage, decreasedUO, resp muscle fatigue, poor nutrition |
| PIP>50, MAP>30, Pplat>35, PEEP>10 can all cause | barotrauma/volutrauma |
Created by:
Dabi2
Popular Respiratory Therapy sets