Vent

Question 1

SIMV (Abbrev)

Answer 1

Syncronised Intermittant Mandatory Ventilation

Question 2

BIPAP

Answer 2

(Biphasic Positive Airway Pressure)
Positive airway pressure at end expiration to open alveoli and improve oxygenation
Monitor for Hypercapnia

Question 3

Tidal Volume (VT)

Answer 3

Volume of air when inhaling or exhaled
Normal: 5-8-12mls/kg
Aim low for sicker lungs (increase peep)

Question 4

PEEP (Positive End Expiratory Pressure)

Answer 4

Pressure that remains in the aveoli after expiration
intrinsic PEEP = 3 (5-6cmH2- PEEP on ventilator)
Sicker lungs you want to increase the PEEP
- opens aveoli
- increases surface area, O2 and spo2
- Forces fluid back into capillaries

Question 5

Fi02

Answer 5

Concerntration of oxygen
Aim 94-99% to reduce oxygen toxicity

Question 6

I:E Ratio (TI)

Answer 6

Inspired time compared to expired time (1:2)
COPD may require prolonged I:E or as a comfort measure

Question 7

Alarm PIP

Answer 7

Indicates: aveolar distension, increased resistance

Increased pressure at larged part of breath
Yellow will alarm when PIP above 30cmH20
Solve: kinks or water, fighting vent

Question 8

Alarm: Plateau Pressure

Answer 8

Measured by ‘inspiratory hold’, reducing flow to zero causing airway and alveolar pressure to equalise

Should be 5cmH20 difference between PIP and Plateau

If PIP and Plateau are raised - compliance issue (reduce TV or PEEP

Question 9

RASS (Acronym, What to say, what is it?)

Answer 9

Richmond Agitation Sedation Scale (30minly, 5minly until -4)
“Say patients name, say to open your eyes and look at speaker”

+4 Combative, Violent to Staff
+3 Pulls or removed tubes
+2 Frequent nonpurposeful movements - fights vent
+1 Anxious, apprehensive
0 Alert and Calm
-1 Awakens to voice
+2 Light Sedation, briefly awaken to voice
+3 moderate sedation, movement or eyeopening
+4 deep sedation, no response to voice, but movement or eye opening to physical stimulation
+5 Unrousable, no response to voice or physical stimulation

Question 10

Fentanyl (Start Rate, Titration range, bolus dose)

Answer 10

Start Rate: 1mcg/kg/hr
Titration Range: 0-200mcg/hr - titrate up increments of 20-30mch/hr
Bolus Dose: 25-50mcg

Question 11

Morphine (Start Rate, Titration range, bolus dose)

Answer 11

Starting Rate: 5mg/hr
Titration range: 0-30mg/hr increments of 2-5mg/hr
Bolus: 1-2mg SBP OVER 100

Question 12

Midazolam (Start Rate, Titration range, bolus dose)

Answer 12

Starting Rate: 5mg/hr
Titrate range: 0-20mg/hr - increments of 1-5mg/hr
Bolus Dose: 0.5-2mg

Question 13

Propofol (Start Rate, Titration range, bolus dose)

Answer 13

Starting Range: 1mg/kg/hr
Titrate Range: 0-100/200mg/hr increments of 20-40mg/hr
Bolus Dose: 20mg SBP Over 100

Question 14

SIMV (What is it? / What does it do?)

Answer 14

Delivers mandatory breathes to a set volume and RR
(also allows patient to breathe spont if needed)

Question 15

SIMV (First 3 Steps in setting up the vent)

Answer 15

1. Make sure you are in SIMV
2. Gender
3. Height inputed

700ml VT
5 PEEP
100% 02
RR Set 12

Question 16

Alarm Limit (RR / fTotal)

Answer 16

Change rate in Control Settings
14-12-5
If you see more in fTotal (pt taking spont breaths)
If RR starts to increase ?indication of pt waking up

Question 16

VTE/mls (Alarm ml/hr)

Answer 16

699 - should be close to your Vt Aim (700)
1050(12ml/kg)
700(8ml/kg)
350(4mg/kg)
(default calculated with body weight inputted)

Question 16

ExpMinVol

Answer 16

The Amount of air passed in and out of the patients lungs in L/1 min
Vt + RR will cause this to change
Just an alarm to alert you that there has been changed
9 - 8.4 - 7.5

Question 16

Peak Inspiratory Peak alarm (PPeakcmH20)

Answer 16

> 30cmH20 (if higher TROUBLESHOOT)
Defaults to 40 as a buffer that it wont shut off. - 5