PNRC07

Question 1

Two main complications of INO

Answer 1

Methemoglobinemia and Nitrogen Dioxide NO2

Question 2

What can you do if the complications arise from INO?

Answer 2

decrease the Nitric

Question 3

What are the levels that we are concerned with when it comes to MetHb and NO2

Answer 3

Need to wean if:
>5% methemoglobin
>5 ppm

Question 4

Indications for weaning INO

Answer 4

hemodynamically stable on FIO2 <40% with Peep of 5 or less.

Question 5

A pt that has ventilation problems can benefit from what

Answer 5

HELIOX

Question 6

A pt that is having issues with oxygenation would benefit from what?

Answer 6

Nitric

Question 7

Nitric Oxide enhances what vessels?

Answer 7

It will selectively produce pulm dilation.

**It will only dilate the blood vessels adjacent to functioning alveoli…NOT alveoli that is collapsed/fluid filled

Question 8

Hyperoxygenating a pt who is ready to wean from INO

Answer 8

Set FiO2 to .6 to .7 OR 20% above before DCing the INO.

***This is done AFTER the INO has been reduced to lowest possible dose.

Question 9

The FDA has approved INO tx for what ppl

Answer 9

Respiratory failure associated with pulmonary HTN and >34 weeks

Question 10

OI formula

Answer 10

(Mean Airway Pressure x O2%) / PaO2

Question 11

Why does INO work well with HFOV

Answer 11

Improves the response to INO by decreasing shunting

Question 12

What likely causes methemoglobinemia vs Nitrogen Dioxide

Answer 12

Met Hb caused from high INO doses

NO2 caused from high PPMs and high FiO2

Question 13

How to wean down INO

Answer 13

Reduce the INO to the lowest effective dose in increments of 50%. (10 to 5 to 2.5 ect)

Question 14

What is the best attribute of Helium?

Answer 14

It has an extremely low density allowing it to decrease WOB, which is why it aids in ventilation NOT oxygenation.

Question 15

Main indications for Heliox treatment

Answer 15

Upper airway obstruction (Foreign body aspiration) and Status asthmaticus.

Question 16

How does heliox work?

Answer 16

It decreases Raw by creating more laminar flow and removes a much larger amount of CO2.
***DOES NOT treat the problem, only acts as a band-aid, this is called a temporizing agent

Question 17

How do you deliver heliox if pt is not on ventilator?

Answer 17

non-rebreathing mask

**HAVE TO KEEP valves closed on the mask

Question 18

Available ratios for heliox delivery

Answer 18

80/20 and 70/30

Question 19

What patients receive 70/30 heliox?

Answer 19

Patients that are already on oxygen or pt that isnt on oxygen with an ABG showing hypoxia
**Think about it, 70/30 has more O2 in it than 80/20

Question 20

Why do you need a special flow meter/regulator?

Answer 20

Because the flow meter will read a very false LOW

**Need to use conversions to calculate actual flow

Question 21

How to calculate actual flow with Heliox delivery

Answer 21

80/20 mixture? Multiply flow by 1.8

70/30? multiply by 1.6

Question 22

Some vents may cause what with some vents

Answer 22

erroneous flows and volumes

Question 23

As someone goes up in altitude, what will you need to change to maintain the same PaO2

Answer 23

you need to increase the % of O2 (FiO2)

Question 24

Temperature vs altitude

Answer 24

Almost always has to do with hypothermia, and fix this by blankets and warming all IV fluids

Question 25

Positioning of patient on flight transport

Answer 25

parallel with the wings to decrease acceleration forces

Question 26

do you place someone with the good lung up or down?

Answer 26

Good lung DOWN | *This helps match the ventilation with perfusion

Question 27

OI of >30

Answer 27

Needs HFOV

Question 28

OI >25

Answer 28

Needs INO

Question 29

OI >40

Answer 29

ECMO

Question 30

Mortality rates associated with OI values

Answer 30

>25 is 50% mortality | >40 is 80%

Question 31

How to calculate P/F ratio

Answer 31

PaO2/FiO2

Question 32

PF ratio values and indications

Answer 32

200-300= ACUTE lung injury 100 to 200 moderate ARDS <100 is severe and NEEDS ECMO

Question 33

Two types of high frequency ventilators

Answer 33

Jet and Oscillatory

Question 34

Similar characteristics between Jet and Oscillatory

Answer 34

Breaths delivered at 150+ rates Very non-compliant vent circuits (very stiff) TV that are small 1-3ml/kg

Question 35

Primary goal of HFV

Answer 35

to minimize negative consequences of ventilatory support through lung protective strategies

Question 36

Requires a special ETT adapter and requires a ventilator

Answer 36

HFJV

Question 37

Range is 4-11Hz

Answer 37

HFJV

Question 38

Has PASSIVE exhalation

Answer 38

HFJV

Question 39

What verifies adequate amplitude in HFOV?

Answer 39

waves that produce a vibration aka "wiggle"

Question 40

Hz for HFOV

Answer 40

3-15Hz

Question 41

1Hz = ?

Answer 41

60 breaths per minute or one cycle per second

Question 42

How is the breath generated in HFJV?

Answer 42

delivered by a high-pressure pulse of gas

Question 43

Active exhalation

Answer 43

This is a characteristic of HFOV. The machine, during exhalation, actively "pulls" the gas out of the lungs

Question 44

Three main things that the HFJV

Answer 44

Creates sigh breath via CMV to prevent atelectasis and produce surfactant PEEP Cont. flow to allow for jet propelled breaths

Question 45

**How do you decrease the amount of CO2 on the oscillator?

Answer 45

You want to DECREASE the frequency (Hz) because it will increase the minute ventilation

Question 46

**On the oscillator how does changing the amplitude effect CO2 ventilation?

Answer 46

Increase the amp/power will remove CO2, decreasing the PaCO2

Question 47

If you need to increase elimination of CO2 on the oscillator what would you adjust first, second?

Answer 47

First change the AMP then the frequency (Hz)

Question 48

On the oscillator, what are the two settings you can change to effect oxygenation?

Answer 48

MAP and FiO2

Question 49

How do you know if you have enough 'wiggle'

Answer 49

wiggle needs to be below the nipple line. If it isn't, you need to increase the AMP via the power **Want it past the nipple line or even down to groin/feet

Question 50

Difference in weaning from HFOV and HFJV

Answer 50

If on HFJV, reason for being placed on the jet is resolved. For HFOV, you want FiO2 <60 and MAP <20