Flashcards in Mid Term Lab Stuff Deck (32):
1
What is IPPB?
Intermittent Positive Pressure Breathing
2
What are the indications of IPPB?
-need to improve lung expansion (only when other devices dont work)
-inability to clear secretions adequately because of pathology that severely limits the ability to ventilate or cough
-short term ventilation
-need to deliver aerosol medications
3
What are contraindications of IPPB?
-Tension pneumothorax
-ICP greater than 15mm Hg
-hemoptysis
-hemodynamic instability
-recent facial/oral/skull surgery
-nausea
-trachoesphageal fistula
-hiccups
-active TB
4
What are the hazards and complications of IPPB?
-increased airway resistance (Raw)
-pneumothorax (barotrauma)
-secretion impaction
-gastric distention
-psychological dependence
-impendence of venous return (cut of blood supply, low BP)
-air trapping, auto-PEEP, over distended alveoli
5
How does IPPB work?
The patient triggers the IPPB machine by inhaling, pressure and flow move into the pts lungs from the device. When the pressure reaches a preset limit the IPPB machine shuts off and the patient can exhale.
6
What is the name of one of the IPPB machines?
Bird Mark 7
7
What are indications for a endotracheal intubation?
-respiratory arrest
-cardiac arrest
-patients where complete obstruction of the airway is imminent (respiratory burns, anaphylaxis)
-inability of the conscious patient to breath adequately
-inability of the unconscious patient to protect their airway (overdose,coma)
8
What are contraindications for endotracheal intubation?
-severe airway trauma or obstruction that does not permit safe passage of an endotracheal tube.
-cervical spine injury, in which the need for complete immobilization of the cervical spine makes endotracheal difficult
-Mallampati Classification of class III/IV or other determination of potential difficult airways
9
Side effects of Endotracheal intubation
-accidental intubation of the esophagus
-oropharyngeal trauma
-broken teeth or dentures
-endobronchial intubation, ETT inserted too far
10
What equipment will you use for endotracheal intubation?
-laryngoscope, curved (Macintosh) or straight (miller) blades, assorted ET tube sizes, 10 cc syringe, water soluble lubricant, securing device, BVM, suction equipment, capnometer, and stethoscope
11
What is the purpose of the capnometer?
It is used to determine if the ET tube is in the lungs or the esophagus. If it is in the lungs, it will turn yellow and if it is in the esophagus it will be purple.
12
Assist Control (AC)
-patient triggered
-flow controlled during inspiration
-time cyled
13
Intermittent mandatory ventilation (IMV)
is a combination of periods of control mode and period of spontaneous breathing
14
Synchronized Intermittent mandatory ventilation (SIMV)
is specific (limited) number of assist control breaths interdispersed with spontaneous breathing
15
Pressure synchronized intermittent mandatory ventilation (P-SIMV)
is a combination of mechanical and spontaneous breaths. The mechanical breaths are time/patient triggered, pressure limited, and time cycled.
16
Pressure control
-time triggered
-pressure controlled during inspiration
-time cycle
17
pressure support
-patient triggered
-pressure controlled
-flow cycled
18
With in-line suctioning, how long should you pre-oxygenate a patient?
for more than 30 seconds
19
How long do you have when you have the suction catheter in place?
10-15 seconds to completely withdraw the catheter.
20
Identify bedside methods of assessing tube placement.
-chest x-ray
-inspection
-capnometer
21
Identify maximum safe cuff pressure.
25-35 cm H2O (20-25 mmHg)
22
identify the amount of water in mg/L that should be provided by the humidification device.
44 mg/L
23
Identify tube and carnia on the chest x-ray and confirm proper distance between the two.
-tube should be about 2 to 3 cm (4-6cm) about the carina in adults or between the 2nd and 4th tracheal rings.
24
Describe 2 purposes or uses of the cuff.
to seal the airways for mechanical ventilation or to prevent or minimize aspiration.
25
Describe the difference between low volume and high volume cuffs. (think about high heel shoe lol)
-increase in volume, decrease in pressure perseveres airway.
-decrease in volume, increase pressure may damage airways
26
Identify proper gas flow rate for manual resuscitator
-FiO2 100% (flush on the flowmeter)
27
Identify appropriate vacuum pressure.
80-120 mmHg not to exceed
28
What are the proper tube size for male and female?
-male: 8.0-8.5
-female: 7.0-7.5
29
Identify proper suction catheter size appropriate for a variety of endotracheal tube size?
-multiply ET tube inner diameter by 2. then use the next smallest size. (7 X 2 =14, so you would take a 12)
30
Identify indication for suctioning
-acute respiratory distress syndrome (ARDS)
-inability to cough
-deterioration of O2 saturation or blood gas values.
-visible secretions
-suspected aspiration
31
Identify potential complications associated with suctioning.
-atelectasis
-hypoxemia
-tissue trauma
-bronchoconstriction/bronchospasm
32