Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
|
Acute respiratory failure |
Clinical objectives of mechanical ventilation Decreased WOB Reverse respiratory failure Reverse respiratory distress Reverse hypoxemia Reverse/prevent atelectasis Reverse muscle fatigue Decreased V.O2 and myocardial V.O2 Decreased intercranial pressure, hyperventilatoin leads to hypocapnia PaCO2 is a constrictor in the lungs, and a dilator in the body, but if you reduce the amount of CO2 by hyperventilating, it means less dilation so reduced ICP Stabilize chest wall |
|
|
3 or more adjacent ribs broken in 2 or more places is flail chest |
paradoxical breathing Another goal of mechanical vent is to permit sedation or paralysis |
|
|
Indications of mechanical ventilation |
acute hypoxemic resp failure type 1 acute hhypercapnic resp failure type 2 Chronic resp failure type 1 and 2 |
|
|
Acute hypoxemic resp failure type 1 |
V/Q mismatch Alveolar hypoventilation Diffusion defect: perfusion diffusion impairment |
|
|
Shunts |
Q greater than V resultig in hypoxemia Shunts where Q is greater than V, has opacities on CXR |
|
|
Diffusion defect |
Thickened AC membrane Increasee time for gas diffusion Pulmonary edema and fibrosis |
|
|
COPD is high commpliance and poor eslastance |
Pulmonary compliance Compliance: change in volume over change in pressure |
|
|
Chronic hypercapnic respiratory failure |
Chronic hypercapnic respiratory failure :COPD, OSAHS Chronic hypoventiatlion PaCO2 = VCO2/ VA Acute resp failure leads to chronic resp failure :pneu;monitis, emboli, infection etc |
|
|
Criteria for mechanical ventilation |
MIF less than -20 cmH20 VC less than 10 to 15 ml/kg VT less than 5 ml/kg RR greater than 35 A-a gradient greater than 450 PaO2 / FiO2 less than 200 torr pH less than 7.25,PaCo2 greater than 55 tor Vd/Vt greater than 60% |
|
|
Criteria for mech vent |
MiF less than - 20 Normal -80 to -100 Indicates respiratory muscle strength VC less than 10 to 15 :normal is greater than 15ml Vt less than 5 ml/kg RR greater than 35/min |
|
|
Criteria for mechanical ventilation |
A-a gradient greater than 450 :fio2 100% PF raio greater than 350 to 450 normal pH less than 7.25, PaCO2 greater than 55, Vd/Vt greater than 60% |
|
|
INitiating mech vent |
Radford nomogram for Vt Mode of ventilation FiO2 |
|
|
Choosing vent modes |
CPAP/BiPAP :reversible hypoxemic respiratory failure :acute processes :pulmonary edema PEEP :Slowly reversible hypoxemic RF :Adjunct to CMV AC (VC- CMV) :Acute alveolar hypventilation :Alterred mental status |
|
|
Choosing ventilator modes |
SIMV :acute alveolar hypoventilation w/ PSV :Weaning :Chronic respiratory failure BiPAP :Chronic alveolar hypoventilation :Respiratory muscle fatigue :Chronic respiratory failure: NOC PCV :ALI or ARDS |
|
|
Lung volumes and flow |
Vt( 6 to 10 ml/kg :Vt less than 5 ml/kg may indicate respiratory problem, :pneumonia, COPD, CHF, ARDS, CNS depression :Large Vt in metabolic acidosis, sepsis, neurological injury :Vt = Va + Vd :Vd of 30% of the Vt is normal ::Vd of greater than 60 needed vent support |
|
|
Lung volume and flows |
High Vt ventilation with positive pressure: volutrauma Peep and smaller Vt maintains FRC Discrepancies between set and measured VT :Compressed volume of the circuit :inspiratory and expriatory flow sensors :pneumothorax :leaks in the circuit or ETT |
|
|
indications for mech vent in head injuries |
Respiratory depression associated with injury, manifested as :cheyne stokes respiration Neurogenic pulmonary edema :Ards like pattern that can occur following head trauma :upper airway compromise :presence of stridor :loss of airway clearance mechanisms Aspiration |
|
|
Other modalities in head injuries |
Airway management (intubation) :head injury ::particularly with glascow coma scale :face jaw |
