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Hemodynamic packet

Hemodynamic Review Packet for Mullarkey/Chaney

QuestionAnswer
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