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28 Cards in this Set
- Front
- Back
Hypoxemic
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Inability to oxygenate (present and delivery of O2)
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Hypercarbic
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Inability to ventilate (clear CO2)
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what are the 4 Clinical Signs of Respiratory Failure
**** |
Tachypnea
Accessory muscle use ****Paradoxical respirations – abdominal contents rise up and into chest during inspiration and outwards during respiration = failure/fatigue of diaphragm ****Decreased respiratory rate and apnea |
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what are paradoxical respirations
**** |
abdominal contents rise up and into chest during inspiration and outwards during respiration = failure/fatigue of diaphragm
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5 pathologic mechanisms for hypoxemia
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Low inspired oxygen – altitude
Hypoventilation – CVA, neuromuscular weakness and drugs Low V/Q (ventilation/perfusion) matching – PE, pneumonia, atelectasis Right to left shunt – PFO, VSD, pulmonary AVM Diffusion impairment – CHF, IPF |
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What is Respiratory Quotient (RQ)?
what is it normally? |
The amount of O2 an individual requires to burn one millimole of carbohydrate, fat and protein
normally RQ=.8 |
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discuss left and right shift of the oxygen disassociation curve
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left shift: O2 stays on Hemoglobin (PO2 goes down)
Right shift: O2 comes off Hemoglobin (PO2 goes up) |
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What 4 things will shift the O2 curve to the left?
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Temp
pH, CO2, 2,3 BPG |
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when do you administer mechanical ventilation?
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Once a patient is determined to be in respiratory failure
, then the decision to establish a “definitive airway” is made as well |
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when intubating where do you stop the tube?
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just past the vocal cords
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on a ventilator, what do you set the tidal volume to?
***********TEST |
6-8ml/Kg ideal body wt
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discuss volume and pressure control with use of a ventilator
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Volume control – set volume, pressure independent (most comfortable, but doesn't let pt choose how much they can take in)
Pressure control – set pressure and volume is independent |
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what is PEEP?
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Positive end expiratory pressure (PEEP) – (0 -20 cm H2O)
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describe Assist control (A/C) ventilation
when is it used |
Machine breath or patient breath always same amount of tidal volume (no matter what you want, you get what we give you, and you will like it)
Least work for patient Least comfortable Usually requires sedation Used early in the ventilatory process |
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describe Synchromized intermittent manditory ventilation (SIMV)
when is it used |
Set number of breaths receive fixed tidal volume
“breathe over” the ventilator and the tidal volume is dependent on the patients effort Commonly receive pressure support to augment spontaneous breaths Can be used as a weaning mode and for those patients waking up but still too weak to shoulder most of the ventilatory mode |
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what is statistically the most successful weaning mode of ventilation?
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Pressure support
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please describe pressure support ventilation
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Generally no set rate or tidal volume
Patient awake and spontaneously breathing Patient has pressure support breath and PEEP with needed FiO2 Statistically the most successful weaning mode |
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what is Minute Ventilation?
equation? |
direct descriptor of your clearance of CO2
RR x VT |
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what do you use for beat-to-beat hemodynamic monitoring of blood pressure
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Arterial Lines
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when placing a central venous line why should you never let go of the wire?
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it can get sucked into the body
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what vasopressor do you use for sepsis?
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NE
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what is the action of vasopressin?
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Increases cyclic adenosine monophosphate (cAMP) which increases water permeability at the renal tubule resulting in decreased urine volume and increased osmolality;
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what effect on the heart does vasopressin have?
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direct vasoconstrictor without inotropic or chronotropic effects
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2 major types of vascular monitoring devices
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a lines or PA catheters
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5 types of vasopressors
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Dopamine
Epi NE Vasopressin Phenylephrine |
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what are the 2 types of respiratory failure?
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Hypoxemic
Inability to oxygenate (present and delivery of O2) Hypercarbic Inability to ventilate (clear CO2) |
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when do you use vasopressors?
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Indicated when volume resuscitation fails to restore adequate arterial pressure/organ perfusion
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phenylepherine MOA?
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Synthetic selective alpha 1 adrenergic receptor agonist
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