Ventilation + RSI 🤿 Flashcards
(21 cards)
What is Rapid Sequence Intubation (RSI)
Administration, after preoxygenation and patient optimization of a potent induction agent followed immediately by rapidly acting Neuro Muscular Blocking Agent to induce unconsciousness and motor paralysis for tracheal intubation
What is the difference of RSI and intubation in trauma
If your patient is apneic and unresponsive, then you’re out of time, and this is a crash intubation scenario where RSI is not indicated. Maintain
oxygenation by all means necessary until a definitive airway is secured.
What are the sequence of RSI?
Component of RSI ( 1.Preparation)
Component of RSI ( 2.Preoxygenation)
Component of RSI ( 3. Pretreatment)
Component of RSI ( 4. Paralysis with induction)
Component of RSI ( 5. Positioning and protection of spine)
Component of RSI ( 6. Placement with proof)
Component of RSI ( 7.Post intubation care)
Overview of RSI steps
What is the objectives of Mechanical Ventilation
What are the goals of mechanical ventilation?
What is PEEP?
Overview of Oxygen Therapy
Summary of Oxygen delivery
Oxygen support involves various methods to deliver oxygen to patients with respiratory difficulties to improve oxygenation and tissue perfusion. The level and type of support vary based on the severity of the patient’s condition. Here’s a summary of the main types of oxygen support:
1. Low-Flow Oxygen Therapy
Nasal Cannula:
Delivers low concentrations of oxygen (1-6 L/min) via prongs in the nostrils.
Provides an oxygen concentration (FiO₂) of 24-40%.
Commonly used for patients with mild hypoxemia and those needing minimal oxygen support.
Simple Face Mask:
Delivers oxygen at 5-10 L/min, with an FiO₂ of approximately 35-50%.
Suitable for patients who require a moderate increase in oxygen but may be uncomfortable for extended use.
2. Reservoir Systems
Non-Rebreather Mask (NRB):
Delivers high concentrations of oxygen (up to 15 L/min) with an FiO₂ of 60-90%.
Equipped with a reservoir bag and one-way valves to prevent rebreathing of exhaled air.
Used for patients with severe hypoxemia needing a higher FiO₂.
Partial Rebreather Mask:
Similar to an NRB but lacks one-way valves, allowing partial rebreathing.
Delivers an FiO₂ of around 50-70% at 8-12 L/min.
3. High-Flow Oxygen Therapy
High-Flow Nasal Cannula (HFNC):
Delivers a high flow of humidified oxygen (up to 60 L/min) with adjustable FiO₂ (21-100%).
Provides positive airway pressure, helping to reduce work of breathing and improve oxygenation.
Useful for patients with moderate to severe respiratory failure or those needing high oxygen concentrations with better comfort.
4. Non-Invasive Positive Pressure Ventilation (NIPPV)
CPAP (Continuous Positive Airway Pressure):
Delivers continuous pressure to keep airways open, providing oxygen (typically 30-60% FiO₂).
Commonly used for obstructive sleep apnea, COPD, and mild respiratory distress.
BiPAP (Bilevel Positive Airway Pressure):
Provides two pressure levels: higher during inhalation (IPAP) and lower during exhalation (EPAP).
Used for patients with moderate to severe respiratory distress, hypercapnia, or neuromuscular disorders.
Allows for better support in exhaling, reducing the work of breathing.
5. Invasive Mechanical Ventilation
Used when non-invasive options are insufficient to support breathing.
A ventilator delivers oxygen directly through an endotracheal tube (ETT) or tracheostomy.
Provides full respiratory support with adjustable FiO₂ (up to 100%) and pressure/volume settings tailored to the patient’s needs.
Indicated for patients with severe respiratory failure, apnea, or when other methods cannot maintain adequate oxygenation and ventilation.
6. Extracorporeal Membrane Oxygenation (ECMO)
A highly specialized form of life support for patients with severe cardiac or respiratory failure.
Blood is oxygenated outside the body through a machine and returned, bypassing the lungs and/or heart.
Reserved for critically ill patients as a last resort, often in intensive care settings.
summary of ventilator settings
Ventilator settings are crucial for providing effective mechanical ventilation and are adjusted based on the patient’s respiratory needs, lung mechanics, and goals for oxygenation and ventilation. Here’s a brief overview of the main ventilator settings:
1. Modes of Ventilation
Volume-Controlled Ventilation (VCV): Delivers a set tidal volume (Vt) regardless of the pressure required. Commonly used to ensure a consistent volume is delivered to the lungs.
Pressure-Controlled Ventilation (PCV):Delivers breaths at a set pressure, with the tidal volume varying based on lung compliance and resistance. Often used in patients with poor lung compliance, such as in ARDS.
Assist-Control (A/C): Delivers a set number of breaths but allows the patient to initiate additional breaths, each reaching the set volume or pressure.
Synchronized Intermittent Mandatory Ventilation (SIMV): Delivers a set number of mandatory breaths, but spontaneous breaths are unassisted. Often used for weaning.
Pressure Support Ventilation (PSV): Used to support spontaneous breaths by delivering a set pressure, often in patients who are partially breathing on their own.
2. Tidal Volume (Vt)
Definition: The volume of air delivered with each breath.
Typical Setting: 6-8 mL/kg of ideal body weight to prevent lung injury.
Consideration: Lower tidal volumes (4-6 mL/kg) are often used in ARDS to reduce the risk of barotrauma and ventilator-induced lung injury.
3. Respiratory Rate (RR)
Definition: The number of breaths delivered per minute.
Typical Setting: 12-20 breaths per minute, adjusted based on blood gas targets.
Consideration: Higher rates are used to manage hypercapnia, while lower rates are used to avoid breath stacking or over-ventilation.
4. Fraction of Inspired Oxygen (FiO₂)
Definition: The percentage of oxygen in the air mixture delivered to the patient.
Typical Setting: Initially set to 100% in emergencies, then titrated to maintain oxygen saturation (SpO₂) >90% or PaO₂ of 60-80 mmHg.
Consideration: Prolonged high FiO₂ (>60%) can lead to oxygen toxicity, so it’s reduced as soon as feasible.
5. Positive End-Expiratory Pressure (PEEP)
Definition: The pressure applied at the end of expiration to keep alveoli open.
Typical Setting: 5 cm H₂O is a common starting point; increased in cases like ARDS to improve oxygenation.
Consideration: PEEP improves oxygenation and prevents atelectasis but can reduce venous return and lead to barotrauma if too high.
6. Peak Inspiratory Pressure (PIP)
Definition: The maximum pressure reached during inspiration.
Typical Goal: Should generally be kept below 30 cm H₂O to avoid lung injury.
Consideration: High PIP may indicate airway resistance or reduced lung compliance; adjustments in tidal volume, PEEP, or mode may be needed.
7. Inspiratory Time and I
Ratio
Inspiratory Time (Ti): Duration of each inspiration.
I
Ratio: Ratio of inspiration to expiration, usually set at 1:2 but adjusted based on the patient’s condition.
Consideration: Inverse I
ratios (e.g., 2:1) may improve oxygenation in severe cases like ARDS, while prolonged expiration is used in obstructive diseases like COPD.
What are the main setting for ventilator
What are the complex ventilator setting
How to classify the ventilator setting based on patient’s need
🛠️ VC = Volume-Controlled
Full name: Volume-Controlled Ventilation
What it means:
The ventilator delivers a preset tidal volume (amount of air).
The pressure will vary depending on the patient’s lung compliance/resistance.
Goal: Guarantee a certain amount of air with each breath.
Example Mode: AC-VC (Assist-Control Volume Control)
🟢 Good for: Making sure the lungs always get enough air
🔴 Downside: Risk of high pressures if lungs are stiff (e.g., ARDS)
🛠️ PC = Pressure-Controlled
Full name: Pressure-Controlled Ventilation
What it means:
The ventilator delivers air up to a set pressure.
The volume delivered varies depending on lung compliance.
Goal: Prevent lung injury by limiting pressure.
Example Mode: AC-PC (Assist-Control Pressure Control)
🟢 Good for: Fragile lungs, preventing barotrauma
🔴 Downside: Volume may drop if lungs become stiff
Pulse Oximetry
Pulse oximetry measures how much oxygen your blood is carrying.
How it works:
1. Light emitter shines two types of light into your skin:
* ➔ Red light (around 660 nm wavelength)
* ➔ Infrared light (around 940 nm wavelength)
2. Oxygenated hemoglobin (HbO₂) and deoxygenated hemoglobin (Hb) absorb light differently:
* ➔ Oxygenated blood absorbs more infrared, less red.
* ➔ Deoxygenated blood absorbs more red, less infrared.
3. A detector on the other side of your skin (usually finger, ear, toe) measures how much light passes through.
4. The device calculates the ratio of red and infrared light absorbed.
5. It then estimates your oxygen saturation (SpO₂) — shown as a percentage.
