LAST CHANCE! Flashcards
(149 cards)
1
Q
normal base deficit/excess
A
-2 to 2
2
Q
normal PaO2
A
80-100
3
Q
what does pH represent?
A
pH is an inverse log of hydrogen ions
-% of hydrogen ions
4
Q
what does CO2 indicate
A
acid
5
Q
Co2 over 45
A
acidotic
apnea
hypotentilaton
6
Q
Co2 under 35
A
hyperventilation
7
Q
replacement formula for bicarbonate
A
0.1 x (-BE) x weight in kg = needd bicarb
8
Q
base deficit pver-4
A
need blood transfusions
9
Q
what happens in left shift?
A
LOW
HIGH affinity
10
Q
relationship between O2 dissociation shifts and affinity for oxygen
A
opposite
left = low data= high affinity
right = high data = low affinity
11
Q
relationships in O2 dissociation curve
A
left = high affinity, LOW values
H, temp, 2,3-DPG, PCO2
12
Q
O2 shift if lot of CO2 is retained
A
CO2 is an acid so it makes the ABG more acidotic and moves left
13
Q
O2 shift if lots of bicarbonate
A
bicarbonate is a base so more alkalotic and moves right
14
Q
how to tell if it is compensated
A
the compensation mechanism is opposite of hte primary problem
r. acidosis is compensated by bicarb
15
Q
partial compensation
A
pH outside of normal, values
both reps and metabolic are outside of normal values
16
Q
fully compensated
A
pH normal|
both bicarb and cow are not normal
17
Q
is it respiratory of acidotic?
A
if co2 folows pH = respiratory
if bicarbonate follows pH = metabolic
18
Q
acid-base balance if Diamox
A
m. alkalosis
19
Q
acid-base balance if steroids
A
m. alkalosis
20
Q
criteria for lactic acidossi
A
lactate over 4
21
Q
acid-base in seizures
A
m. acidosis
22
Q
acid-base in rhabdomyolysism
A
acidosis
23
Q
acid-base if breathing too fast
A
r. alkalosis.
24
Q
intervedntion if on m. vent and breathing too fast
A
r. alkalosis
1. Vt
2. F
25
acid-base if hypermetabolic state
r. alkalosis
26
acid-base if pregnant
r. alkalosis
27
acid-base if high altitude
r. alkalosis
28
acid-base if pain
r. alkalosis
29
acid-base if anxiety attack
r. alkalosis
30
what happens in ASA poisniong
it is a respiratory center stimulant
31
can't remove CO2
breathing slowly/hyperventilation is r. acksosis
32
acid-base in CNS depression
r. acisosis
33
acid-base irf lung or chest injury
r. acidosis
34
intervente r. acidosis
breathing too slow. so buildup CO2. so increase RR
35
acid-base in asthma
r. acidosis
36
acid-base in COPD
r. acidosis
37
every __ ETCO2
pH changes __
in ___ direction
every 10 mm ETCO2
pH changes 0.08
in opposite direction
38
10
0.08
__ direction
ETCO2
pH
oppsite
39
every __ pH
bicrab __
in __ direction
0.15 pH
10 bicarb
same direction
40
0.15
10
in __ direction
pH, bicarb, same
41
every __ pH
K shifts __
in __ direction
0.1
0.6
opposite
42
0.1
.6
__ direction
pH, K, opposite
43
every __ CO2
__ changes
__ direction
0.1 pH
K 0.5 shifts
same
44
0.1
0.5
__ direction
CO2, K, same
45
relationship between pH and K
as pH falls, K shifts outside the cell to make the K look false high
- when shifting imbalance by raising pH, K shifts intracellulary leaving life-threatening low K
46
shifts involving K
every 0.1 pH, shifts 0.5 in the same direction
every CO2 0.1m J sgufts 0.5 same
47
shifts involving pH
0.15 pH, bicarb 10 same direction
10 ETCO2, 0.08 opposite direction
48
ABG to intubate
only one off!
pH under 7.2
CO2 over 55
pAo2 under 60
49
LEMON
look
evaluate 3-3-2
mallampati
obstructions
neck mobnility
50
practice finger positions for the "E" of LEMON
51
mneumonic for the "E" of LEMON
3 fingers in mouth
3 fingers between jaw an dhyoid
2 fingers between hyoid and thyroid
52
predictor for diffiuclt airway
LEMON
HEAVEN - emergency difficult airway predictor
53
Mallampati II
tonsilar pillars are hidden by tongue
54
Mallampati III
only base of uvula can be seen
55
Mallampati IV
can't see uvula
56
can't see uvula
mallampati IV
57
only can see the base of the uvula
Mallampati III
58
can't see the tonsilarpillars
Mallampati II
59
HEAVEN criteria
for difficult airway prediction in emergency
Hypoxemia under 93%
extremes of size (under 8,, obesity)
anatomic challenges
vomit/bood/fluid
exsanguination/anemia
neck mobility
60
blood concern that make an emergency intubation difficult
HEAVEN
= blood in oral cavity
- suspected anemia can potentially accelerate the rate of decompensation during RSI apneic period
61
ramping
ear to sternal notch
62
problems of supine transport/intubation
low runctional reserve capacity, Vt, preload
63
lifts epiglottis via vallecula
McIntosh blade
64
Macintosh blade
lifts the epiglottis via the vallecula
65
directly dispacement epiglottis
miller blade
66
miller blade
direct displacement of epiglottis
67
preferred intubation blade for pediatrics
miller
68
size bougie
adults 15 Fr
pediatic 10 Fr
69
inflate ETT cuff
20-30 mm hg
only use the amount you need to create a good seal
70
CXR confirms ETT
distal tip 4-5 cm above carina
level of T3-T4 (visualizing Murphy's eye where the clavicle meets)
71
ETCO2 waveform
72
7 P's for success
preparation
preoxygenate
pretreatment
paralysis with induction
protect and position
placement with proof
post intubation management
73
the D of LOAD
RSI pretreatment
- desfasiculating dose: 1/10 roc or vec
74
purpose of lidocaine as a RSI pretreatment
blunts the cough reflex preventing ICP
75
purpose of atripoine as RSI pretratmetn
prevents reflexive bradycardia in udner 1 yo
76
caution if use fentanyl for RSI
caution if low bp
chest wall rigidity
77
DO NOT use etomidate for RSI
adrenal suppression
shock
septic shock
COPD
asthma
78
DO NOT use as induction if shock
etomidate
79
side effect of the reversal agent for benzos
flumazenil 0.2 mg adversely affectsw bp
80
description of propofol
hypnotic with no analgesic properties
81
good induction agent for shocky patients
ketamine
82
contraindication for propofol
head injury b/c decreases CPP and MAP
not for hemodynamically unstable
83
not a good induction agent if head injury
propofol b/c decreases CPP and map
84
not a good induction agent if hemodynamically unstable
propofol
versed -bp
85
description of propofol
hypnotic without analgestic properties
86
electproblem of Succ
high K
87
burns where you shouldn't use succ
over 24 hrs
88
contraindications to succinycholine - 7
crush
eye
narrow-angle glaucoma
malignant hyperthermia
burns over 24 hours
high K
nervous system disorder
89
problem of malignant hyperthermia
defect in the skeletal muscle sarcoplasmic reticulum
can't remove Ca form teh cell
90
reverse Roc
sugammadex 16mg/kg
91
use sugammadex
reverse Roc
92
changes to make to RSI dosing if hemodynamically unstable
1/2 inducton dose (less needed b/c depleated catecholamine stores)
double paralytic ( low CO means slow onset of action)
93
SALAD tercnique
suction assisted laryngoscopy airway decontaminatin
-suction, once the airway is clear, place suction tube in esophagus while pass tube
94
post intubatin rx
fentanyl, ketamine, versed
95
Pediatic cric guidelines
surgical if over 8
needle if under 8
96
Fick's Law of Diffusion
gases travel from high to low concentrations
97
gases travel from low to high concentration
Fick's Law of Diffusion
98
apneuristic breathing
decerebrate posturing
deep gasiping inspiration with pause at full inspiration then breief insufficient release
99
deep gasping inspiration with a pause at full inspiration followed by a brief insufficient release
apneuristic
100
ataxic
complete irregular breathing with irregulart pauses and increasing periods of apnea
101
irregular breathing, pasues, and apnea
ataxic
102
BIots
shallow inspiration with apnea
103
shallow inspiration iwth apnea
Biots
104
brainstem heriniation breathign patern
cheyne-stokes
105
DKA breathing
Kussmaul
106
deep rapid and gasping breathign
Kussmaul
107
Kussmaul breathing
deep rapid and gasping breathing
108
Cheyne-Stokes breathign
progressively depeer and faster then decrease and apnea
109
treatment for hypoxic respiratory failure
FiO2 & PEEP
110
treatmetn for hypercarbic respiratory failure
increase pPlat then increase rate
double minute ventilation
111
Vt setting for weight
over 8ml/kg of IBW for Vt settings can cause VILI
112
normal Vt
4-8 ml/lg IBW
113
PIP
not over 35
- amount if resistence to overcome the ventilator circiut, appliances, the ETT, main airways
114
waveform on ventilator
115
pPLAT
under 30
-pressure applied to the small airways and alveoli
- represents teh static end inspirationry recoil pressure of hte respiratory system, lung, and chest wall
116
when do you measure pPLAT
durng inspiratory pause (i-hold)
117
Assist-control
trigger for deliver of bretht by either pt or elapsed time
-0 preferred mode for pt with respiratory distress
FULL Vt regardless of respiratory effort of drive
118
how much of a Vt do you get per breath on Assist control
trigger for breath is either pt or elapsed time
- gets full Vt regardless of respiratory effort or drive
119
prblem of auto-peep
- predispose to barotrauma & hemodynamic compromises
- increases teh effort to trigger the ventilator and WOB
- diminshes the efficiency of hte force generated by respiratory muscles
120
SIMV
if pt fails to breathe, the ventilator will provide the breathe
can breathe in between preset intervals
121
purpose of pressure support ventilation
Vt, rate
- must have consistent ventilation effort
0 decreases overall WOB
122
patient-ventilator dyssynchrony indication
inadequate pain and sedation. resp demands not being met
curare cleft per ETCO2 waveform
123
curare cleft
ETCO2 shows curare cleft
inadequate pain/sedation
fighting the vent
124
problem of patient-ventilator dyssynchrony
increased WOB, HR, BP, ICP, oxygen demand
125
treat patient-ventilator dyssynchrony
manage auto-peep
adjust rate to match pt demand
adjust sensitivity
suchtion
pain/sedation rx
adjust minute ventilation (F x Vt)
126
ventilator setting to check if acute respiratory deterioration is noted
DOPE
PIP first (decrease/increase/no change)
then plateau pressure
127
ventilator shows decreased PIP
air leak
hypERVENT
HYPOventilation
128
ventilator shows increased PIP
chec to see if there is a change or no change in pPLAT
129
ventilator shows no change in PIP
PE
extrathoracic process
130
acute respiratory deterioration
shows increased PIP
but no change in pPLAT
airway obstruction
131
acute respiratory deterioration
shows incrased PPLAT
and increased pPLAT
decreased compliance is the cause
132
calculate VQ
alveolar ventilation / CO
133
low V/Q
shunting (alveoli is perfused but not ventilated)
ET tube in mainstem bronchus
134
high VQ
deadspace: aveoli ventilation but not perfused (cardiac arrest)
135
normal V/Q
around 0.8
alveoli is perfused and ventilated
(low V/Q is shunting. alveoli perfused not ventilated)
high is deadapace: alveoli ventilated, not perfused
136
problem of lwo V/Q
ventilation is not keeping pace with perfusion
-r. failure, ARDS< pneummonia
-low PaO2
high PaCO2
137
problem of asthma
problem is breathing out
r. acidosis b/c hypercarbic r. failure
138
CXR of asthma
flattened diaphragm
chest cavity overexpanded b/c air traping
139
ventilation for asthma
increase I:E to 1:4
zero peep
consider bipap
140
rx for asthma
bronchoD
steroids
epi
magnesium
IVF
ketamine
141
CXR of COPD
flat diaphragm
chest cavity overexpanded b/c air trapping
142
COPD exacerbation intubatin
increase i:E to 1:4 to facilitate CO2 offloading
zero peep
143
thing to consider abotu I:E ratuis
uncomfortable & need deep sedation
longer E increases CO2 clearnence but can cause risk fo atelectasis
144
what happens in ARDS
diffuse alveolar injury
- incrased permeability of hte alveoliar-capillary barrier so influx of fluid in the alveolar space
= hypoxemia and p. HTN
145
CXR of ARDS
ground glass
patchy infiltrates
bilateral diffuse infiltrates
146
Swan-Ganz results of ARDS
PAWP is over 18 b/c the right heat is pumping against increased resistence inteh lung vasculature
147
treat ARDS
increase Peep and FIO2
Vt low at 4ml/kg
increase F to ensure adequate minute volume
148
intervention if IABP has condensation
place pump on standby,
disconnect at safety chamber/extension tubing,
pump for 30 seconds iwth tubing/chamber faced downward to expel droplets,
set pump back on standby,
reconnect/refill/resume
149
intervention if IABP has a consol malfunction
manually inflate/deflate balloon with 20-50ml luerlock syyronge q 5-15 minutes|-use at least 15ml lessfill gas or air (this is not counterpulsation- inflation can occur at systole
- replace IABP asap
