Respiratory 4

Question 1

mechanical ventilators use…

Answer 1

• *all positive pressure
• pushing air into lungs
• decreases BP

Question 2

normal tidal volume

Answer 2

5-15 ml/kg or about 450-500

Question 3

normal FiO2

Answer 3

fraction of inspired air

25-100%

Question 4

normal rate

Answer 4

12-15 min

Question 5

normal PAP

Answer 5

5 cm (of H2O)

Question 6

normal PEEP

Answer 6

5 cm

Question 7

normal I/E ratio

Answer 7

1:2

Question 8

describe what the PEEP is

Answer 8

• at the very end of push, exerts more pressure (about 5) to open up at the end of the tubes of alveoli
• *increases O2 to alveoli (if something is blocking, it will need an extra push and increase)

Question 9

these are used to open alveoli

Answer 9

pressure support and PEEP

Question 10

some of the complications of ventilators

Answer 10

Decreased cardiac output, decreased BP, barotrauma, pneumothorax, atelectasis, oxygen toxicity, stress ulcers and VAP

Question 11

what is barotrauma

Answer 11

• pressure trauma

- alveoli collapse and can lead to atelectasis

Question 12

how do you prevent VAP

Answer 12

• no ventilator longer than >3 days
• HOB >30-45 degrees
• mouth care q4 hrs

Question 13

if in ARDS, what should the FiO2 be set to

Answer 13

100%

Question 14

what is assist control (AC) ventilator

Answer 14

• ventilator is mainly controlling their ventilator
• used when pt is not breathing well (can’t ventilate well) or are not awake
• set to deliver a specific amount, assist to hit what they need
• typically start on this after surgery

Question 15

describe thoracentesis

Answer 15

• Procedure to remove lung fluid or blood
• May be done at the base of the ribs or under sternum
• Done at the bedside, patient is medicated and site is numbed

Question 16

features of ARDS

Answer 16

• Patchy infiltrates
• No signs of heart failure
• No improvement in PaO2, desprite increasing oxygen delivery (FiO2 at 100%)
• Tissues lining the alveoli and capillaries are injured

Question 17

only treatment of ARDS

Answer 17

Only treatment is to ventilate and give 100% O2

Question 18

lung injury/ARDS leads to

Answer 18

Inflammation
Impaired gas exchange
Stiff lung tissue
Shunts blood away from alveoli, right-left shunt
Thick, frothy sputum (common)

Question 19

causes of ARDS

Answer 19

Sepsis, trauma
PE, shock, DIC
Pancreatitis, burns
Drug overdose
Aspiration
Pneumonitis, pneumonia
Inhalation of noxious gases

Question 20

how does ARDS start out

Answer 20

hyperventilatory

progresses through stages 1-4

Question 21

tests for ARDS

Answer 21

• ABG’s- PaO2 low, PaCO2 low and pH is increased, showing respiratory alkalosis at first, then becomes acidotic, pH is low, PaCO2 is high
• CXR
• PA catheter for PAWP, PAWP is very elevated, > 15

Question 22

treatment for ARDS

Answer 22

ET and mechanical ventilation, PEEP
Prone positioning
Diuretics
Antibiotics 
Steroids

Question 23

describe acute respiratory failure

Answer 23

• Lungs just give out, cannot oxygenate or ventilate (cannot get rid of CO2)
• impaired gas exchange
• mismatch VQ
• acidosis and lactic acid develop

Question 24

why would a pt dies of ARF

Answer 24

d/t not being able to ventilate

Question 25

what to look out for in pt with ARF

Answer 25

- tachypnea >30/min - tachycardia >100/min - cold, clammy sking, diaphoresis - diminished breath sounds

Question 26

treatment of ARF

Answer 26

``` Oxygen therapy (hyperoxygenate) Ventilator if needed Reversal agents, Narcan Bronchodilators Antibiotics Steroids Inotropic agents to maintain BP and output Diuretics ```

Question 27

what is ECMO

Answer 27

- extracorporeal membrane oxygenation - Blood is extracted, oxygenated, remove CO2 and then reinfuse - 100% o2 in blood to attempt to save organs and lungs

Question 28

treatment of ARF

Answer 28

``` Oxygen therapy Ventilator if needed Reversal agents, Narcan Bronchodilators Antibiotics Steroids Inotropic agents to maintain BP and output Diuretics ```

Question 29

types of COPD

Answer 29

Emphysema (cannot recoil), chronic bronchitis (swollen bronchile tubes, asthma