Puritan Bennet 840 Unit III
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| What are the circuit basics for the PB 840? | Double circuit (heated or non heated wire)
Filters: Insp/Expiratory (smaller w/mount clip for NICU; regular for adults
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| How do you clean the PB 840? | Change Circuits and filters, wipe down with approved cleaner
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| Functionality | Turn, Touch Access
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| The air compressor is separate and may provide | up to 200 L/minute flow
w/minute ventilation of 50 L/minute
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| GUI stand for | Graphical User Interface
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| The GUI contains the | screen and is "AKA" the brain; input data
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| The BDU stands for | Breath Delivery Unit
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| The BDU is the | box and is also known as the lungs or heart; performs the task
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| The BDU has a | flow transducer, fully charged battery and internal air compressor
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| The monitor | sends information to the lower portion of the vent and receives information to monitor graphics.
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| The rectangular box contains the | batter and has a 45 minute life if fully charged
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| Portions of the screen | top includes patient data and graphics
bottom includes ordered parameter and alarms
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| Self Testing includes the | POST
EST
SST
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| The POST is the | Power on Self test and occurs automatically.
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| The EST is the | Extended self test and is done every 6 months by biomed
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| The SST is the | short self test and takes 3 to 6 minutes. It is a function test and must pass to use. You must have an open circuit when the machine is turned one
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| The SST works by | hitting SEST on the screen and then there is five seconds to hit the EST
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| The MA1 has the following modes | Control-VC
AC-Volume Controlled
IMV
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| The 84o has the following modes | AC-VC or PC
SIMV- VC w or without P/S; SIMV PC w or without P/S
Spont-with or without PS
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| Assist control is | volume or pressure targets
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| In assist control breaths have one of the following | preset volume
preset pressure
volume targeted
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| Pressure is a | square wave form
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| Flow is | decelerating
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| In AC/VC TLC is as follows | T-RCT/P or F triggered
L- Flow
C-It
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| The settings in AC/VC are | rate
volume
peak insp flow
fio2
Trigger
PEEP
Alarms
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| The advantages of AC/VC are | guaranteed set VT
gauaranteed VE
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| The disadvantages of AC VC are | pressure varies which can lead to potential barotrauma
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| In AC/PC the TLC is | T-RCT/ P or F
L-Pressure
C-It
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| The settings for AC/PC are | Rate
PIP
IT
O2
Trigger
PEEP
Alarms
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| The advantages of AC/PC are | control pressures
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| The disadvantages of AC/PC is that | TV and VE can vary and there is a variable Peak flow
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| SIMV is the same as IMV except it | avoids breath stacking
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| If a pts spontaneous breath is initiated at the same time as a mandatory breath is required it will | deliver an assisted mechanical breath (like and ac breath)
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| What are the indications, advantages and complications of SIMV | same as with IMV, except machine breaths are synchronized with pts spontaneous breaths
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| CPAP is used on | spontaneous breaths when there is no pressure support
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| Spontaneous made includes | NO set rate and may be used with CPAP and/or Pressure Support
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| What else must be set in spontaneous mode? | Apnea parameters
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| What are the indications for spontaneous mode? | Facilitate weaning
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| What are the complications of spontaneous mode? | muscle fatigue
Increased WOZBZ
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| Mean airway pressure is | the average pressure in the airway during one complete respiratory cycle
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| Mean airway pressure is affected by | pressure and time and the relationship is directly proportional.
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| The greater the mean airway pressure the greater the risk of | barotrauma.
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| MAP does have some oxygenation benefits especially | when used with the inverse ratio ventilation
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| MAP should be less than | CVP
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| Normal MAP is | 5-10 cmH20
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| Map for obstructive patients is | 10-20 cmH20
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| MAP for ARDS patients is | 15-30 cmH20
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| MAP on the 840 Ventilator is calculated based on 1 | RCT
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| Intrinsic PEEP is unintentional PEEP and may also be termed as | Auto-PEEP
Inadvertant PEEP
Occult PEEP
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| Unintentional PEEP during mechanical ventilation is present when | end-expiratory pressure does not return to baseline pressure
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| Unintention PEEP is commonly associated with | significant airway obstruction
insufficent flow rates
rapid respiratory rates
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| What are the complications of inadvertant PEEP? | barotrauma and decreased CO
Increased WOB
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| How do you correct Auto-PEEP? | increased expiratory time (with flow or rate change)
Reverse the airway obstruction
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| PEEP can reduce effects of | Auto PEEP
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| List of ways to fix Auto-PEEP | increase Peak Flow
Decrease Respiratory Rate
PEEP
Bronchodilators
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| What is the formula to calculate MAP? | (It*PIP)+(ET*PEEP)/RCT
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| When using a ventilator in which peak flow is preset a change in flow wave form from square to any other pattern will change | I time
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| Any flow wave form other than square must be calculated as such | It=RCT/Total Parts of the I:E ratio
The I:E will come from the vent
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| Raw cannot be calculated when the flow is not | constant
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| Pressure support (PSV) provides | a preset pressure plateau to the patients airway for the duration of a spontaneous breath.
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| PSV can be used with | SIMV or as a stand alone mode
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| PSV will | augment a patients spontaneolus VT
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| PSV will be terminated when the | patients flow drops to to a predetermined level
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| What are the indications for PSV? | It facilitates Weaning
Helps overcome airway resistance
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| You use an expiratory hold maneuver to find the | AUTO PEEP
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| Pressure support must be automatically set at what without pressure support to overcome Raw? | 1.5 cmH20 over the PEEP level
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| In PSV what is the trigger, Limit, Cycle? | Trigger-Pressure/Flow
Limit-Pressure
Cycle-E-Sensitivity
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| PSV is cycled when | a patients inspiratory flow drops to a predetermined level.
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| E-sensitivity is | the sensitivity required to cycle spontaneous pressure supported breath into exhalation.
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| Expiratory Sensitivity (Esens) is defined as | the percentage of the projected peak flow at which the ventilator terminates flow, and thus cycles from inspiration to expiration during spontaneous breathing.
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| Some ventilators have already predetermined | E-sensitivity
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| ESensitivity can be adjusted up if | there is a leak in the cuff
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| the smaller the e-sensitivity the | longer the I time
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| Th larger the e-sensitivity | the shorter the I time
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| What is the predetermined E-sensitivity on several vents? | Servo 900C 25%
Servo I- 40%
Galileo-25%
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| The default E-sensitivity on the PB 840 is | 50%
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| Inspiratory rise time % is also known as | Pramp
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| Inspiratory rise time or Pramp determines | how quickly the pressure will rise to its peak
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| Pramp is only active in | a pressure mode of ventilation
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| The more increased Pramp the sharper the | pressure
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| Inspiratory rise time can | blunt flow so that the pressure doesn't rise immediately.
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| Pramp changes pressure curve by manipulating | flow
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| Rise Time is | 1-100 in range
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| If rise time is set too low or too high | tidal volume may be reduced or increased
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| What are the alarm parameters for fio2? | +- 7%
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| What are the alarm parameters for VE? | 2-4 liters above observed VE
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| What are the low exhaled VE alarm parameters? | 1-2 liters below observed VE
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| What are the parameters for high respiratory rate? | 10-15 breaths/minute over observed rate
30 breaths/minute is good
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| Dsens alarm parameters | disconnect sensitivity
20-95%
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| PEEP(TOT)/PEEPI is equivalent to | Expiratory Hold Maneuver
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| PO.1 can be found in respiratory mechanics and measures | pressure generated during the first 100 milliseconds of inspiration against an occluded airway
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| The apnea alarm is usually how long for an adult? | 20 seconds
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| When setting apnea parameters it is import to | consider the fluctuations in patient's spontaneous rate
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| Some ventilators require the apnea parameters to be programed but | others have the apnea parameters predetermined.
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| The other puritan bennette 840 features include | pressure ventilation
volume support
neomod
bilevel
PAV+
Respiratory mechanics
tube compensation
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| PAV+ stands for | proportional assist ventilation
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| Proportional assist ventilation is when the | patient generates flow and volume and the machine will push pressure based on their needs to assist.
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| For proportional assist ventilation a percentage is chosen and is | what percentage the machine will add to help ventilation (5-100%)
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| What are the advantages of volume ventilation? | Tidal volume is guaranteed
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| What are the disadvantages to volume ventilation? | pressure is not limited which may result in unnecessary barotrauma.
Flow rate is fixed (limited, therefore patient cannot control flow demand
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| What are the advantages of pressure ventilation? | Pressure is limited so barrotrauma risk is decreased.
Flow rate is variable and changes in response to pt effort/lung characteristics.
More even distribution of gas flow to lung, resulting in lower pressure requirements to achieve VT.
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| what are the disadvantages to pressure ventilation? | VT varies with changes in resistance and compliance.
May be uncomfortable if the inspiratory time is not set appropriately.
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| Volume support is | pressure support ventilation with target volume.
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| What is the TLC for volume support? | T- Patient (flow or pressure)
L-Pressure Limited
C-Patient (Flow-ETS)
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| For VS pressure is adjusted to meet the target volume but will not exceed | high pressure limit minus 5 cmh20
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| If apnea the following with associated parameters must be chosen | VC or PC
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| Bilevel ventilation provides | 2 levels of PEEP or C PAP
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| Rate and Time for what must be set? | PEEPH and PEEPL
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| How is time shown for bilevel? | TH and TL
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| Pressure support is set for | Spontaneous breaths
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| What are the advantages to BiLevel Ventilation? | Increased Patient Comfort
Reduced Requirement for sedation
Prevention of alveolar collapse and overdistention
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| The PEEP High can be set between | 5 and 90 cmh20
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| The PEEP low can be set between | 0-45 cmh20
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| PEEP high can be set at | 2-3 cmh20 above Mean airway pressure
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| PEEP high can also be set at | 12 above Ppl
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| Bilevel ventilation | can cause airtrapping
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