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Flashcards in Pulmonary II Deck (41):
1

When HCO3 is low due to loss you will see...

increase in chloride ions

2

All the positive charges in your body and all the negative charges in your body have to..

remain equal

3

Normal Anion gap is...

12

4

Normal Bicarb is....

24

5

Normal pH is...

7.4

6

Normal pCO2 is

40

7

What makes up the majority of the anion gap...

Albumin

8

Albumin of 4 makes up the anion gap of...

12

9

Predicted anion gap should be...

Albumin x 3

10

Acute respiratory acidosis

Bicarb has not had a chance to increase

11

Chronic respiratory acidosis

Bicarb has had a chance to increase

12

Indications for intubation

Airway support (altered mental status, secretions, airway anatomy)
Pulmonary disease (ARDS, pulmonary edema, failed NIV)
Circulatory causes (cardiopulmonary arrest, shock)

13

Two types of positive pressure ventilation

Volume controlled ventilation
Pressure controlled ventilation

14

Trigger of MV

Trigger initiates inspiration
Pressure, flow, or time
Usually Flow

15

Cycle of MV

Cycle terminates inspiration
Pressure, volume, flow or time

16

Limit of MV

Maximum level that can be reached and sustained during inspiration
Can be pressure, volume or flow

17

Ventilator breath phases

Trigger (when to deliver)
Control variables (how to deliver)
Cycle phase (how much to deliver-terminate)
Expiratory phase

18

Conditions that affect compliance

ARDS, Pulmonary edema, pneumothorax, atelectasis

19

Complications of Volume ventilation

Barotrauma
uneven gas distribution
may induce ARDs

20

Pressure ventilation advantages

Improved gas distribution
improved alveolar filling
reduced barotrauma
improved comfort

21

Winter's formula ratios

Metabolic acidosis- 1 bicarb/1CO2
Metabolic alkalosis- 2 bicarb/ 1 pCO2
Acute respiratory acidosis- 1 bicarb/10pCO2
Chronic respiratory acidosis- 1BIcarb/3pCO2
Acute respiratory alkalosis- 1Bicarb/5pCO2
Chronic respiratory alkalosis- 1Bicarb/2pCO2

22

Anion gap metabolic acidoses

Methanol
Uremia
DKA-all sorts of ketones
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol, ethanol
Salicylates

23

Non anion gap metabolic acidosis

Diarrhea
Renal tubular acidosis
Carbonic anhydrase inhibitors- medications

Addisons disease- the only one of the three that causes hyperkalemia

24

Metabolic alkalosis

Vomiting- chloride responsive
Cushings disease- nonchloride responsive

25

Acute respiratory acidosis

COPD exacerbation
Drug overdose

26

Chronic respiratory acidosis

COPD

27

Acute respiratory alkalosis

Asthma exacerbation
hyperventilation anxiety

28

Chronic respiratory alkalosis

Pregnancy

29

High peak pressures with low plateau pressures

Mucus plug
bronchospasm
ET tube blockage
Biting

30

High peak pressures
High plateau pressures

ARDS
Pulmonary edema
Pneumothorax
ET tube migration to a single bronchus
Effusion

31

CMV ventilation

Controlled mandatory ventilation
delivers a preset number of breaths per minute of a predetermined tidal volume
additional breaths cannot be initiated by the patient

32

AC ventilation

Set RR and TV
Every breath is supported by the ventilator
A back up rate is sent and the patient may choose any rate above that rate

33

AC advantages

Controlled ventilation with breath support
Increased ventilatory support on demand
May help critically ill patients who need constant TV or near full support

34

AC disadvantages

Excessive patient work
May be poorly tolerated
May lead to respiratory alkalosis
May worsen air trapping in COPD

35

IMV ventilation

Intermittent mandatory ventilation
Combines a present number of ventilator breaths of a preset tidal volume with the capability of intermittent patient initiated breaths
Spontaneous breaths above the set rate will be whatever TV the patient can generate

36

IMV advantages

Patient can perform a variable amount of work with a preset level of mandatory ventilation

37

IMV disadvantages

Risk of dyssynchrony between patient effort and machine delivered volume

38

SIMV ventilation

Synchronized mandatory intermittent ventilation
Will sense if the patient is trying to initiate a breath and will deliver the mandatory breath in synchrony with the patients effort

39

PSV ventilation

Pressure support ventilation
Amount of positive pressure is pre set, each breath must be initiated by the patient

40

Applications for PSV

used to improve patient tolerance and decreased work in spontaneous breathing
Used as sole ventilatory mode for patients under consideration for weaning or during the stabilization period

41

PSV disadvantages

Tidal volume not controlled: may be poorly tolerated in patients with high airway resistance. requires very careful monitoring in unstable patients