advanced airway management - complex exam three

the volume of air going into the lung with a given amount of pressure is -

compliance

compliance should be -

high (less pressure is required to give a volume of air)

the difference between alveolar and arterial blood O2 is -

alveolar to arterial oxygen gradient

the A-a gradient demonstrates -

the lungs efficiency

what is the normal A-a gradient?

5-20 mmHg

what is the expected A-a gradient in a patient with diffusion impairment (COPD, elderly, ARDS)?

25-30 mmHg

what is the priority intervention for a patient experiencing hypoxemia due to hypoventilation?

hyperventilation

patient has hypoxemia with normal ventilation and no perfusion - what do you suspect?

pulmonary embolism

patient has hypoxemia with no ventilation and normal perfusion - what do suspect?

atelectasis

patient has hypoxemia with no ventilation and no perfusion - what do you suspect?

pulmonary infarction

what will cause a drop in A-a gradient?

a change in ventilation or perfusion

V/Q mismatch causes what change in A-a gradient?

increase

diffusion impairment will cause what change in the A-a gradient?

increase

what is the normal compensatory response to hypoxemia?

hyperventilation to obtain O2 (but is unable to obtain it themselves)

what is the first sign of hypoxemia?

changes in LOC

what is the expected ABGs for a patient with hypoxemia?

acute respiratory alkalosis (high pH, low oxygen, low CO2)

when is an FiO2 of 100% safe?

less than 24 hours

when does an FiO2 of 60% become dangerous?

longer than 48 hours

when is a FiO2 of 50% the safest?

2 to 7 days

what can too much oxygen cause?

inflammation

what kind of breathing assist device is indicated for obstructive sleep apnea, improvement of oxygenation, or prior to exubation?

CPAP

what breathing support is indicated for CHF, neuromuscular disease, or support if a patient refuses intubation?

BIPAP

what is an important consideration for a CPAP and BIPAP?

patient must be able to exhale against pressure

what is the initial way to confirm an ETT placement?

end-tidal colorimetric CO2

what in the final confirmation for the placement of an EET tube?

breath sounds in 5 sites (gut, bilateral upper and lower lobes) and CXR

this type of mechanical ventilation externally applies pressure to the patient -

negative pressure

this type of oxygen therapy forces oxygen into the lungs and initiates respirations -

positive pressure

positive pressure affects CO by -

decreasing venous return

what ventilation is indicated if the patient can not control RR or pattern?

controlled ventilation

this mode of ventilation allows the patient to control the ventilation pattern and rate, but does almost all the work of breathing -

assist-controlled ventilation

this vent setting is used to wean people off the vent but allowing the patient to breath at their own rate with their own tidal volumes -

intermittent mandatory ventilation (IMV)

this ventilator setting prevents alveoli from collapsing and enhances oxygenation -

PEEP (positive end-expiratory pressure)

the main benefit of PEEP is -

it creates higher PaO2 levels at lower FiO2 levels

what is baseline PEEP?

5+

what is the therapeutic range of PEEP?

\+10 to +30 cm H2O

what is used to determine the optimal PEEP?

the PEEP needed to maintain a PaO2 of 60 with an FiO2 of less than 50

when is nosocomial pneumonia most likely to develop?

less than 48-72 hours following intubation