Vent material Flashcards
(172 cards)
1
Q
A
restriction
2
Q
A
airway obstruction
3
Q
A
fixed obstruction
4
Q
A
variable intra thoracic obstruction
5
Q
A
early airflow obstruction
6
Q
A
variable extra thoracic obstruction
7
Q
A
normal flow volume loop
8
Q
spirogram
A
9
Q
wright respirometer
A
10
Q
3 types of dead space
A
11
Q
what is I TIME
A
amount of time spent in inspiration
12
Q
what is E time
A
amount of time spent in expiration
13
Q
what is volume
A
the amount of tidal volume a patient recieves
14
Q
what is pressure
A
measure of impedence to gas flow rate
15
Q
what is flow
A
measure of rate at which gas is delivered
16
Q
what is the ideal amount of tidal volume
A
6-8ml/kg of ideal body weight
17
Q
when do you give lower TVs
A
ARDS or COPD or ASTHMA
18
Q
what is PIP
A
peak inspiratory pressure
the highest level of pressure aplied to lungs in cm H2O
19
Q
what is PIP limit
A
40 cmH2O
20
Q
when can PIP be higher
A
ARDS
21
Q
what should PIP be in masked or LMA patient
A
20 cmH2O
bc lower esophageal sphincter opens at >20cmH20
22
Q
what triggers a ventilator to cycle inspiration
A
time
pressure
volume
flow
23
Q
what is a normal peep level
A
5-8 cm h2o
24
Q
what conditions require higher peep of 8-12 or 20 cm H2O
A
ARDS
25
what happens if PEEP exceeds 20 cm H20
severe lung damage
barotrauma
subq emphysema
pneumo
26
slope is a measure of
time
27
slope is how long it takes to reach a set
pressure
28
what is range of slope
0-2 seconds
29
a higher number slope is a more (gradual/steep) slope
gradual
30
what mode is slope important in
pressure support
31
if slope is longer than inspiratory time what is comprimised
TV
32
what is PIP- PEEP
delta P
33
pressure control is
preset
delivered Vt changes according to lung compliance
when the patient is spontaneously breathing, as the PIP is fixed, reduces pt discomfort
34
volume control is
volume is preset
delivered PIP varies based on pulm compliance and airway resistance
pt spontaneously breathing, PIP is variable, it will deliver a breath during asynchrony leading to increased work of breathing and discomfort
35
pressure vs volume waveforms
36
which vent mode provides guaranteed MV and is more comfortable for patients
volume control
37
which vent mode is not optimal for poorly compliant lungs
volume
38
which vent mode provides more support at lower PIP for poorly compliant lungs
pressure
39
which vent mode does not have a guaranteed MV
pressure
40
which vent mode do we use right before extubation
pressure support
41
which vent mode is pressure support but with a BACKUP rate
PSV-pro
42
which vent mode has madatory breaths (synchronized) and pressure support for spontaneous breaths
SIMV
43
what flow is diminished in COPD
expiratory
FEV1 is low
44
normal flow volume loop
45
COPD flow-volume loop
46
how does restrictive lung disease affect volume loop
residual volume is low
inspiratory volume (TLC)
FEV1 normal
peak exp flow normal
47
restrictive flow-volume loop
48
flow volume loop comparison
49
what would cause a pattern of expiratory flow-volume curve to be normal, but have a low inspiratory value
upper airway obstruction
50
what causes upper airway obstruction
paralysis of vocal cords
laryngospasms
thuyromegaly
tracheomalacia
51
what complication obstructs both inspiration and expiration
fixed intrathoracic or extrathoracic airway obstuctions
EX. tracheal stenosis, foregn body, neoplasm
52
what is a cause of post of bradypnea
opioid overdose
53
what is a cause of post op tachypnea
pain
54
as TV decreases, dead space____
increases
55
what must be set in VCV mode
TV
RR
I:E ratio
56
PIP is ____ related to lung compliance
inversely
57
what is set in PCV
peak airway pressure
RR
I:E ratio
58
what must be monitored closely in PCV
tidal volume
CO2
59
what is the amount of gas inspired or expired with each normal breath
Tidal Volume (TV)
60
what is the maximum amount of additional air that can be inspired from the end of a normal inspiration
inspiratory reserve volume
61
what is the maximum volume of additional air that can be expired from the end of a normal expiration
expiratory reserve volume
62
what is the volume of air remaining in the lung after a maximal expiration
residual volume
63
what s the only lung volume which cannot be measured with a spirometer
residual volume
64
what is the volume of air contained in the lungs at the end of a maximal inspiration
total lung capacity
65
what is the sum of the 4 basic lung volumes
TLC
IRV+TV+ERV+RV
66
what is the maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration
vital capacity
67
what is the sum of inspiratory reserve volume, tidal volume and expiratory reserve volume
vital capacity
68
what is the formula for VC
IRV+TV+ERV= TLC-RV
69
what are some factors that decrease FRC
obesity
pregnancy
upright position
supine position
anesthetic induction
neuromuscular blockers
surgical displacement
70
what is the reservoir of oxygen that prevents hypoxemia during apnea
functional residual capacity
71
what is the volume of air remaining in the lung at the end of a normal expiration
functional residual capacity
72
what is the residual volume plus the expiratory reserve volume
FRC
73
what is the fomula for FRC
RV + ERV
74
how does GA affect FRC
decreases
75
how does obesity affect FRC
decreases
76
how does pregnancy affect FRC
decreases
77
how is FRC in neonates
decreased
78
how does advanced age affect FRC
increases
79
how does supine position affect FRC
decreased
80
how does lithotomy affect FRC
decreases
81
how does trendelenburg affect FRC
decreases
82
how does prone affect FRC
increases
83
how does sitting affect FRC
increases
84
how does lateral position affect FRC
no change or increases
85
how does paralysis affect FRC
decreases
86
how does inadequate anesthesia affect FRC
decreases
87
how does excessive IV fluids affects FRC
decreases
88
how does high FI02 affect FRC
decreases
89
how does reduced pulmonary compliance affect FRC
decreases
90
how does obstructive lung disease affect FRC
increased
91
how does PEEP affect FRC
increased
92
how do sigh breaths affect FRC
increased
93
what is the maximum volume of air that can be inspired from end expiratory position
inspired capacity
94
what is the sum of tidal volume and inspiratory reserve volume
inspired capacity
95
what is the formula for IC
tidal vol + inspiratory reserve volume
96
which lung zone has no blood flow
zone 1, pathological zone
97
in what lung zone does pulmonary pressure exceed alveolar pressure. blood flow here is pulmonary artery pressure-alveolar pressure
zone 2
98
what lung zone is blood flow proportional to PAP- pulmonary vein pressure
zone 3
99
where should Swan be
zone 3
100
which zone is present in pulmonary edema
zone 4
101
blood flow in zone 4 is PAP- ___________
pulmonary interstitial fluid pressure gradient
102
which lung zone is:
PA(alveolar)>Pa>Pv
zone 1
103
which lung zone is:
Pa>PA>pv
zone 2
104
which lung zone is:
Pa>Pv>PA
zone 3
105
which lung zone is:
Pa>Pi (interstitial pressure)> Pv>PA
zone 4
106
what is normal Va (alveolar ventilation)
4 L/ min
107
what is normal pulmonary capillary perfusion (Q)
5 L/min
108
what is normal V/Q ratio
0.8
109
what is normal V/Q range
0.3-3.0
110
what causes a low V/Q ratio
LUNG PROBLEM
shunt
airway obstruction to area
111
what causes a high V/Q ratio
BLOOD PROBLEM
deadspace
blood flow problem
pulmonary emoboli
112
low v/q
113
high V/Q
114
what is the affect of shunt/low V/Q
hypoxia
115
what is the affect of deadspace high V/Q
hypercapnea
hypoxia
116
shunt
117
dead space
118
in shunt:
PaO2 is __________
PaCO2 is ___________
high
low
119
in pulmonary embolism (dead space):
PAO2 is_________
PACO2 is _________
higher
low
120
mapleson circuits
121
bain circuit
122
at what flow do you not need a CO2 absorber on circuit
>5L
123
where is dead space on a circle cicuit
distal to Y piece
124
what gives lungs their elasticity
collagen and elastin fibers
125
lungs with low compliance require (less/more) pressure to inflate
more
126
what is the elastance formula
127
what is compliance formula
128
what causes resistance in the lungs
tissue resistance and airway resistance
129
what law gives us the formula for resistance
poiseuilles law
130
poiseuilles law pressure formula
131
what does an increased alfa angle suggest
expiratory airway obstruction
-copd, bronchospasm, kinked et tube
132
what can cause increased dead space causing low etco2
pulm embolism
133
what does an increased beta angle suggest
rebreathing due to faulty inspiration valve
soda lime
134
what needs to be monitored when giving neuromuscular blocking agents
neuromuscular function and status
135
what are advantages of side stream sampling
lightweight,
less chance of disconnect,
accurate <40 breaths/min,
no dead space
136
what are disadvantages of side stream monitoring
water/secretions may clog line,
flexible tube easily obstructed,
inaccurate >40 breath so no peds
137
describe side stream sampling
pump in monitor aspirates sample of gas trhough thin/flexible sampling line
138
what monitoring sampling measures gas directly in breathing system
mainstream aka non diverting
139
what are advantages of mainstream sampling aka non diverting
fast, good fidelity, water and secretions not an issue
140
which sampling method can increase etco2
mainstream sampling by increasing dead space
141
what are disadvantages of mainstream sampling aka non diverting
heavy in circuit,
increases dead space,
greater opportunity for disconnect,
gas options limited
142
what is the measurement and numerical display of co2 concentrations during respiratory cycle
capnography
143
what is a graphic record of co2 concntratino on screen or paper
capnography
144
what is the actual waveform genered by capnometer
capnogram
145
what may be detected due to abnormalities in capnography
airway obstruction
146
what is produced by cells of body during metabolism into circulatory system and then is diffused into lungs
CO2
147
what is a better indicator of rosc during resuscitation
exhaled CO2
148
what cardiac changes can etco2 aid in detecting
decreased cardiac output,
pulmonary embolism,
reduced blood flow to lungs
149
what guides ventilator changes and can give a trend of anesthesia depth
CO2
150
what could a sudden increase in co2 represent during code
spontaneous cardiac function/output
151
what is difference between etco2 on monitor and blood
blood is usually 5 higher than monitor
152
What are some complications that can happen that etco2 can help alert to
esophageal intubation,
apnea,
extubation,
disconnection,
ventilator malfunction,
ett partial obstruction,
compliance vs resistance changes,
spontaneous resp w/muscle relaxant use,
poor lma fit,
leaking ett cuff
153
what is phase 1 in capnography (A)
inspiratory baseline- 0- low valley
154
what could be a problem if your co2 isn't reading 0 during phase 1
co2 canister needs to be changed out
155
what is phase 2 in capnography and what letters are in it
initiating exhale- b- c
156
what is phase 3 in capnography and what letters are in it
plateau c-d
no plateau= not reading correctly
157
how is slope of phase 3 increased
kink, ventilation perfusion status,
158
what is phase iv in capnography and what letters are in it
end tidal point down to zero (inhalation)
d-e
159
what is the letter with the highest co2 number on capnography
d- 35-40 torr
160
what could cause no co2 in gas line
obstruction, disconnection, esophageal intubation, no blood circulation to lungs
161
what uses each anesthetic gas's ability to absorb specific frequencies of emr in the infrared spectrum
infrared absorption analysis
162
what anesthesia gas monitoring has advantages of being fast, reliable, low cost, multiagent/multigas
mass spectrometry
163
what anesthesia gas monitoring has disadvantages of warm up time, space, must be scavenged, and measures only preprogrammed gases
mass spectrometry
164
what has a laser that interacts with gas molecule and measures the fraction of energy absorbed at different live wavelengths called scattering
raman spectrometry
165
what anesthesia gas monitoring is less accurate with pediatric cases, since they use high carrier gas flow rates and small tidal volumes
raman spectrometry
166
what are disadvantages of raman spectrometry
costly, less accurate in pediatrics
167
what are advantages of raman spectrometry
no scavenging,
accurate,
fast multi-gas/agent
168
what do you need to do with o2 flow sensor (galvanic cell)
calibrate to room air, degrade in 30 days
169
what does vaporizer output assess
detects incorrect agents
detect vaporizer turned off/empty
provides info on uptake and elim of agent in pt
170
what should baseline be on capnography
zero
171
what can interfere with bis
shivering, electrocautery, forced air warmer, cardiac pacemaker spikes
172
how does electrocautery interupt bis
unipolar cautery overloads bis signal transmission
