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Managing Clinical Cases - CVR > Lecture 2 - Advanced Treatment Techniques > Flashcards

Lecture 2 - Advanced Treatment Techniques Flashcards

1
Q

Define tidal volume

A

The normal volume inhaled and exhaled while breathing

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2
Q

Define expiratory reserve volume

A

The maximum exhalation possible over tidal volume

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3
Q

Define inspiratory reserve volume

A

The maximum volume of inhalation possible over tidal volume

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4
Q

What can make it difficult to take an inspiratory reserve volume?

A

If a patient has a higher breathing rate it will be difficult for them to take a full breath in

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5
Q

Define residual volume

A

The volume left in the lungs after maximum exhalation

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6
Q

Define vital capacity

A

The total amount that can be exhaled following maximum possible inhalation

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7
Q

Define inspiratory capacity

A

The total volume that can be inhaled (tidal volume + inspiratory reserve volume)

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8
Q

Define total lung capacity

A

The total volume of air in the lungs when they are at maximum capacity - residual volume + expiratory reserve volume + inspiratory capacity

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9
Q

Define functional residual capacity

A

The total volume of air left in the lungs are a normal expiration

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10
Q

What is the closing volume?

A

The volume of air in the lungs after normal expiration at which airways will begin to close

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11
Q

What happens when functional residual capacity is lower than closing volume?

A

The dependent airways collapse during a normal expiration

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12
Q

What can cause functional residual capacity to decrease?

A

Issues that physically reduce the space:
- Obesity
- Scoliosis
- Pregnancy

Restrictive lung conditions

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13
Q

Why does alveoli collapse cause respiratory failure?

A

If alveoli collapse, there is wasted perfusion whereby the lungs are being well perfused with blood but the ventilation doesn’t match this (V/Q mismatch). This leads to hypoxaemia (reduced oxygen in the blood) and then hypoxia (reduced oxygen in the tissues). This is therefore respiratory failure.

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14
Q

Give some internal factors affecting lung volumes

A
  • Restrictive lung diseases
  • Obstructive lung diseases
  • Consolidation
  • Atelectasis
  • Pulmonary Oedema
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15
Q

Give some external factors affecting lung volumes

A
  • Scoliosis
  • Obesity
  • Pregnancy
  • Pleural effusion
  • Pneumothorax
  • GI distention
  • Chest wall deformity
  • Neuromuscular diseases
  • Reduced inspiratory drive
  • Pain
  • Anxiety
  • General anaesthetic
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16
Q

Identify and describe the four stages of coughing

A

Stage 1 - Initiation - something is in the respiratory tract that shouldn’t be

Stage 2 - Deep inhalation - deep breath in is taken as volume required to move air in the next stage

Stage 3 - Compression - the larynx closes, the diaphragm, muscles of the chest wall and abdominal wall all contract and this creates a large rise in intrathoracic pressure

Stage 4 - Expulsion - the sputum is expelled from the lungs as the air rushing through the airways due to a large increase in pressure pushes it out

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17
Q

What part of the phases of coughing would muscle weakness impact?

A

Compression

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18
Q

Which of the phases of coughing would pain impact?

A

Compression and Deep inhalation

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19
Q

What are the three elements of ‘work of breathing’ and give an overview of each

A

Load = the physical pressures on the lung tissue, the airways and the thoracic region

Capacity = the ability of muscles to work as they should, key impacting factors are strength and innervation

Demand = the demand on the respiratory system for example the drives (hypoxic and hypercapnic) and the metabolic demands

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20
Q

Define lung compliance

A

Expandability of lungs and chest wall

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21
Q

Why is decreased compliance an issue

A

Patients are unable to inflate their lungs to receive an appropriate amount of perfusion - the functional residual capacity decreases increasing likelihood of collapse

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22
Q

Why is increased compliance an issue

A

Lungs are easier to inflate but the patient is less able to exhale as they are less able to change their lung volume due to less elastic recoil

This leads to air being trapped in the lungs - this makes the patient feel short of breath

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23
Q

What happens to lung compliance in prone and side lying compared to supine

24
Q

What is the Bird

A
  • Intermittent positive pressure breathing
  • Assisted inspiration and passive expiration
  • Powered by pressured oxygen/air
25
What triggers breaths with the BIRD?
Patient's own inhalation
26
What are three things you need to set on the Bird when you use it
Starting effort/trigger - the amount of effort required to trigger a breath - this should be minimal if the patient has increased WOB Flow rate - determines the length of the breath, high flow rate is a short breath and low flow rate is a longer breath - the aim should be for a low flow rate in order to engage collateral ventilation Pressure - sets the amount of pressure, greater pressure = greater volume taken into the lungs due to an increased pressure gradient
27
What are some indications for using the Bird
Increased work of breathing Sputum retention Atelectasis Reduced tidal volumes Self ventilating patients
28
What are some contraindications of using the Bird
Undrained pneumothorax Surgical emphysema
29
Name some precautions of using the Bird and what should you do if a patient has any of the following?
Cardiovascular instability Bullae in the lungs Active TB Haemoptysis (coughing up blood) Bronchial cancer Lung abscess Bronchopleural fistula Recent thoracic surgery Recent upper GI surgery Raised ICP Vomiting Facial trauma or surgery Hypotension Hypoxic drive Severe COPD exacerbations Flail chest You should speak to the patient's consultant to discuss using the technique
30
Why is haemodynamic instability a precaution for using machinery that increases intrathoracic pressure?
Increasing intrathoracic pressure can compromise mean arterial pressure (as venous return is decreased) therefore this further increases the effort required from the body to maintain adequate tissue perfusion
31
Why is recent surgery a precaution to use of machinery that increases intrathoracic pressure?
High airway pressure can cause trauma to the anastamosis (surgically created connections)
32
Why is lung bullae a precaution for use of machinery that increases intrathoracic pressure?
The pressure can lead to risk of pneumothorax
33
Why are raised ICP and recent head injury, precautions for use of machinery that raises intrathoracic pressure?
Increased intrathoracic pressure can reduce mean arterial pressure reducing cerebral perfusion
34
Why is severe exacerbations of COPD a precaution for use of machinery that increases intrathoracic pressure?
The increased airway pressure increases airway irritation and the inflammatory response
35
Why is hypotension a precaution for use of machinery that raises intrathoracic pressure?
The respiratory pump that increases venous return to the heart relies on decreases in intrathoracic pressure to do so, this decreases and compromises venous return therefore cardiac output falls and this can further decrease blood pressure
36
What is the cough-assist
- Mechanical insufflation/exsufflation - Alternates negative and positive pressure to aid clearance of secretions in the airways
37
What are indications of using the cough assist?
- Sputum retention - Cough weakness due to poor inspiratory effort or poor expiratory effort
38
What are some things to consider when beginning a patient on the cough assist
The ratio of breaths to forced coughs - start lower Start on lower pressures to acclimatise the patient and build up to pressures high enough to force a cough
39
What is a manual assisted cough?
Manual upward compression of the diaphragm to decrease the volume in the lungs to increase pressure sufficiently enough to facilitate a cough
40
What are the indications for manual assisted cough?
Sputum retention Poor cough caused by poor expiratory effort
41
Give some considerations for performing a manual assisted cough with a patient
- Size of the patient - do you need a second person assisting - Your upper body strength - Spinal stability of the patient - Secretion thickness - more force required, do you need a second person assisting? - The position of the patient
42
Why would you not perform a manual assisted cough with a child and what would you do instead?
Children have a very delicate abdomen Children have very springy ribs so push down on the ribs instead
43
Give a contraindication for manual assisted cough
Direct pressure over fractured ribs or chest wall injuries/incisions
44
Give some precautions for manual assisted cough
- Take care after upper abdominal surgery, eye surgery and cardiothoracic surgery - Rib fractures - Raised intercranial pressure - Undrained pneumothorax - Osteoporosis - Pain - Unstable spine - Paralytic ileus - the muscles that move your food through your digestive system are temporarily paralysed
45
What is manuel hyperinflation?
Use a manual bag to deliver a deeper breath to a patient
46
What are some indications of manual hyperinflation?
Atelectasis/reduced lung volume Decreased lung compliance Retained secretions Hypoxia
47
What are some contraindications of manual hyperinflation?
Undrained pneumothorax Someone with high lung compliance PEEP higher than 15cmH2O as this will lead to too much hyperinflation Unexplained haemoptysis Severe bronchospasm CVS instability
48
What are some precautions for manual hyperinflation
PEEP higher than 10 Drained pneumothorax Recent lung surgery Unstable BP 100% FiO2 Acute head injury Lung abcess Bullae
49
What is suction
- Physically removing secretions from a patient
50
What are the two options for suction in self-ventilating patients and which is usually favoured?
Nasally or orally - nasally as orally is often more uncomfortable for the patient and harder to guide for the practitioner
51
What are contraindications of suction?
- Base of skull fractures - Pharyngeal obstruction (stridor) - Acute pulmonary oedema
52
What are some precautions of suction?
- Face injury - Severe bronchospasm - CVR instability - Clotting disorder - Post-op thoracic surgery - Upper GI surgery - Malignancy in the area - Hypoxia (can cause collapse) - Frank haemoptysis (coughing up blood)
53
What is a PEP device and an oscillatory PEP device?
A device that provides a bit of back flow during expiration allowing collateral ventilation so that air can build up behind mucus Oscillatory PEP devices also provide vibrations that help to move mucus from the surface of the airways
54
What is an incentive spirometer
- Encourages patient to focus on volumes of breathing with a visual target to reach
55
What are nebulisers and mucolytics?
Nebulisers turn medications into mist to ease inhalation into lungs Mucolytics loosen and decrease the viscosity of secretions to aid clearance Used in combination to clear sputum
56
What do bronchodilators do?
They open your airways when in bronchospasm and reduce inflammation
57
What are anti-axiolytics and why are they relevant to CVR
Drugs to treat anxiety - anxiety can be a reason for respiratory issues due to changes in breathing patterns, quality of breathing etc

Managing Clinical Cases - CVR (5 decks)

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