SPC Mechanical Ventilation Unit 5 Exam 3
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What do you do if plateau pressures are >30? | show 🗑
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show | Time for full exhalation and may cause "auto-trapping/auto-PEEP"
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FiO2 >50% increases risk of what? | show 🗑
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What is PEEP? | show 🗑
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show | The positive baseline pressure continuously applied to th airway of a SPONTANIOUSLY breathing patient.
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PEEP and CPAP are used to increase what? | show 🗑
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show | 1. Keeps alveoli from collapsing at end-expiration
2. Can reopen alveoli that have already collapsed
3. Increase Lung Compliance
4. Improves Gas exchange
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What are the 5 indications for PEEP? | show 🗑
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What are Relative contraindications of PEEP? | show 🗑
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What are Absolute contraindications of PEEP? | show 🗑
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show | PEEP that is set on the machine
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Intrinsic PEEP is also known as what? | show 🗑
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What is Intrinsic/Auto-PEEP? | show 🗑
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show | 1. Ventilation-associated
2. Disease-associated
3. High Inflation Volume
4. Rapid Respiratory Rate
5. Relative decrease in exhalation time relative to inspiration time
6. Airway Obstruction
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Cardiac consideration for PEEP | show 🗑
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Oxygen Transport considerations for PEEP | show 🗑
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show | All breaths are mandatory & vent controls timing, tidal volume, & pressure. Can be timed or patient triggered.
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CMV/AC mode is used on what patients? | show 🗑
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show | 1. Inappropriate Sensitivity settings
2. Response Time
3. Respiratory Alkalosis
4. Muscle Atrophy
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show | Tidal Volume is constant, PIP is variable, Flow, Rate & I-Time is set
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What happens with PC-CMV mode? | show 🗑
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show | 1. Helps prevent lung trauma (barotrauma)
2. may require sedation
3. tidal volume varies
4. spontaneous breathing patient may fight gas delivery.
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show | Used to treat Acute Respiratory Distress Syndrome (ARDS)
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What 4 things should be known about (PCIRV) mode? | show 🗑
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show | f and VT or pressure is set.
Vent delivers breaths in synchrony with patient’s inspiratory effort. Assist window.
During spontaneous breaths, patient sets rate and volume (usually with pressure support ventilation (PSV) to reduce WOB).
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show | PSV Pressure Support Ventilation
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show | Spontaneously breathing patients
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show | May improve oxygenation, used prior to extubation and liberation from ventilator, always have back-up ventilation settings in case of fatigue or failure
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show | Augments patients spontaneous inspiratory effort.
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T/F PSV mode should be added to CPAP mode during weaning. | show 🗑
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show | WOB and Inspiratory effort
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show | Weans until patient is doing all of the work of breathing.
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What 4 settings mean the same thing? | show 🗑
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show | 1. Provides two levels of CPAP
2. Allows spontaneous breathing
3. Most of the time is spent at higher level of CPAP. Pressure “released” just long enough to decrease lung volume and eliminate CO2.
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show | 1. Short release time creates intentional auto-PEEP.
2. After short release, pressure is returned to set upper pressure.
3. Increases MAP and has been proven to improve PaO2, reduce physiologic dead-space ventilation and reduce PIP.
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Settings in APRV mode include? | show 🗑
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APRV is also known as what? | show 🗑
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show | Refractory hypoxemia and non-compliant lungs. (i.e. ARDS)
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show | HFV delivers a small amount of gas at a rapid rate (as much as 60-100 breaths per minute.)
Tidal volumes < anatomical dead space.
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What is required with HFV mode? | show 🗑
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When is HFV mode used? | show 🗑
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show | 1. Microsurgery of URT (upper respiratory tract).
2. ARDS - to reduce the risk of barotrauma.
3. Fistulas (B-P, T-E) - when large leaks are present.
4. To reduce cardiovascular side effects.
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What are the 3 patient disadvantages of HFV mode? | show 🗑
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show | 1. Poor humidification
2. Necrotizing Tracheobronchitis
3. Tracheal tissue trauma
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show | 1. Uses very low tidal volumes at fast rates as well
2. A diaphragm or piston in the ventilator causes vibrations or “oscillations” to produce frequencies in excess of 50Hz or 300 breaths/min
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show | Uses “open lung approach”-alveoli are opened and the patency of the alveoli are maintained
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show | Bias Flow - continuous flow of warmed humidified gas through circuit establishes MAP (like flowby).
Facilitates elimination of CO2 and prevents drying of mucosa (secretions)
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What is the key in HFV & HFOV? | show 🗑
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show | Decrease
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show | 1. Has Oxygenation issues
2. OSA Obstructive Sleep Apnea
3. Ventilate Fine
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BiPAP mode is acceptable to be used when the patient? | show 🗑
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show | PIP to increase volume
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show | PEEP to improve Oxygenation
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show | IPAP, EPAP, Rate, FiO2
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show | To decrease WOB
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In BiPAP FiO2 is set for what? | show 🗑
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show | Provides positive pressure during inspiration and expiration.
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show | Pressure Support
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T/F Mouth piece ventilation is relatively new? | show 🗑
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What is mouth piece vent used to treat? | show 🗑
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show | Does not require airway, patient can talk
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Increased flow rates lead to what? | show 🗑
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show | Flow accelerates very quickly and reaches a set flow which is maintained throughout inspiration.
Allows for an adequate I:E ratio with a normal flow rate. This optimization of I:E ratio is beneficial for those patients in which air trapping is a concern
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show | COPD & Asthma
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show | Flow slowly accelerates to a peak flow and tapers off towards the end of expiration.
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What to know of Square Wave | show 🗑
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What to know of Sine Wave | show 🗑
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Describe Descending Wave | show 🗑
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T/F Descending Wave is most commonly used? | show 🗑
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What to know of Descending Wave | show 🗑
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show | The setting determines how easily a patient can trigger or initiate a machine delivered breath.
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What happens if the sensitivity dial is turned all the way off? | show 🗑
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What happens if the sensitivity dial is turned all the way on? | show 🗑
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show | Occurs when a patients inspiratory effort causes a drop in pressure within the circuit and when this drop in pressure is sensed by the pressure sensing mechanism of the ventilator, the ventilator triggers on and delivers a breath.
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What is important to remember about patient sensitivity triggering? | show 🗑
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show | At continuous flow of 5 - 6 L/m through circuit with a sensitivity of 2 - 3 below this baseline to trigger breath
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Where is Low Pressure alarm set? | show 🗑
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Where is High Pressure alarm set? | show 🗑
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show | About 2-3 cm/H2O below set level
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show | 10-15 above total
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show | At no more than 20 seconds
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show | 1. Ensure Vent is working
2. Check humidifier or add HME
3. Set initial startup parameters (as ordered or per protocol)
4. Adjust Alarms
5. Emergency Airway Tray
6. Suctioning Equipment
7. ECG monitor
8. Resuscitation bag & mask
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