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34 Cards in this Set
- Front
- Back
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What cahnges need to be made if you have an elevated PaCO2?
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Increase the rate
Increase Vt |
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What are formulas for desired PaCO2?
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Desired Vt= Known PaCO2 x Known Vt/ Desired PaCO2
Desired f= Known PaCO2 x Known f/ Desired PaCO2 Desired Ve= Known Ve x Known PaCO2/ Desired PaCO2 |
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What conditions can cause an increase in CO2 production?
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Fever
Burns Sepsis Hyperthyroidism Siezures |
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A 20 year old female has a size 9 ETT. What suction cath size? Pressures used? How often?
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Multiply the ETT by 3
and devide by 2 (14) Suction pressure : -100 to -120 Suction as needed |
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A closed suction cath may be more appropriate than using an open suction because?
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Considered to be safer
Maintains FIO2 and PEEP Reduces aerolization of secretions in air |
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Define permissive hypercapnia.
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Delibrate limitation of ventilatory support .
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What value on an ABG increases and what will decrease?
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PaCO2 will increase
O2 decrease PH will decreasebelow normal (7.10 to 7.30) |
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List some techniques for Airway clearance during mechanical ventilation.
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Suctioning
CPT Aerosol Delivery Fiberoptic bronchoscopy |
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List some complications associated with suctioning?
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Duration of procedure
Amount of suction applied Size of catheter Whether pre and post oxygenation done Atelectasis Cardiqac arrythmias Increased ICP |
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Why is instilling saline during suctioning is no longer recommended?
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May irritate airways and cause bronchospasms
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Silent aspiration and VAP can occur with cuffed ETT due to which of the following?
A. Injury to the mucosa during intubation. B. Interference with normal cough reflex C.Aspiration of contaminated secretions that pool above the cuff. D. All of the above. |
D. All of the above
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What can we do as RT's to prevent VAP?
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suction as needed
oral care 30 degrees of head position |
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What type of drugs can be administered through the ventilator and give an example of each?
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MDI and SVN used for Bronchodilators
SVN delivered: Mucolytics- mucomists Anitbiotics- Toby Steroids- Pulmocort Surfactants |
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List some problems associated with inline SVN's when the SVN has to be externally powered?
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Power source adds volume and FIO2 to the Vt.
The added flow dilutes or increases the FIO2. depending on what delivery gas is used. Bacterial contamination of the device can lead to bacteria in the lower airways. |
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List 3 jobs an RT would be responsible for while assisting with a bronchoscopy procedure? The RT can anticipate what types of changes in the ventilator function.
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Monitor Sats
Heart rate Tube placement Place 100% O2 |
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Why do we prone patients/?What type of patients would benefit from this type of therapy?
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To improve oxygenation .
In theory, the redistribution of ventilation and perfusion maybe a major factor. Helps with gas exchange Allows recruiting of alveoli ARDS patients |
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Where in the circuit should the inline SVN or MDI be placed?
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Inspiratory limb of the circuit
Before the HME (Patients Mouth) |
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List some problems associated with prone positioning?
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Moving a patient from supine to prone position can create problems:
Sedation maybe necessary Paralysis Labor intensive (requires a team of staff) Risk of extubation Loss of lines an Catheters |
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Explain lateral positioning.
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Places the goodd lung in a dependent position (good lung down)
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List 3 things to prevent ICU psicosis?
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Mild sedation
Keep patient oriented to time and place Allow patient to sleep as much as possible (Sedation Vacation) |
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Know the formula for desired FIO2
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Dsiresd FIO2 = Desired PaO2 x Known FIO2 / Known PaO2
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List some common parameters used when assessing oxygenation
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FIO2
SaO2 PaO2/ PAO2 (a-A Ratio) PaO2/FIO2 ratio Shunt C.O. CvO2 SvO2 |
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Factors that affect Paw
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PIP
Total PEEP (set PEEP and Auto-PEEP) I time Flow CL Raw |
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List the goals of PEEP
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Increase oxygenation and prevent atelectasis
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Know the difference between Flow resistor and Threshold resistor.
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Flow risistor- Expiration pressure created by resistance to gas flow through an orifice (restriction).
Threshold resistor- Expiration pressure created by constant pressure tru-out expiration. Regardless of flow rate Uses diaphragm or spring loaded valve. |
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CPAP can only be used with patients who have the following characteristics?
A. Have high levels of PaCO2 B. Can breath spontaneously C. Are Hypovoloemic D. Have central sleep apnea |
B. can breath spontaneously
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List 3 conditions that benefit from PEEP
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ALI or ARDS
Cardiogenic pulmonary edema Bilateral diffuse pneumonia |
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Goals of optimum PEEP
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Gaols to be targeted
PaO2 of 60 -100 torr on FIO2 of 40% SaO2 of 90-97% at normal PH Optimum O2 transport present O2 transport of 1000ml/min of O2, 5L/Mx 20% vol% x 10 Shunt < 15% (need pulm catherter to asses) A minimum affect on cardiovascular function (Good BP and HR) Improving Lung compliance A PaO2/FIO2 ratio >300 Optimum mixed venous O2 values find the peep that doesnt hinder them Hemodynamically stable pt. |
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What parameters must you observe following the increase of PEEP?
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Pt appearance
Bp BS Ventilator parameters Static compliance (improved compliance is good) Arterial PO2, FIO2, and PaO2/FIO2 (PaO2/FIO2 > 300 is Good) |
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List absolute contraindications of PEEP
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Untreated Pneumothorax
Tension Pneumothorax Bronchopleural fistula |
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List relative contraindications effects of PEEP
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Hypovolemia
Low blood volume increased ICP PEEP may increase ICP levels Emphysema Unilateral lung disease |
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To avoid damage from excessive pressure and volumes in ARDS. Plateau must be kept at what value?
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below or less than 30cm/H2O
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What is the PaO2/ FIO2 values for ALI and ARD's.
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ALI= PaO2/FIO2 less than or equal to 300.
ARDS= PaO2/FIO2 less than or equal to 200. |
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A pt. has a PaO2/ FIO2 of 150 and severe sepsis. compliance is reduced and x-rays show ground glass opacification. Which are the following statements are true/ Circle all that apply
i. the patient has ARDs ii. This pt will probaly improvr in oxygenation with a recruitment maneuver. iii. Low Vt and therapeutic PEEP should be used with this pt. iv. Protective lung strategies should be strated as possible. |
All of them
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