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RTH 132 > PPV > Flashcards

PPV Flashcards

(64 cards)

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1
Q

what is cerebral perfusion pressure

A

CPP = amount of blood perfusing brain

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2
Q

what two values equal CPP

A

mean arterial blood pressure - intercranial pressure = CPP

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3
Q

what does PPV do to ICP

A

increases

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4
Q

what does PPV do to MAP

A

decreases

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5
Q

what is normal cpp

A

88

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6
Q

to treat ptx with CPP what can you do

A

medically induced hyperventilation

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7
Q

when is medically induced hyperventilation good for

A

in emergencys like seizures and coughing

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8
Q

where should you keep MAP at

A

30 cmH2O or less

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9
Q

increased airway pressure increases what 4 things

A

increased MAP, intrapleural pressure, intrapulmonary pressure, intrathoracic pressure

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10
Q

what factors affect MAP

A

mode of ventilation, level of positive pressure, duration of insp & exp, nature of waveforms, level of PEEP, lung/thorax mechanism

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11
Q

VILI

A

ventilatory induced lung injury

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12
Q

VALA

A

ventilator associated lung injury

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13
Q

in normal lungs what amount of pressure is transmitted to the thoracic cavity

A

50%

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14
Q

how much deadspace is increased just bc pt is on a vent

A

40%-60%

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15
Q

what types of traumas can occur in the lungs from PPV

A

barotrauma/volutrauma

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16
Q

how often does barotrauma/volutrauma occur

A

5-15%

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17
Q

what is shearing

A

one portion inflates faster than others

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18
Q

tearing

A

overdistension

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19
Q

where should you keep PIP

A

less than 60

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20
Q

what things can happen as a result of barotrauma

A

pneumothorax, pneumomediastinum, pneumoperitoneum, etc

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21
Q

biotrauma

A

causes excessive stretching of alveolar cells

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22
Q

what does biotrauma cause

A

forms edema, releases inflammatory mediators and chemical mediators

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23
Q

vent factors that increase risk of barotrauma

A

large VT, high peak/mean pressure, high PEEP, long insp times, high FIO2, infections, aspiration

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24
Q

patient factors that increase risk of barotrauma

A

decrease compliance, increase resistance, pre-existing bullous DX, surfactant deficiency, host immunity, ARDS

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25
what does auto peep increase
WOB and pulmonary vascular resistance
26
air trapping has what length of time constant
long length
27
in a pressure volume loop what does a flat top indicate
overdistending lung
28
how do you fix a flat pressure volume loop
decrease pressure or volume
29
T/F pressure in upper airway may not reflect alveoli pressure
t
30
how many ventilator pts develop lung infections
15-40%
31
where should you keep the head of bed
less than 30
32
commonly isolated pathogens - gram negative
pseudomonas, klebsiella, E-coli, influenzae
33
gram positive
staphlyococcus aureus, streptococcus pneumoniae
34
what does high concentrations of oxygen produce
oxygen free radicals
35
what detoxifies radicals
superoxide dismutase
36
what produces superoxide dismutase
type II cells
37
what does oxygen toxicity cause
decrease in: tracheal mucus flow, macrophage, VC, surfactant production, compliance, diffusion capacity, pul cap blood flow, cap injury, endothelial cell damage, absorption atelectasis
38
hemodynamic considerations increase
increased intrathoracic pressure, systemic blood volume
39
hemodynamic considerations decrease
pul blood flow, venous return, right vent stroke volume, pul arterial pressure, filing pressure, left vent stroke volume
40
how much blood do the kidneys recieve
25% of bodys circulating blood
41
what do volume receptors do
found within left atrium, sensing decreased volume,, which then signals increase in ADH, to stop urine output
42
what do baroreceptor stimulation cause
carotid bodies in aortic arch decreases CMO
43
what does low PAO2 effect on kidneys
decrease in urinary flow/function
44
what level of co2 has a big effect on kidneys
65
45
what level of o2 effects kidneys
below 40
46
what does plasma renin activity do
activates cascade to retain sodium and ater
47
where does blood flow redistribute in the kidneys
outer cortex decreases while inner cortex (juxtamedullary region) increases
48
what does blood flow redistribution lead to
more sodium, urine, and creatine being absorbed
49
what indications renal failure
oliguria <180 ml in 8 hours | increase BUN and creatinine
50
what is normal BUN (blood urea nitrogen)
10-20 mg/Dl
51
what is normal creatinine levels
0.7-1.5 mg/dl
52
diet changes bun or creatinine
bun
53
perfusion changes bun or creatinine
creatinine
54
what can decrease portal vein flow to the liver
drop in CMO and diaphragm moving into abdomen
55
indicators of liver dysfunction
prothrombin time >4 seconds bilirubin level >50mg/L albumin level <20g/L
56
what causes mucosal edema
blood being pushed out from the organs
57
in terms of ab considerations what can happen to bowel and stomach
swelling of bowels and stomach and bowel obstruction
58
what can make swelling in abdomen worse
peep
59
how many patients get ulcers caused by what
20% and stress
60
what type of diet can lead to higher co2
high carb diets
61
t/f vent slows wound healing
true
62
t/f copd pts have high caloric needs
true
63
what does induced hyperventilation do to the hemoglobin curve
shifts to the left causing less o2 to tissues and can cause hypoxia
64
how does induced hyperventilation interfere with cerebral tissue metabolism
reducing atp stores and 2,3 DPG levels

RTH 132 (11 decks)

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