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LAC/USC RT Dept

  1. What does VDR stand for?
    Volumetric Diffusive Respirator
  2. Name the Indications for the use of the VDR
    • 1. Burn Inhalation Injuries
    • 2. ARDS
    • 3. Bronchiestasis
    • 4. Bacterial Pneumonia
    • 5. Bronchial Pleural Fistulas
    • 6. Independent Lung Ventilation
  3. What must be checked and documented every Ventilator Check
    Monitor cuff pressure
  4. When inflating the cuff what technique is used with the VDR?
    Minimal leak technique
  5. Working pressure for the ADULTS IS WHAT?

    What is the working pressure for Peds?
    • 50 psi - adults
    • 40 psi - peds
  6. What is documented Peak Inspiratory Pressure or Mean Airway Pressure?
    Mean Airway Pressure (MAP) is documented every shift
  7. What must be checked every vent check and for what what?
    Nebulizer, insure it's misting
  8. How do you trouble shoot the nebulizer on the vdr?
    Fluid control valve missing, change the nebulizer
  9. What alarms do you set when using the VDR
    High pressure alarm set 10-15 above the PIP

    Low pressure alarm set 5 below PIP
  10. What type of ventilator is the VDR
    Pneumatic ventilator
  11. What is the name of the electrical device that is used with the VDR?
    Wave Form Analyzer
  12. What happens to the VDR during a power failure?
    The machine would continue to operate
  13. What controls PIP on the VDR?
    Pulsitile Flowrate knob
  14. PIP on the VDR are set to what pressure
    2/3 the Peak Pressure of the conventional ventilator
  15. PIPs should be started at
    30-40 for adults

    20-30 for peds
  16. At the carina, what is the PIP?

    Why?
    • 1/3 lower than the set PIPs
    • Due to the cuff leak
  17. How do you adjust PIPs on the VDR, What knob is it?
    • Pulsatile Flowrate Knob
    • Turn
    • Left to increase, right to decrease
  18. In comparison to a conventional ventilator, where do you want to set the peak pressure on the VDR?
    Start by setting the peak pressure 2/3 the pressure of a conventional ventilator.
  19. What type of volumes does the VDR provide?
    Sub-Tidal Volumes
  20. How big are the Volumes per percussion on the VDR
    • 50 cc for adults
    • 40 cc for peds
  21. What is the I:E Ratio on the VDR
    Should be 1:1
  22. What is Small rate on the the VDR?
    • 15 bpm adults
    • 20-25 bpm peds
    • 25-30 bpm infants
  23. What knobs adjust the small rate in the VDR
    Inspiratory time and Expiratory time
  24. How do you adjust the Large Rate on the VDR?
    Adjusting the Pulse Frequency Knob and the Pulse I:E Ratio Knob
  25. Where do you want the Pulse Frequency Knob and Pulse I:E Ratio Knob for Diffusive Ventilation?
    Set the Knobs at 11
  26. Total PEEP is a combination of what two factors?
    Demand PEEP and Oscillatory CPAP
  27. Where do you set the Demand PEEP
    2
  28. Where do you set the Oscillatory CPAP
    8
  29. What do you adjust the FiO2
    The Blender Knob on the top of the device
  30. What must always BE ON AT ALL TIMES?
    Heated Humidifier
  31. The nebulizer must have what in the cup at all times?
    Sterile water dripping to allow for misting
  32. How do you deliver nebulizer TX w without opening the nebulizer cup
    Use IV port to inject medication
  33. How do you increase PaO2 & decrease PaCO2?
    • Increase PIPS
    • Be patient and allow time for improvement
    • Consider going up by 4
  34. When adjusting PIP's how much should you increase and how much should you decrease by?
    • Go up by 4 to 5
    • Go down by 2
  35. How do you increase PaO2 only
    • Check hemodynaics, blood and fluid levels
    • Increase Oscillatory CPAP in increments of 2
  36. What is YOUR Max CPAP
    20
  37. When making adjustments to CPAP what must be checked after?
    • PAP, MAP
    • BLOOD PRESSURE AND CARDIAC OUTPUT
    • Watch for increased CO2 and PH over 72 hours
  38. To decrease PaCO2 only
    Increase PIP IN INCREMENTS OF 5-10
  39. REMEMBER PIP's AT THE CARINA ARE 1/3 LOWER THAN SET PIP

    If PIP is > or = to 80
    • Decrease high rate from 50p to 350 per minute
    • Monitor PaO2 for decrease in levels
  40. What should you do if you have PaO2 that is normal but have high PaCO2 and high CPAP
    Decrease CPAP in increments of 2-4
  41. A decrease in CPAP = less air trapping and decrease FRC causing what
    De-recruitment of alveoli
  42. How do you increase PaCO2 when you have a low PIP's?
    Increase CPAP levels by 4
  43. What is the BURN Protocol
    • Must be on the VDR
    • 10,000 units of Heprin Q4 times 7 days
    • Alternating with
    • Albuterol Q4 hr
    • Mucomyst
  44. Who is a candidate for BURN PROTOCOL?
    • 18 years or older
    • Inhalation injury must be confirmed
  45. How is an Inhalation injury confirmed
    Bronchoscope
  46. Burn protocols require what type of Ventilation
    High Frequency Percussive Ventilation
Author
AguilarLAGen
ID
361901
Card Set
LAC/USC RT Dept
Description
Updated

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