Mechanical Ventilation Exam 1

Front 1

Define acute respiratory failure

Back 1

Any condition in which respiratory activity is completely absent or is inadequate to maintain oxygen uptake and carbon dioxide clearance. PaO2 and SpO2 are the key indicators of the severity of acute hypoxemic respiratory failure

Front 2

Recall specific examples of diseases associated with impaired neuromuscular function (8)

Back 2

intracranial hemorrhage

cerebrovascular accidents

central alveolar hypoventilation

syndromediaphragmatic paralysis

severe respiratory muscle failure

high spinal cord injury

end-stage pulmonary interstitial fibrosis

end-stage neuromuscular disorders

Front 3

Acceptable and critical values for MIP

Back 3

MIP: acceptable: -50 to -100cmH20

critical: 0 to -20cmH2O

Front 4

Acceptable and critical values of MEP

Back 4

MEP: acceptable: > 100cmH2O

critical: < 40cmH20

Front 5

Acceptable and critical values is PaCO2

Back 5

PaCO2:acceptable: 35-45mmHg

critical: >50mmhg and rising

Front 6

Acceptable and critical values of vital capacity

Back 6

VC: acceptable: 65-75ml/kg

critical: <15ml/kg

Front 7

Acceptable and critical values of dead space (VD/VT)

Back 7

VD/VT: acceptable: 0.3-0.4

critical: >0.6

Front 8

Acceptable and critical values of PaO2

Back 8

PaO2: acceptable: 80-100mmHg

critical: <60-70mmHg

Front 9

Acceptable and critical values of pH

Back 9

pH: acceptable: 7.35-7.45

critical: <7.25

Front 10

Acceptable and critical values of tidal volume

Back 10

VT: acceptable: 5-8ml/kg

critical: <5ml/kg

Front 11

Acceptable and critical values of FEV1

Back 11

FEV1: acceptable: 50-60ml/kg

critical: <10ml/kg

Front 12

Acceptable and critical values P(A-a)O2

Back 12

P(A-a)O2: acceptable: 3-30mmHg

critical: >450mmHg (on O2)

Front 13

Acceptable and critical values of PaO2/PAO2

Back 13

PaO2/PAO2: acceptable: >0.75

critical: <0.15

Front 14

Acceptable and critical values of PaO2/FIO2

Back 14

PaO2/FIO2: acceptable: >475

critical: <200

Front 15

Define refractory hypoxemia, and explain how it may best be treated

Back 15

Refractory Hypoxemia: A PaO2 less than 70 mm Hg (or SpO2 less than 90%) on an oxygen mask (FIO2 >0.6) (hypoxemic respiratory failure.)Can be treated with PEEP or CPAP

Front 16

Signs and symptoms of mild-to-moderate hypoxemia

Back 16

Respiratory: tachypnea, dyspnea, paleness

Cardiovascular: tachycardia, mild hypertension, peripheral vasoconstriction

Neurologic: restlessness, disorientation, headaches, lethargy

Front 17

five goals of the therapy for the mechanically ventilated patient

Back 17

1. maintain an adequate level of alveolar ventilation

2. Reduce the work of breathing

3. Restore arterial and systemic acid–base balances

4. Increase oxygen delivery

5. Prevent complications associated with mechanical ventilation

Front 18

Technique associated with measurement of MIP

Back 18

MIP: 8-10 consecutive breaths are monitored, may take up to 20 seconds to reach most negative value, should be performed at RV, effort dependent

Front 19

Situations which may lead to airway narrowing, or occlusion

Back 19

aspiration of food, liquids and GI contents, foreign objects

loss of muscle tone

excessive secretions

airway smooth muscle constriction

bilateral vocal cord paralysis

laryngospasm

swelling of the laryngeal tissues (epiglottitis, submucosal or retropharyngeal hemorrhage, allergic reactions, head or neck trauma, and post extubation)

Front 20

differentiate partial from complete airway obstruction

Back 20

Absence of breath sounds may indicate complete airway obstruction

Front 21

Maintenance and monitoring of ETT

Back 21

Position and depth

Security

Appearance of Surrounding Tissue

Cuff Pressure

Disconnect and Apnea alarms set appropriately

Ease of suctioning

Looking for Necrosis/Pressure Sores

Front 22

How, and where to “needle” a life-threatening pneumothorax.

Back 22

Prep skin

palpate 2nd intercostal space, mid-clavicular line on affected side

insert needle/valve, over the top of the rib

Front 23

Write out the formula for CaO2

Back 23

CaO2 = ([Hbx1.34]xSaO2)+(PaO2x0.003

Front 24

Write out the formula for PAO2

Back 24

PAO2 = ([PB-PH2O]xFIO2)-PaCO2(1.25)

Front 25

Write out the formula for P(A-a)02

Back 25

P(A-a)02= PAO2-PaO

Front 26

Left chamber of Pleur-evac

Back 26

LEFT: suction control, height of water (20cmH2O) determines negative pressure

Additional suction -60 to -80, too high can lead to evaporation

Front 27

Middle chamber of Pleur-evac

Back 27

MIDDLE: water seal chamber, water level 2cm, spontaneous inspiration = H2O rises, expiration = H2O falls

Tidaling = patent chest tube

Front 28

Right chamber of Pleur-evac

Back 28

RIGHT: collection chamber for fluid

<25ml/hr and no leak = remove chest tube

500-1000ml of bright red = report

Front 29

problems with long-term intubation (5)

Back 29

Infection

Vocal cord paralysis

Trachial stenosis

Tracheoesophageal fistula

Tracheal erosion: sudden hemoptysis or pulsating trach tube

Front 30

Cause of re-expansion pulmonary edema

Back 30

Fluid pouring into alveolar spaces after rapid re-expansion (thoracentesis: draining of pleural effusion)

Occurs most frequently when negative pressure is used to evacuate the pleural space rapidly

Front 31

conditions associated with altered chest wall movement (5)

Back 31

Abdominal paradox, sometimes with respiratory alternans

Accentuated abdominal breathing

Paradoxical chest wall movement

Accessory muscles augmenting inspiration and sometimes expiration

Unilateral decrease in chest expansion

Front 32

conditions that may cause tracheal deviation towards (2)

Back 32

atelectasis

pneumonectomy

Front 33

conditions that may cause tracheal deviation away (3)

Back 33

pleural effusion

tension pneumothorax

unilateral hyperinflation secondary to ball-valve obstruction of main bronchus

Front 34

Disorders associated with transudative pleural effusions (9)

Back 34

CHF

pericardial disease

pulmonary embolism

cirrhosis

hypoalbuminemia

nephrotic syndrome

hydronephrosis

acute glomerulonephritis

peritoneal dialysis

Front 35

Disorders associated with excudative pleural effusions (9)

Back 35

pulmonary infections

malignancy

gastrointestinal

collagen-vascular disease (lupus, rheumatoid) trauma

iatrogenic disorder

radiation therapy

uremia

drug induced

Front 36

Problems which may cause stridor

Back 36

Laryngospasm

Front 37

Problems which may cause wheezing

Back 37

Bronchial narrowing

Front 38

Problems which may cause gurgling

Back 38

Presence of excessive secretions or foreign matter in the airway

Front 39

Problems which may cause snoring

Back 39

Partial occlusion of pharynx