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30 Cards in this Set
- Front
- Back
Lower lobe is a _____ structure, thus an infiltrate in the lower lobe will silhouette the ____, not the heart
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1)posterior
2)diaphragm |
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Compliance curve--when compliance increases the curve shifts____
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Left
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When compliance decreases, the curve shifts___
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right
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Obesity, pregnancy,kyphoscoliosis, stiff chest muscles, increased FRC cause___
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respiratory system compliance to decrease
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PEEP was developed in the OR because
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when patients are sedatesd and paralyzed their respiratory muscles relax and FRC decreased, resulting in a lower FRC.
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Increased physiologic dead space and intrapulmonary shunting cause mismatch that requires____
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increased postive pressure ventilation and increased PEEP
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Tidal volume for an ARDS patient
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6cc-kg
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Percentages of intubated patients who develop nosocomial pneumonia
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1)20 percent after 4 days
2)40 percent after a week on the vent |
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Problems associated with invasive mechanical ventilation
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1)upper airway is no longer intact
2)vocal cord damage, tracheal stenosis 3)expense 4)no communication 5)increased sedation 6)cough mechanism is compromised |
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Characteristics of pressure support
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1)Patient is ventilated to a set pressure
2)flow is initially rapid, then varies to pt. compliance, inspiratory demand, or volume changes to deliver a set pressure 3)Tc, I time, and RR are all controlled by the patient 4)PSV reduces the load on inspiratory muscles, reduces WOB, 02 consumption, and improves synchrony between pts. and the ventilator |
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Why does PEEP work with ARDS people?
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Because it increases FRC, and creates a reservoir
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To help prevent aspiration, the cuff should be maintained at
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at least 18 cm H2O
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Problems associated with mainsterm intubation
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1)Decreased ventilation of the left lung, possible atalectasis in the left lung
2)Increased PIPs with VC 3)decreased oxygentation due to shunting |
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Characteristics of a tension pneumothorax
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1)Respiratory distress
2)Absence of BS 3)Hypertympanic 4)distended neck veins 5)unilateral absence of BS 6)Tracheal deviation 7)mediastinal shift 8)hypotension |
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Indications for acute NIV
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1)alveolar hypoventilation
2)ventilatory muscle fatigue 3)early extubation 4)C-spine injury 5)end stage disease 6)extrathoracic inspiratory stridor 7)DNI's 8)Post op patients with OSA |
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Pathologies that respond well to NIV (Strong evidence for)
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1)COPD
2)CHF 3)immunocompromised patients |
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Pathologies were there is less evidence of success with NIV
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1)Ashthma
2)pneumonia 3)ARDS 4)Hypoxemic respiratory failure 5)DNI 6)post-ops |
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Why patients with CHF benefit from NIV
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Patients who have COPD benefit from the effects of positive pressure on venous return
a)decreaased blood volume causes a decrease in ventricular filling pressures |
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Contraindiactions for NIV
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1)hemodynamically unstable
2)need for intubate intubation 3)Swallowing dysfunction 4)Inability to protect the upper airway (OD, hemoptysis patients) 5)uncooperative patients (except for CO2 narcosis) 6)excessive secretions 7)facial trauma 8)active GI bleeding |
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Common predictors for worse outcome with NIV
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1)Ph less than 7.25
2)APACHe scale greater than 29 3)GCS less than 11 4)RR greater than 36 |
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APACHE score chracteristics
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compilation of physiologic and demogrpahis factors like age, chronic disease, and hemodynamic status
(The greater the no, the greater the risk for mortality |
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Pressure support should be at least ___ for patients on Bipap
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4 cm H2O
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breathing for quadraplegis pts.
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1)Abdomen moves up as diaphragm contracts
2)chest wall moves down, since he chest muscles are not innervated and do not contract |
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Kink in the tube
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Belly will move progressively downward
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Fine crackles heard at the end of inpiration
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Consistent with CHF or pneumonia
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Methods used to evaluate the adequacy oxygentation
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1)Central cyanosis
2)mental deterioration 3)SPo2 |
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Compromises to sat probes
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1)sunglobin
2)diagnostic dyes 3)hemoglobin abnormalities |
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Central cyanosis will occur when____
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When oxygen content is reduced by 5 ml per 100 cc of blood cyanosis will occur
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A patient with chronic bronchitis_______
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May be cyanotic with a relatively modest decrease in O2 saturation
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Increasing PCO2 will cause ______ in the brain
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vasodilation
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