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PEEP
- -A major oxygenation adjunct treatment modality
- –AN IMPORTANT GOAL OF PEEP IS TO AVOID INCREASING FiO2WHICH CAN LEAD TO OXYGEN TOXICITY
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Normal physiological PEEP in the average adult is what?
» Levels above 10-12 cm H2O are generally considered high
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Positive End Expiratory Pressure Monitoring Guidelines
If a significant drop in BP occurs, PEEP may need to be reduced or vasoactive drugs may be indicated
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How do you prevent atelectasis?
- • Ensuring adequate Tidal Volumes
- • Ensuring adequate and appropriate ventilator settings
- – Dependent on every single patient
- • Age
- • Weight
- • Diagnosis
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What is Ventilation?
The process by which gases are moved into and out of the lungs
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What is Perfusion?
The process of blood moving through the pulmonary capillary system to the alveoli for the purpose of gas exchange
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What is Anatomical dead space?
- The entire area from nose to terminal bronchioles where gas flows, but is not exchanged
- Calculated as 2 ml/kg
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What is Physiological dead space?
The sum of the anatomical dead space plus the volume of any nonfunctional alveoli
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What is Tidal volume?
- The volume of air inspired in a single, resting breath
- • Calculation for TV when placing a patient on a ventilator is 7-10 ml/kg
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What is Oxygen Toxicity?
O2 greater than 50% for > 12 hours can destroy type 2 alveolar cells and they don’t make surfactant, thereby creating atelectasis
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What are the Factors that increase the amount of energy
- needed for ventilation include?
- – Loss of pulmonary surfactant
- – Increase in airway resistance
- – Decrease in pulmonary compliance
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ARDS
- Acute Respiratory Distress Syndrome
- – Acute lung inflammation
- – Diffuse alveolar-capillary injury
- • Resulting in
- –Refractory Hypoxemia
- – Severe pulmonary edema
- – A decrease in pulmonary compliance
- • The cause of ARDS is not well known
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What is Shunting as it relates to Acute Respiratory Distress Syndrome?
- • Blood goes from the RV to the pulmonary vasculature and returns to the LV and never comes in contact with an aerated alveoli
- • Gas exchange can not take place
- • There is a separation of alveoli from blood supply
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What causes ARDS?
- – Direct physical or toxic injury to the lungs
- – Indirect, blood-born injury to the lungs
- • Trauma
- • Gastric aspiration
- • Bypass surgery
- • Multiple blood transfusions
- • Infections
- • Sepsis
- • Oxygen toxicity
- • Toxic inhalation
- • Drug overdose
- • Pneumonia
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ARDS Management-
- – High concentration of oxygen
- – Ventilatory support
- – Fluid replacement to maintain cardiac out and perfusion
- – PEEP (Positive End Expiratory Pressure)
- – Adequate Tidal Volume
- – Pressure control ventilation vs. Volume control
- – Drug therapy to support mechanical ventilation
- – Pain management
- – Sedatives
- – Paralytics if needed
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What are Pleural effusions?
An abnormal accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity
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What are the indications for Surgical Cricothyrotomy?
- • Absolute need for definitive airway, AND
- – unable to perform ETT due to structural or anatomical reasons, AND
- – risk of not securing airway is > than surgical airway risk
- OR
- • Absolute need for definitive airway AND
- – unable to clear an upper airway obstruction, AND
- – multiple unsuccessful attempts at ETT, AND
- – other methods of ventilation
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Contraindications for Surgical Cricothyrotomy
- • No real demonstrated indication
- • Risks > Benefits
- • Age < 8 years (some say 10, some say 12)
- • Evidence of fractured larynx or cricoid cartilage
- • Evidence of tracheal transection
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