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30 Cards in this Set

  • Front
  • Back
Lower lobe is a _____ structure, thus an infiltrate in the lower lobe will silhouette the ____, not the heart
Compliance curve--when compliance increases the curve shifts____
When compliance decreases, the curve shifts___
Obesity, pregnancy,kyphoscoliosis, stiff chest muscles, increased FRC cause___
respiratory system compliance to decrease
PEEP was developed in the OR because
when patients are sedatesd and paralyzed their respiratory muscles relax and FRC decreased, resulting in a lower FRC.
Increased physiologic dead space and intrapulmonary shunting cause mismatch that requires____
increased postive pressure ventilation and increased PEEP
Tidal volume for an ARDS patient
Percentages of intubated patients who develop nosocomial pneumonia
1)20 percent after 4 days
2)40 percent after a week on the vent
Problems associated with invasive mechanical ventilation
1)upper airway is no longer intact
2)vocal cord damage, tracheal stenosis
4)no communication
5)increased sedation
6)cough mechanism is compromised
Characteristics of pressure support
1)Patient is ventilated to a set pressure
2)flow is initially rapid, then varies to pt. compliance, inspiratory demand, or volume changes to deliver a set pressure
3)Tc, I time, and RR are all controlled by the patient
4)PSV reduces the load on inspiratory muscles, reduces WOB, 02 consumption, and improves synchrony between pts. and the ventilator
Why does PEEP work with ARDS people?
Because it increases FRC, and creates a reservoir
To help prevent aspiration, the cuff should be maintained at
at least 18 cm H2O
Problems associated with mainsterm intubation
1)Decreased ventilation of the left lung, possible atalectasis in the left lung
2)Increased PIPs with VC
3)decreased oxygentation due to shunting
Characteristics of a tension pneumothorax
1)Respiratory distress
2)Absence of BS
4)distended neck veins
5)unilateral absence of BS
6)Tracheal deviation
7)mediastinal shift
Indications for acute NIV
1)alveolar hypoventilation
2)ventilatory muscle fatigue
3)early extubation
4)C-spine injury
5)end stage disease
6)extrathoracic inspiratory stridor
8)Post op patients with OSA
Pathologies that respond well to NIV (Strong evidence for)
3)immunocompromised patients
Pathologies were there is less evidence of success with NIV
4)Hypoxemic respiratory failure
Why patients with CHF benefit from NIV
Patients who have COPD benefit from the effects of positive pressure on venous return
a)decreaased blood volume causes a decrease in ventricular filling pressures
Contraindiactions for NIV
1)hemodynamically unstable
2)need for intubate intubation
3)Swallowing dysfunction
4)Inability to protect the upper airway (OD, hemoptysis patients)
5)uncooperative patients (except for CO2 narcosis)
6)excessive secretions
7)facial trauma
8)active GI bleeding
Common predictors for worse outcome with NIV
1)Ph less than 7.25
2)APACHe scale greater than 29
3)GCS less than 11
4)RR greater than 36
APACHE score chracteristics
compilation of physiologic and demogrpahis factors like age, chronic disease, and hemodynamic status
(The greater the no, the greater the risk for mortality
Pressure support should be at least ___ for patients on Bipap
4 cm H2O
breathing for quadraplegis pts.
1)Abdomen moves up as diaphragm contracts
2)chest wall moves down, since he chest muscles are not innervated and do not contract
Kink in the tube
Belly will move progressively downward
Fine crackles heard at the end of inpiration
Consistent with CHF or pneumonia
Methods used to evaluate the adequacy oxygentation
1)Central cyanosis
2)mental deterioration
Compromises to sat probes
2)diagnostic dyes
3)hemoglobin abnormalities
Central cyanosis will occur when____
When oxygen content is reduced by 5 ml per 100 cc of blood cyanosis will occur
A patient with chronic bronchitis_______
May be cyanotic with a relatively modest decrease in O2 saturation
Increasing PCO2 will cause ______ in the brain