Week 3 Flashcards
(34 cards)
what are relative contraindications for NiPPV?
- dec LOC
- Lack of resp drive
- Incr secretions,
- Hemodynmaic instability
- Facial trauma
- Cardiac arrest
- Other risks for aspiration
- Need to intubate - unless using Bipap to pre-oxygenate
For bipap what is a starting pressure?
10/5
IPAP/EPAP
what is the maximum IPAP you should give someone on BLPAP
20 cmH2O - overcomes esophageal sphincter and can cause gastric insufflation
when should abg be done after intubation and what is one of its main uses?
15-20 minutes after intubation to compare ETCO2 with PaCO2
ABG generally correlates well with ETCO2 (PaCO2 may be 5-10 mmHg higher)
Does pH of arterial samples correlate with VBG?
yes unless critically ill in which case vbg is less reliable
Does CO2 in arterial correlate with venous?
Correlation is less reliable. ABG better.
what does PIP (peak inspiratory pressures) represent?
Airway resistance, lung compliance and resistance of the circuit itself
Circuit resistance, airway resistance, Lung compliance.–> this is only in VCV
PIP therefore in VCV is not reflective of alveolar pressure.
In PCV PIP is a reflection of aveolar pressure.. dang.
how are PPlat measured?
Pressure measured on inspiratory hold
it represents maximal end inspiratory alveolar pressure in VCV
What is the likely cause?
Pt intubated, then notice decreases in lung pressure
Ventilatory circuit leaks or disconnection from circuit or unintended extubation
Recent ED-based data have demonstrated that the use of rocuronium during rapid sequence intubation (RSI) is associated with increased time to adequate sedation, as well as decreased overall dose of sedation, when compared to patients intubated with succinylcholine
Gasp!
what is an indication NMBA use again after RSI?
- If patient asynchrony/tense patient – need to sedate and paralyse
- ARDS - use of NMBA has been assoc with shorter duration of ventilation and improved mortality
Does impaired hepatic or renal function increase duration of paralysis?
it may yes.
in obese pts and those with renal and hepatic insuff why are benzo’s not ideal for sedation post intuabtion?
tissue accumulation and prolonged sedation
What is a calculation for IBW?
men = 50 + 2.3 (height in inches - 60)
women = 45 + 2.3 (ht -60)
what is a good starting peep for COPD?
5 cm H20
why should we avoid NMBA in COPD patients?
NMBA with the combination of steroids puts pts at higher risk for critical illness polymyopathy
With ARDS development what 2 things confer mortality benefit?
Vt 5-6 cc/kg
Pplat <31 cm H2o
In neonates and infants what is the abx choice for empiric coverage and why would you add vanco?
Cefotaxime50 mg/kg q 8 hours plus ampicillin 50-100mg/kg q 6
you would add vanco if there is suspected strep pneumoniae resistant to penicillins and cephalosporins.
sickle cell pts are at particular risk for what condition?
Salmonella osteomyelitis
A retic count in febrile sickle pt is important because many infections (ex Parvovirus B19) can induced life threatening _____
aplastic crisis
In VP shunt infections what are the most common bugs?
Staphylococcus epidermidis then staph aureus are the usual causative organisms.
what artery in epidural hematoma/
middle meningeal artery
Epidural hematomas are a disease of the young but are rare in age<2 and elderly. why?
in <2 and elderly the dural is closely attached to the skull so less likely to have blood accumulation between
What are examples of extra axial intracranial injuries and intra-axial intracranial injuries
Extra- axial: SDH, EDH, traumatic SAH, subdural hygroma (CSF),
Intra-axial: cerebral and cerebellar Contusion, Traumatic axonal inj, cerebral and cerebellar hematomas
