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12 Cards in this Set
- Front
- Back
What are indications for intubation?
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1. Mechanics
-RR>35, -VC<15mL/kg for adults and 10mL/kg for children, -MIF<20cm H2O, 2. Oxygenation -PaO2<70mm Hg on FiO2 40%, -A-a gradient>350 torr with FiO2 100%, 3. Ventilation -PaCO2>55(except if chronic hypercarbia) -Vd/Vt>0.6(normal is 0.3) |
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What are criteria for extubation?
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1. awake and alert with stable vital signs and good strength,
2. RR<30-35/min, 3. no inotropic support, 4. afebrile, 5. ABG reasonable(PaO2>70, PaCO2<55) with FiO2 40%, 6. MIF more negative than -20 cm H2O, 7. VC>15mL/kg |
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Describe Tpiece technique for weaning from mechanical ventilation
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1. T piece adapter and heated nebulizer are attached to ETT,
2. Set FiO2 slightly higher than was set with mechanical ventilation, 3. check vital signs on a very frequent basis during the first hour or two 4. if weaning is well-tolerated extubate after 2-4 hrs |
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What is the IMV technique for weaning from mechanical ventilation
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IMV is gradually decreased so that eventually spontaneous ventilation begins
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How does PEEP affect FRC?
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PEEP acts by increasing FRC. For every 5cm H2O PEEP, FRC increases about 400cc
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How does PEEP affect intrapulmonary shunting?
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PEEP improves the relationship between FRC and closing capacity and thereby decreases intrapulmonary shunting
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How does PEEP affect Cardiac output?
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decreases CO by increasing intrathoracic pressure and decreasing venous return
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What are signs of fat embolism syndrome?
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1. Cardio
-tachycardia and hypotension, -EKG changes suggest MI and right heart strain, 2. Resp -increased VD/VT leads to moderate to severe hypoxemias, -PaO2 falls and PaCO2 rises, 3. CNS -confusion, obtundation, and coma are often present, 4. Blood -rise in serum lipids, free fatty acids, and triglycerides, -decreased Hct, - thrombocytopenia, -prolonged PT/PTT, - increased fibrin degradation products, 5. Skin -petechiae present over the ant chest, axilla, and neck, and conjunctiva |
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Prophylactic vs conventional PEEP
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Prophylactic PEEP = 1-5 cm H2O
Conventional PEEP = 5-20 cm H2O |
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Define total physiologic dead space.
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The sum of the anatomic dead space and alveolar dead space representing the fraction of tidal volume that does not participate in gas exchange.
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Define anatomic dead space.
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The volume of gas found in the conducting airways.
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Define alveolar dead space.
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The volume of gas that does not participate in gas exchange at the alveolar level.
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