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Hemodynamic packet
Hemodynamic Review Packet for Mullarkey/Chaney
| Question | Answer |
|---|---|
| Positive pressure inspiration affects venous return by inc, dec, same | decrease |
| Positive pressure inspiration affects pulm capillary flow by inc, dec, same | decrease |
| Positive pressure inspiration affects Pulm Vascular resistance by inc, dec, same | increase |
| Positive pressure inspiration affects cardiac output by inc, dec, same | decrease |
| Negative pressure inspiration affects venous return by inc, dec, same | increase |
| what are the central chemoreceptors | medulla oblongotta |
| what does the medulla oblongotta primary stimulus | responsive to increase PCO2 and decrease in pH |
| what are the 2 peripheral chemoreceptors located and what stimulates them | Glassopharyngeal and vagus (9 and 10 nerve) sensitive to decrease in PaO22 |
| what chemoreceptor primiarily stimiulates breathing for those without CO2 retention? | Central Chemo Receptor |
| What torr level are peripheral receptors set? | 60 torr PO2 |
| What is airway resistance | anything that impedes the airways |
| Where is RAW primarily located? | airways |
| 3 general factors that affect RAW | length, diameter and flow (sometimes visosity) |
| Normal range for RAW | 0.5 - 3 cwp/l/s |
| Formula for Raw | PIP-PLAT/Flow |
| Raw is a problem on inspiration or exhalation | exhalation |
| what type of a problem is RAW a restrictive or obstructive | obstructive |
| on a vent,an increase in RAW will increase PIP, Plat or both | PIP |
| Increase in RAW increases | WOB |
| what is static compliance | true measurement without air moving |
| what is dynamic compliance | measurement with air moving |
| what type of complaince do we use for trending of chest wall compliance | static |
| static compliance shows collective compliance in what 3 areas | chest wall, pleural space, and parenchyma |
| Formula for static compliance | Exh Vt/Plat-peep |
| Formula for dynamic compliance | exh Vt/pip-peep |
| Normal value for static compliance | 70-100 ml/cwp |
| normal value for dynamic compliance | 50-80 ml/cwp |
| what does emphysema do to static compliance | increase |
| what does restrictive disorders do to static compliance | decease |
| on a vent, decreased static compliance will increase pip increase plat or both | both |
| name 4 diseases with decreased compliance | ARDS, Pulm Fibrosis, Plum Effusion, obesity |
| what zone has the most natural alveolar dead space | one |
| which zone has the best blood flow | three |
| normal value for VQ ratio | 0.8 |
| deadspace is the opposite of | shunting |
| gas in the conducting airways not involved in gas exhange | anatomical deadspace |
| anatomical deadspace = | 1 ml/lb |
| describe alveolar deadspace | pt is ventilating but not perfusing |
| 2 examples of alveolar deadspace | hyperinflation and pulm embolism |
| severe restrictive disorder pts Vd/Vt would increase decrease same | increase |
| pt exercising their Vd/Vt would increase, decrease same | decrease |
| formula for Vd/Vt | PaCO2-PeCO2/PaCO2 |
| normal range for Vd/Vt | 25-40% |
| whend does deadspace become critical | >60% |
| CaO2 formula | (Hb x 1.34x SaO2)+(PaO2 x 0.003) |
| normal value for CaO2 | 20 vol % |
| CvO2 formula | (Hb x 1.34x SvO2)+(PvO2 x 0.003) |
| Normal Value for CvO2 | 15 vol % |
| Formula for O2 transport | CaO2 x CO x 10 |
| Normal value O2 transport | 1000 ml/min |
| C(a-v)O2 normal value | 5% |
| O2 consumption formula | C(a-v)O2 x CO x 10 |
| O2 consumption normal value | 250 ml/min |
| if Hb is low how does it affect tissue oxygenation | decreases it |
| if CO decreases what does SvO2 do? | decrease |
| CO increases SvO2 | increases |
| CO decreases C(a-v)O2 | increases |
| CO increases C(a-v)O2 | decreases |
| pt is febrile the C(a-v)O2 | increases |
| Pt is febrile the SvO2 | decreases |
| pt is hypothermic the SvO2 | increases |
| pt is febrile O2 consumption | increases |
| pt is exercising O2 consumption | increases |
| CO decreases O2 consumption | stays the same |
| Normal SvO2 | 68-77% |
| Normal PvO2 | 40 torr |
| Room air norm for P(A-a)O2 | 0-20 torr |
| norm for P(A-a)O2 on 100% FiO2 | 30-50 torr |
| what is the normal PaO2/FiO2 ratio | 380-475 |
| at what point is the PaO2/FiO2 ratio critical? | <200 |
| What is the normal shunt range | 2-5 up to 10% |
| formula for shunt (Qs/Qt) | CcO2-CaO2/CcO2-CvO2 |
| at what level do we treat a shunt? | greaster than 20% |
| 2 treatments to correct a shunt | increase PEEP and FIO2 |
| 2 examples for shunt | Pulm embolism, CHF |
| what type of shunt doesnt comein contact wtih alveoli | true shunt |
| what type of shunt does capillary perfusion in excess of alveolar ventilation | shunt like |
| which shunt is more treatable true or shunt like | shunt like |
| what is the opposite of shunting | deadspace |
| which is a shunt pulm embolism or pneumonia | pneumonia |
| indication of nasopharyngeal airway | freq sux |
| indication of oropharyngeal airway | pt biting on ETT |
| hazard of oropharyngeal airway | damage to oropharynx |
| ETT how long do we pre-oxygenate | 3-5 min |
| ETT how long do we oxygenate between attempts | 1-2 min |
| how long do we attempt ETT | 30 sec |
| which hand do we hold laryngoscope | left |
| what is a miller | strait blade |
| 4 ways to initially verify placement of ETT | Listen to stomach and lungs, watch for chest rise, CO2 detector, Tube condensation |
| what is the average depth of ETT markings | 21-23 cm |
| what is the average depth for Nasotracheal intubation | 26-28 cm |
| how many cm above the carina should the ETT be placed | 5-7 cm |
| how many fingers between tube holder and pt neck | one |
| how many days till a pt should be considered for a trach | 21 |
| 2 types of procedures for trach | surgical and percutaneous |
| softening of trhe cartilaginoal rings and causes trahcea to collapse | tracheomalacia |
| narrowing of trhe trachea due to scarring | tracheostenosis |
| average range ETT cuff should be kept in torr and cwp | 20-25 torr 25-30 cwp |
| 2 contradictions of HME | thick secretions spontaneous Ve >10 lpm |
| formula for calculating suction cath | ETT x 2 = then the next size smaller |
| what is the max time spent sux a pt | 15 sec |
| where should the sux pressure be kept | 100-120 torr |
| absolute contradiction of sux | epiglottitis |
| container used for collection sample | luken trap |
| ABG shows pt is hypoventilating and hypoxemic, in vol vent CMV name 2 ways to fix hypoventilation | increase rate increase volume |
| ABG shows pt is hypoventilating and hypoxemic, in vol vent SIMV name 3 ways to fix hypoventilation | increase rate, increase Vt add PS |
| ABG shows pt is hypoventilating and hypoxemic, in pressure control vent name 2 ways to fix hypoventilation | Increase PIP Increase I-time |
| ABG shows pt is hypoventilating and hypoxemic, in vol vent name 2 ways to fix hypoxemia | increase FiO2 add PEEP |
| In PC/CMV list 3 ways to fix hypoxemia | increase PEEP, Increase PIP, Increase I-Time |
| what is the best way to fix airtrapping without changing acid base balance | Increase PIF |
| if high pressure alarm is sounding you would expect to also see what alarm | Ve |
| if secretions are causing high pressure alarms, you would expect delivered Vt to be higher, lower or the same as set | lower |
| Pt has Pulm Edema, Dr gives a diuretic you would expect inspiratory pressure to increase, decrease or stay the same | same |
| Pt has Pulm Edema, Dr gives a diuretic you would expect Vt to increase, decrease or stay the same | increase |
| Weaning: minumum acceptable value for RR | 25 |
| Weaning: minumum acceptable value for Vt | >5 ml/kg IBW |
| Weaning: minumum acceptable value for Ve | 5-10 LPM |
| Weaning: minumum acceptable value for VC | 10-15 ml/kg/IBW |
| Weaning: minumum acceptable value for NIF/MIP | -20 cwp |
| Weaning: minumum acceptable value for RSBI | <105, 80+90% sucess |
Created by:
RTCincinnati
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