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Critical Care 1 > *Mechanical Ventilation > Flashcards

*Mechanical Ventilation Flashcards

(99 cards)

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1
Q

Vt

A

tidal volume

amount of air in normal breath

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2
Q

problem of too high Vt

A

tidal volume too high causes Ventilator Induce Lung Injury

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3
Q

cause of Ventilator Induced Lung INjury

A

too high Vt

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4
Q

Fick’s law of Diffusion

A

gas travels from high to low concentration

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5
Q

when do you hear apneuristic posturing

A

decerebrate postuirng

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6
Q

apneuristic breathing

A

depe gasping inspiration with a pause at full inspiration followed by a brief insufficient release

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7
Q

deep gasping inspiration with a pase inspiration followed by brief insufficient relase

A

apneuristic brathing

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8
Q

complete irregular breathing w/irregular pasuses and apnea

A

ataxic

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9
Q

ataxic

A

complete irregular breathing w/irregular pasues and apnea

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10
Q

quick shallow inspiration followed by regular/irregular apnea

A

Biot’s

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11
Q

respiration in stroke

A

Biot’s

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12
Q

respiration if pressure on medula r/t herniation

A

Biot’s

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13
Q

cause of BIot’s

A

stroke

pressure on medulla from herniation

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14
Q

progressively deeper and faster then decreased to tempary apnea

A

Cheyne-STokes

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15
Q

when do you see Cheyne Stokes

A

decorticate

cushing’s brainstem herniation

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16
Q

resp in DKA

A

Kussmaul’s

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17
Q

Kussmau’s Respirations

A

resp in DKA

respiration gradulally becomes deeper, labored, and gasping

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18
Q

respirations deep and labored

A

Kussmauls’

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19
Q

gold standard for oxygenation

A

SpO2 = pulse ox

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20
Q

inability to diffuse oxygen

A

hypoxic respiratory failure

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21
Q

respiratory failure in ARDS

A

hypoxic respiratory failure

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22
Q

respiratory failure in pneumonia

A

hypoxic respiratory failure

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23
Q

respiratory failure in CHF

A

hypoxic respiratory failure

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24
Q

definition of hypoxic respiratory failure

A

pO2 below 60

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25
increase FiO2 (oxygen concentration) and PEEP
treatment for hypoxic respiratory failure
26
inability to remove CO2
hypERcarbic respiratory failure
27
cause of hypercarbic respiratory failure
damage to pons/upper medulla from stroke or trauma | respiratory acidosis
28
dx hypercarbic respiratory failure
ETCO2 over 45
29
dx if ETCO2 is over 45
hypercarbic respiratory failure
30
treatment of hypercarbic respiratory failure
incrase tidal volume (pPLAT) then rate increasae (double the minute volume (Ve), normal is 4-8L'min
31
what happens if you exceed __ml/kg of ideal body weight for tidal volume settings
over 8ml/kg for tidal volume settings can cause ventilatior associated lung injuries *slowly increase and reassess every 15min
32
ventilator setting that is the volume of air delivered per breath
Vt = tidal volume 4-8ml/IBW over 8 = ventilator associated lung injury
33
Ve
minute volume how much air is breathed by the pt in one minute F x Vt
34
4-8 ml/kg IBW
Vt = tidal volume
35
F x Vt
calculate Ve = minute volume | how much air breatahed by a pt over 1 minute
36
calculate Ve
minute volume = F x Vt (tidal volume)
37
3 ventilator settings that keep alveoli open so oxygen can diffuse
adequate peep increased FRC driving pressure
38
2 ventilator delivery methods
``` volume = preset volume consistent. once tidal volume is delivered, exhalation begins pressure = preset inspiratory pressure. once the pressure is achieved, exhalation begins ```
39
max PIP
35
40
when is pPlat measured
during an inspiratory pause while on m. ventilator
41
normal pPlat
under 30
42
values for PIP & pPlat
PIP under 35 | pPlat under 30
43
who needs CMV
controlled mandatory ventilation sedated/apneic/paralyzed all breaths are trigged, limited, cycled by the ventilator pt unable to breathe on own
44
best ventilator mode for apneic
CMV ventilator does all work pt can't breathe on own
45
best ventilator mode for paralyzed
CMV | ventilator does all the work
46
ventilator setting that does all the work and the pt has no ability to initiate their own breaths
CMV = controlled mandatory ventilation
47
preferred ventilator mode for respiratory distress
Assist COntrol
48
trigger for breath in Assist Control
either the pt or by elapsed time
49
anxious pt on Assist Control
can cause breath stacking/auto-PEEP
50
what ventilator setting can cause auto-PEEP
Assit COntrol
51
good ventilator setting for ARDS
AC
52
ventilator setting where the ventilator supports every breath even if pt initiates in order to deliver the full Vt
AC
53
SIMV
synchronized intermittent mandatory ventilation
54
how does SIMV work
if pt fails to take a rbeath, the ventilator will provide a breath spontaneous breathing by pt in-between assisted breaths at preset intervals
55
ventilator setting where it can sense pt taking a breath and either support it while also allowing pt to take spontaneous breaths in-between preset interval
SIMV
56
best ventilator setting for intact respiratory drive
SIMV
57
candidate for SIMV
someone with an intact ventilation drive | *able to take their own breaths in-between preset intervals
58
how does Pressure Support Ventilation (PSV) work
pressure support makes it easier to overcome the resistance of the ET tube and is often used during weaning b/c it reduces WOB *supports or provides pressure during inspiration to decrease pt's overall WBO
59
what does pt determine in PSV
pressure support ventilation | *tidal volume and rate
60
PSV
pressure support ventilation
61
ventilator setting that provides pressure during inspiration to decrease pt overall work of breathing
PSV = pressure support ventilation
62
what does pt need to be able to do in order to use PSV
consistent ventilatory effort by pt | pt determines Vt, rate (minute volume)
63
what does BiPAP mean
BiPAP refers to a specific manufacturer, not a vent setting
64
pressure alarm if pt is hypovolemic and on ventilator
low pressure
65
pressure alarm if ARDS
high pressure
66
pt and ventilator are fighting
pt-ventilator dyssynchrony
67
problem patient-ventilator dyssynchrony
PROBLEM: inadequate sedation or pain control | b/c increased oxygen demand & WOB. increased HR/BP/ICP
68
curare cleft
waveform sign of patient-ventilator dyssynchrony
69
interventions for patient-ventilator dyssynchrony
``` manage auto-peep adjust rate to pt demand, adjust sensitivity Y minute volume suction analgesia & sedation ```
70
what settings does teh algorithm have you look at if sudden acute respiratory deterioration while on a m. ventilator
``` PIP (decreased/increased/no change) plateau pressure (no change or increqased) ```
71
troubleshooting the ventilator | acute respiratory deterioration and the PIP is decreased
air leak hypoventilation hyperventilation
72
troubleshooting the ventilator | acute respiratory deteroration w/o PIP changes
consider PE
73
troubleshooting the ventilator | acute respiratory deterioation with increased pPLAT -6
``` abd distension atelectasis pneumo p. edema atelectasis pleural efflusion ```
74
troubleshoot the ventilator | acute respiratory deterioration with no change in pPlat
airway obstruction, bronchospasm, ET tube cuff herniation
75
tool used to monitor m. vented pt for over/undersedation
``` RASS = Richmond Agitation-Sedation Scale +4 = combative 0= alert and calm -4= deeply sedated ```
76
decreased V/Q
ventilation is not keeping up with perfusion | *resp fail/pneumonia/ARDS, low PaO2, high PaCO2
77
formula for V/Q
alveolar ventilation/CO | = ~.08
78
low V/Q normal V/Q high V/Q
normal V/Q = ~0.8. alveoli are ventilated and perfused low V/Q = shunted. alveoli are perfused but not ventilated high V/Q= deadspace. alveoli are ventilated but not perfused
79
example of low V/Q
shunt perfusion = alveoli are perfused by not vented | ET in mainstem bronchus
80
example of high V/Q
deadspace | alveoli are ventilated but not perfused
81
shark fin ETCO2
asthma
82
asthma as reflected on ETCO2
shark fin
83
I:E setting on ventilator if asthma attak
increase to 1:4 b/c exhalation problem
84
PEEP if on a ventilator & asthma attack
zero to under 5 PEEP
85
rx for asthma attack
``` bronchoD steroid epii magnesium ketamine if sedated ```
86
CXR if COPD
flatted diaphragm. chest cavity is expanded from air trappign
87
problem if COPD
problem is breathing out | respiratory acidosis b/c hypercalrbic respriatory failure
88
benefit of increased I:E ratio
more expiratory time increases CO2 clearance but it does carry a risk of atelectasis (increased I only is uncommon but it may be used to increase oxygen at a cost of CO2 clearence)
89
pleural efflusion
fluid in the pleural space | gravitates to the most dependent space
90
CXR of pneumonia
patchy infiltrates | lobular consolidation
91
what happens = hypoxemia & p. HTNin ARDS
diffuse alveolar injury * increased permeability of the alveolar-capillary barrier * influx of fluid into the alveoliar space
92
CXR of ARDS
ground glass appearence patchy infiltrates bilateral diffuse infiltrates
93
ground glass appearence on CXR
ARDS
94
Swan-Ganz findings in ARDS
high PAWP (18-20) b/c the right heart is pumping against incresed resistance in the lung vasculature
95
ARDS treatment
focus on oxygenation -increase PEEP & FiO2 -lower tidal volume (4) increase rate (F)
96
calculate male predicted body wt
50 + 2.3(height in inches - 60)
97
calculate female predicted body wt
45.5 + 2.3(heigh in inches -60)
98
oxygenation goal for ARDS
minimam PEEP of 5. incremental FiO2/PEEP combos to achieve goal fo PaO2 55-80 & SpO2 88-95%
99
pPlat goal if ARDS
under 30 check pPlat q4hrs or after each change in PEEP/Vt *pPlat over 30 = decrease Vt by 1ml/steps *pPlat under 25 and Vt under 6ml/kg = increase Vt by 1ml/kg until pPlat is over 25 or Vt 6ml/kg *pPlat under 30 and breath stacking, incrae Vt in 1ml/kg increaments to 7 or 8

Critical Care 1 (12 decks)

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