Exam 2 Basics Of Breathing Part 4

Front 1

Four Phases Of The Ventilatory Cycle

Back 1

Inspiration
Transition from Inspiration to Expiration
Expiration
Transition from Expiration to Inspiration

Front 2

Ventilators Generate Tidal Volume By Gas Flow

Back 2

Along a Pressure Gradient

Front 3

Solenoid Valve

Back 3

Sets the Timing of when Inspiration Begins and Ends
Sets the I : E Ratio
Electric Current Flows to Solenoid Valve
Sets Precise Timing Sequence

Front 4

Inspiratory Duration and Flow Rate Determine Tidal Volume
ventilator type

Back 4

Time Cycled Ventilators

Front 5

Will Not Cycle from inspiration to Expiration Until Preset pressure is Reached

Back 5

Pressure Cycled Ventilators

Front 6

Pressure Support Ventilation
3x

Back 6

1. Augments the Tidal Volume of Spontaneously Breathing Patients
2. Gas Flow with Every Inspiratory Effort
3. Overcomes Increased Inspiratory Resistance

Front 7

Jet Ventilation

Back 7

1. High Pressure Gas Blown Into the Airway to Achieve Ventilation
2.Specially Constructed Tube Inserted Beyond the Vocal Cords to Direct the Vet
3. Must be At Least 16 Gauge to Deliver Gas
4. Pressure as high as 2-3 atmospheres

Front 8

Positive End Expiratory Pressure
5 points

Back 8

Improves Oxygen Delivery to Tissues
Stabilizes and Expands Partially Collapsed Alveoli
Increases Functional Residual Capacity
Improves Lung Compliance
Improves V/Q Mismatch

Front 9

Pressure Threshold Allows

Back 9

Allows Expiratory Flow to Occur ONLY WHEN Airway Pressure Equals or Exceeds the Selected PEEP Level

Provided By a Pressurized Expiratory Valve or Diaphragm

Front 10

Continuous Positive Airway Pressure-CPAP used

Back 10

During Inspiration and Expiration with Spontaneous Breathing

Front 11

Continuous Positive Airway Pressure-CPAP Pressure >15cmH2O

Back 11

15cmH2O Increases the Risk of Gastric Distention and Regurgitation

Front 12

CPAP Masks Should ONLY be used with

Back 12

Alert Patients with Intact Airway Reflexes

Front 13

Traditional Ventilators
3 old points

Back 13

Double Circuit System
Pneumatically Powered
Electronically Controlled

Front 14

Modern Ventilators
4 new changes

Back 14

Microprocessor Control
Sophisticated Pressure & Flow Sensors
Double-Circuit System Ventilators
Piston Ventilators

Front 15

Ventilator Flow Control Valve Regulates

Back 15

Drive Gas

Front 16

Double Circuit System Ventilators

Back 16

Two Circuits:
Patient Circuit: Inside the Bellows and Contains O2, N2O, Air and Inhalational Gas Mixture
Drive Gas Circuit: Outside the Bellows Between the Plastic Bellows Housing
Pushes the Bellows Up & Down

Front 17

Ascending Bellows

Back 17

Ascending (Standing) Bellows: Rise during Expiration

Front 18

Descending Bellows

Back 18

Collapse during Expiration

Front 19

OHMEDA MACHINES used for Pneumatic Power

Back 19

1 100% O2
2 Pressure Regulated Down to 26 PSIG by Second-Stage Regulator
3 O2 Rate at least Equal to Minute Ventilation

Front 20

Drager Machine’s Venturi Device

Back 20

Entrains Room Air due to Fall in Pressure at the Narrowing of the Tube

Front 21

Venturi Device Results is an FIO2

Back 21

of 35%

Front 22

Drive Gas Leaks Into the Bellows
5

Back 22

Hyperventilation
Possible Barotrauma
Increased FIO2
Decreased N2O
Dilution of Inhalational Agents

Front 23

Ventilator Relief Valve Prevents

Back 23

the Build Up of Pressure or Volume within the Breathing Circuit or Lungs

Front 24

Ventilator Relief Valve vents

Back 24

vents Drive Gas OUT to the Room
(big difference)
Vents Patient Circuit Gas OUT to the Scavenger

Front 25

Ventilator Relief Valve OPEN During

Back 25

Expiratory Phase

Front 26

When Utilized with Ascending Bellows

Back 26

Creates 2-3 cmH2O of PEEP within the Breathing Circuit at End Expiration

Front 27

When this 2-3 cmH2O of PEEP is Sensed within the Breathing Circuit, the Ventilator Relief Valve will Vent the Excess Pressure from

Back 27

from the Breathing Circuit to the Scavenger

Front 28

Ventilator Relief Valve CLOSED by

Back 28

the Drive Gas During Inspiratory Phase
(Prevents Gas within the Bellows from Escaping to the Scavenger as the Bellows are Compressed)

Front 29

Ventilator Relief Valve Also Called The
2x

Back 29

Pressure Limiting Valve

Spill Valve

Front 30

Free Breathing Valve

Back 30

Allows Outside Air to Enter the Drive Chamber & the Bellows to Collapse, IF the Patient Generates Negative Pressure by taking Spontaneous Breaths during Mechanical Ventilation

Front 31

Piston Ventilators
4 points

Back 31

Electronic Motor Compresses the Bellows during Inspiration
DOES NOT Use Drive Gas
Has a Positive and Negative Pressure Relief Valve
Can Vent N2O and Inhalational Agents to the Room

Front 32

Piston Ventilators
Positive Pressure Relief Valve
OPENS if

Back 32

if pressure within the Piston reaches 75 cmH2O (at the Highest)
Many Manufacturers set an automatic default to open at 40 cmH2O

Front 33

Piston Ventilators
Negative Pressure Relief Valve
Opens is the Pressure in the Piston Declines to

Back 33

Declines to -8 cmH2O

Front 34

Prevents the Patient from Negative End Expiratory Pressure (NEEP)

Back 34

Negative Pressure Relief Valve

Front 35

Fresh Gas Decoupling
3 points

Back 35

Ensures Set & Delivered Tidal Volumes are Equal
Fresh Gas Flow is NOT Added to the Delivered Tidal Volume
One Way Check Valve Diverts FGF to the Reservoir Bag during Inspiration

Front 36

Key
ventilator relief valve (spill valve)
opens

Back 36

weight or disk holds valve pathway closed untill bellows are filled then excess gas vented

Front 37

Peak Inspiratory Pressures

Back 37

Highest Pressure during the Inspiratory Cycle

Front 38

Plateau Pressure

Back 38

Pressure during an Inspiratory Pause
Time of NO Gas Flow But Where Gas Exchange Occurs

Mirrors Static Compliance

Front 39

Excessive Positive Pressure

Back 39

Incorrect Ventilator Settings
Ventilation Malfunction
Fresh Gas Coupling
Activation of O2 Flush During Inspiratory Cycle
Scavenger system malfunction

Front 40

Standard for Pediatric Breathing Circuit is

Back 40

1.5-2.5 ml/cmH20
Circuits are stiffer

Front 41

Standard for Adult Breathing Circuit is

Back 41

5 ml/cmH2O
If PIP is 20cmH2O, about 100ml of set TV is lost to the expanding circuit
* Actual Loss Unpredictable & Depends on Vent, Circuit and PIP

Front 42

Compression Loss

Back 42

Accounts for 3% Due to Gas Compression

Compliance of breathing circuit

Front 43

Gas Sampling and Capnography loss =

Back 43

(250 ml./min)

Front 44

Calculate ideal body weight women

Back 44

(Ht. Inches x 2.54 -105[women])

Front 45

Calculate ideal body weight men

Back 45

(Ht. Inches x 2.54 – 100[men])

Front 46

Minute Ventilation: for normocarbia

Back 46

80 ml/kg

Front 47

Minute Ventilation: increased CO2 load (laparoscopy)

Back 47

100ml/kg

Front 48

Minute Ventilation: TO START for hyperventilation

Back 48

150ml/kg

Front 49

Tidal Volume: for patient with severe lung disease

Back 49

6 ml/kg

Front 50

Tidal Volume:
for patient with healthy lungs

Back 50

10 ml/kg