Test 8 Notes

Question 1

What happens when you place a patient on a ventilator

Answer 1

we reverse the normal pressure changes in the chest

• Normal insp causes negative pressure in chest, this expands blood vessels and heart aiding in blood delivery to the heart
• PPV will put pressure on the blood vessels and heart impeding blood delivery to the heart and lung

Question 2

Minimize effects Positive Pressure ventilation

Answer 2

Primary way to diminish effects of PPV on pulmonary and cardiovascular system is to keep mean airway pressure at its lowest

Question 3

Cardiovascular - Most likely to affect cardiac patients and patient without lung disease

Answer 3

Decreased compliance (stiff lungs) and airway disease pressure not transferred to heart

Question 4

PPV in chest of pt with CHF may improve

Answer 4

cardiac function

• pushes blood out of heart and vessels so makes it easier for the muscle to pump the blood
• PEEP is commonly used to treat left heart failure

Question 5

Cardiac monitorings

Answer 5

ECG, a common cause of dysrhythmias is hypoxia

• Arterial blood pressure monitoring
• Continuous monitoring via arterialcatheter (Art-line)
• Oxygen delivery is dependenton a good BP and CO

Question 6

Hemodynamics Direct measurements

Answer 6

Pulmonary Artery Catheter (Swan-Ganz)
Central Venous Pressure (CVP)0-8 mmHg
Right Atrial Pressure (RAP) 0-8 mmHg
Pulmonary Artery Pressure (PAP) 15-30/4-12 mmHg
Mean Pulmonary Artery Pressure (PAP) 9-18 mmHg
Pulmonary Capillary Wedge Pressure (PCWP) 4-12 mmHg
Cardiac Output (CO) 4-8 L/mi

Question 7

Barotrauma vs. Volutrauma

Answer 7

Caused by overdistention
-Barotrauma caused from too much pressure in lungs.
Volutrauma caused from too much volume in lungs, regardless of pressure
controversy over pressure vs volume, usually both pres

Question 8

Overdistention of lungs can cause

Answer 8

Alveolar capillary level damage
From:
Stiff lungs
ETT in rt mainstem bronchi
Too much volume in lungs
Vt too high
Auto PEEP

Question 9

pressure ventilation can cause

Answer 9

lung damage to tissue leading to ALI and ARDS causes of overdistention

Question 10

Avoid VILI monitor

Answer 10

Peak Pressures and set alarms appropriately
Plateau pressures
Auto-PEEP
CX

Question 11

Prevention of VILI

Answer 11

small Vt
decrease Vt when raising PEEP
keep plateau below 30 mcH2O
keep peak pressure below 35 cmH2O
avoid mainstem intubation
don’t use pause pressure with volume ventilation
monitor and treat autoPEEP
use PEEP for optimal lung recruitment 
permissive hypercapnia

Question 12

Other causes of auto PEEP

Answer 12

high minute ventilation>10
High RR
I;E

Question 13

how to find auto PEEP

Answer 13

EASIEST WAY: FLOW TIME CURVE
-exp flow not returning to baseline
Increased resonance on percussion
Decreased BS
Expiratory Hold

Question 14

How to get rid of auto PEEP

Answer 14

increase E time
-faster flows, smaller Vt
Lower rate
Large ETT
or allow permisive hypercapnia

Question 15

Inverse I:E ratios cause

Answer 15

autoPEEP and improves O2

Question 16

O2 toxicity leads to

Answer 16

ALI/ARDS

Question 17

In pneumothorax mediastinum moves

Answer 17

towards affected side, tension moves away

Question 18

Pneumothorax

Answer 18

air enters pleural space

• increased pressure in pleural space crushes the heart and great vessels causing cardiovascular collapse and death
• treat all with chest tube unless very small and no problem

Question 19

Signs of pneumothorax

Answer 19

subcutaneous emphysema

Question 20

Subcutaneous emphysema

Answer 20

air leaks out of lungs and into soft tissue

which is a sign of pneumo, always get CXR

Question 21

signs of tension pneumo

Answer 21

-Increased Peak Pressures
-Increased WOB
-Absent BS on affected side
-Mediastinal shift away
-Increase in HR and decrease Spo2
-Loss of BP/CO
CHEST XRAY IS BEST DX

Question 22

Emergent tx for tension pneumo

Answer 22

14 guage needle

• anterior 2nd and 3rd on affected side, midclavicular space
• pt head up position

Question 23

papillary response

Answer 23

pinpoint, drug overdose
dilated and fixed, atropine
mid-position and fixed, severe cerebral damage

Question 24

gag reflex used to

Answer 24

used to test cranial nerve function but also to assure airway protection post extubation.
-Place a tongue depressor in back of throat and there should be a response of those muscle

Question 25

what controls breathing

Answer 25

brainstem, there would be no breathing if this is affected

Question 26

Cheyenne stokes breathing

Answer 26

increase in ICP, CHF, Hyoxia

Question 27

ICP

Answer 27

amount of pressure in brain - increased pressures cause decreased perfusion in brain - goal to keep lowest pressures possible in chest keeps blood from entering the chest causing a back up of blood in the skull leading to increased ICP

Question 28

What will decrease ICP

Answer 28

hyperventilation- CO2 is a cerebral vasodilator | -Keep CO2 28-32 on closed head injury 24-36 hours

Question 29

ICP Monitoring

Answer 29

normal mean ICP is 10-15 in a supine position 15-20 compress the capillary bed and compromise circulation 30-35 venous drainage is impeded and edema develop 40-50 perfusion cannot be maintained

Question 30

Cerebral perfusion pressure (CPP)

Answer 30

blood floww through brain, maintain above 70

Question 31

CPP=

Answer 31

MAP-ICP | wanna maintain above 70

Question 32

Glasgo Coma Scale

Answer 32

Scale 3-15 9-13 need ICU 8 or less need an ICP

Question 33

Endocrine effects

Answer 33

increase in anti-diuretic hormone(ADH) causes lower urine output several other hormone changes that may lead to lower urine output

Question 34

ABG with RENAL FUNCTIONS

Answer 34

(Kidney, Endocrine, ABG) | lower PaO2 and higher PaCO2 lead to lower urine out

Question 35

Normal urine output

Answer 35

is 1ml/kg/hr or about 30-70 ml/hr | -poor urine output leads to pulmonary edema from too much fluid in the body and acid base problems, usually acidosis

Question 36

PPV and liver functions

Answer 36

PPV can lead to venous distention with ischemia to the liver | increased bilirubim

Question 37

Gastric effects with PPV

Answer 37

PPV can lead to GI bleed and ulcers acid reflux can lead to pneumonia pt needs to be on antacids and histamine H2 blockers (Pepcid)

Question 38

Nutrition and PPV

Answer 38

Nutrition not enough calories to breath too many carbs lead to increase CO2, makes weaning difficult for COPD Oral feedings best

Question 39

Lung protective Strategies

Answer 39

keep peak pressures <35 Keep Plateau pressures <30 Vt 6 ml/kg may need to increase RR to compensate Permissive hypercapnia

Question 40

Lung recruitment maneuver

Answer 40

``` Sustained high-pressure inflation Intermittent sigh Extended sigh Intermittent PEEP increase Pressure control + PEEP ```

Question 41

VAP causes within

Answer 41

48-72 hours, usually bacterial

Question 42

Causes of VAP

Answer 42

``` Aspiration of oral secretion Aspiration of gastric contents Inadvertent instillation of an infectious agent down the artificial airway Inhalation of infectious aerosol ```

Question 43

Risks of VAP

Answer 43

``` nasal intubation Reintubation Low endotracheal tube cuff pressures Supine position Enteral feeding Hyperglycemia Blood transfusion Inadequate staff ```

Question 44

CVP Catheters

Answer 44

Filling pressure or preload of rt atrium | -most useful in pts with volume-depleted state

Question 45

PA catheter

Answer 45

Estimate SVR and PVR | -Assess pulm hypertension

Question 46

adding a plt will

Answer 46

Increase the MAP add to the I time Improve O2

Question 47

Does rate affect Pressures and volumes

Answer 47

NO