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neg pressure vent is also known as
extrathoracic
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neg pressure vent is controlled by adjusting the length of _____ and the amt of _____
- inspiration (time cycled)
- suction
-
neg pressure vent is indicated for what type of pts
- intermitted use
- home care
- neuromuscular pathologies
-
examples of neg pressure vent include
- iron lung - body tank
- chest cuirass
-
if a chest cuirass is hissing and unable to reach pressure, what should u do?
check for leaks
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if the pt is breathing faster that the rate set on the neg pressure vent, what should you do?
increase the set rate to match the pt
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positive pressure creates positive pressure that will push air into the pts lungs and increase ___
intrapulmonary pressure
-
side effect of pos press vent include
- dec venous return
- dec c/o
- inc icp
- inc intrathoracic pressure
-
positive pressure vent- pressure cycles vent are normally pneumoatically powered with how much psi
50 psi
-
pos press vent- press cycled vent- vt is adjusted by increasing or decreasing the
pressure limit
-
pressure cycled positive vent is best for ippb or con vent for pts with
-
examples of pressure cycled pos press vent
-
what must be considered when using air and o2 cylinders to power a transport vent
duration of flow
-
typical vent circuit includes
- ins limb
- exp limb
- wye adaptor
- neb
- humidifier
-
how many person do you need to change a vent circuit
- 2
- 1 bags while the other attaches and tests new circuit
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vent circuits should NOT be changed on a regular basis UNLESS
- circuit is grossly contaminated
- malfunctioning
-
pt should be off the vent for the ____ possible amt of time
shortest
-
vent alarms-
high pressure limit should be set
10 ABOVE peak airway pressure
-
vent alarms-
min exh volume should be set
100 BELOW exh vt
-
vent alarms-
low pressure limit should be set
10 BELOW peak airway pressure
-
when troubleshooting vent alarms, what should you always provide to the pt?
manual ventilation first
-
if the LOW pressure alarm is sounding, what should you consider?
- pt d/c
- leak
- insufficient flow
- cuff leak
IMPORTANT. cause theres a leak
-
if the HIGH pressure alarm is sounding, what should you consider?
- pt obstruction
- equipment obstruction
-
if the LOW EXH VOL is sounding, what should you consider
pt d/c
-
time cycled pressure limit vent are common for what type of pts
infant
-
TCPL maintains preset press limit using
pressure popoff
-
indications for mech vent
- apnea
- acute vent failure
- impending resp failure
- oxygenation
-
normal range for vt
5-8 ml/kg
-
normal range for vc
65-75 ml/kl
(10 X vt) = vc
-
normal range for rr
12-20
-
normal range for min vent
5-6 l/min
-
-
-
-
-
formula for alveolar minute ventilation
(vt - vd) x f
-
alveolar ventilation is best increased by
increasing vt
-
formula for static comp
exh vt / (pl - peep)
-
increasing airway pressure indicates the lung is becomming
more difficult to ventilate (stiff)
-
2 reasong for airway pressure to INCREASE on mech vent
- increasing airway resistance Raw
- decreasing lung compliance CL
-
increasing airway resistance=
- increase PIP
- Ppl stays the same
-
decreasing lung compliance=
-
common cause of increase airway resistance
-
tx of an increase airway resistance
-
common cause of decrease lung compliance
- atelectasis
- pulm edema
- ARDS
- pneumonia
-
tx of an decrease lung compliance
increase peep
-
avg pressure transmitted to the airway from the beginning of one breath to the beginning of the next
mean airway pressure Paw
-
-
Paw of 10-20
obstructive disease
-
-
simv mode is used for pts with
- copd
- tachypnea
- weaning
- reduce barotrauma
- w/ peep
-
pressure control vent is used when
- peak ins pressure is very hihgh > 50
- low pao2 and decreased comp ARDS
-
exh vt will vary, adjust ___ or __ as necessary
-
inverse ratio ventilation is used when
- pip is very high >50
- pt req high fio2
-
pt should be __ and __ bc inverse ratio breathing is uncomfortable and difficult to tolerate
-
indications for high freq vent
- lower peak/mean airway pressure
- pt with bronchopleural fistuba or ards
- air leak prob
-
indications for ILV independent lung ventilation
protect one lung from contamnation or infectiong
-
examples of ILV
- double lumen tube DLT
- Carlens tube
-
copd pts i:e ration
- 1:4, 1:5
- they need more time to exhale
-
increasing ____ will increase the time for exhalation
flow rate
-
positioning the pt for mech vent, pt should INITIALLY be placed in a a ___ position
supine
-
PEEP/CPAP therapy is used to
- increase a pt FRC
- improve compliance
- improve oxygenation prob caused by shunting
- improves myocardial o2
- increases cardiac output
-
increase/decrease peep/cpap in increments of
2-5
-
optimal or best PEEP is the lowest amt to provide good oxygenation without any
side effects
-
formula for Flowrate
(vt - rate) x (i + e)
-
vent protocols for pt with ARDS
- reduce vt to 6
- maintain ppl <30
-
vent protocols for pt with asthma
- reduce vt to 4-6
- set rr btwn 10-12
- consider perm hypercapnea- allow co2 to rise
-
loop that looks like a fish
assisted= pt trig
-
loop that looks like a football
controlled- machine
-
loop that looks like a oval head
spotaneous
-
setting the optimum peep on a football loop that has a flat on the bottom, how would you change it
increase peep
-
what would you do if there is a over distention on a loop (looks like a duck)
decrease vt
-
a broken loop is an indication of a
leak
-
what would you increase on a ventilator to get rid of auto peep/air trapping
increase flow
-
decrease anxiety and promote relaxation
sedatives
-
-
reduces pts ability to perceive sensation
anesthetics
-
ex of anesthetics
propofol
-
reduce sensation of pain
analgesics
-
ex of analgesics
morphine
-
cause paralysis of skeletal muscle
neuromuscular blocking agents
-
ex of neuromuscular blocking agents
- succinylcholine- intubation
- pancuronium- long term
-
if a pt is fighting, and is agitated on a vent, what should you give
morphine
-
if morphine is not an option when pt is agitated and fighting while on a vent, what should u give
versed
-
abg should be drawn after ____ minutes off of mech vent to assess the pts vent/o2 status
20-30 min
-
what should u do if the pt is having difficulty in weaning
PSV - can be used with IMV/SIMV
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