CC Instrumentation exam 2

Pulmonary embolism will cause a ____ in alveolar dead space

increase

a decreased VT will cause a ___ anatomic deadspace to volume percent?

higher

Indications for Mechanical ventilation w/ example

Apnea = cessation of breathing

Acute ventilatory/respiratory failure = PaCO2 > 55mmHg; pH < 7.25

Impending respiratory failure

airway protection: GCS < 8

Normal range for ICP?

12-15 cmH2O

How is pressure support ventilation cycled?

FLOW

Pts with ___ I:E ratios have an increased risk for developing auto-peep?

Larger

An increase in set RR in VC ventilation will cause ___ in I:E ratio?

increase

air located within a body space or compartment is known as?

barotrauma

What change should be made to the vent to increase oxygenation besides FiO2?

Increase PEEP

What settings can you change that will affect the I:E ratio?

RR, peak flow rate, tidal volume, flow pattern

If you increase your RR what happens to the I:E ratio and E time ?

E time gets shorter and Ratio gets larger

Normal I-Time?

0.8 - 1.2 sec

High pressure alarm should be?

10 cmH2O above PIP

Low pressure alarm should be?

5-10 cmH2O below PIP

Low PEEP alarm?

2-5 cmH2O below PEEP level

Low exhaled VT alarm?

10-15% below set VT (58-87mL)

Low exhaled Ve alarm

10-15% below average MV (0.7-1.5)

Reasons that the Low pressure alarm would go off?

possible disconnection or leak

What should you look for on the pt for a low pressure alarm?

LOC, accessory muscles, chest wall movement, appearance, auscultate

Why could the high pressure alarm be going off?

biting ETT, kinking of ETT, coughing, secretions, change in lung characteristics, nebulizer residue on expiratory filter

What is another name for auto-peep?

dynamic hyperinflation

What maneuver is performed to measure auto-peep?

an expiratory hold. Total PEEP - Set PEEP = Auto-PEEP

How do you fix auto-PEEP?

Increase your E-time by decreasing your RR, VT, I-time, or increase inspiratory flow

What is the appropriate time interval for an apnea alarm?

20 seconds

Minute Volume (MV) = VT x RR

RR = MV / VT

Why are HMEs inappropriate for use with infants, children, and small adults?

Creates mechanical deadspace

Respiratory mechanics that indicate acute ventilatory failure

VC < 10-15 mL/kg IBW

MIP/NIF > -20 to -30 cmH2O

MEP < 40 cmH2O

VT < 5 mL/kg IBW

RR > 35 BPM

Decrease VT causes a ___ anatomic deadspace to volume percent (delete )

increased

Normal shunt level

<10%

Mild shunt level

10-20%

moderate shunt level

20-30%

severe shunt level

>30 %

IBW formula for females

105+5 (ht - 60) / 2.2 × 8

IBW formula for males

106+6 (ht-60) / 2.2 × 8

MAP is associated with?

oxygenation but it primarily affects VT

what is the range for therapeutic PEEP?

5-14 cmH2O

Pt with ___ I:E ratios have an increased risk of developing auto-peep?

larger

An inappropriately set flow cycle will provoke which alarm if a leak exceeds the flow cycle % settings?

I-time too long

if the PaCO2 increases the pH will?

decrease

After 72 hrs the HME should be changed to which of the following?

heated wick type humidifier

hypercapnic respiratory failure type 2 occurs when?

a person cannot achieve adequate ventilation to maintain a normal PaCO2 (lungs cannot eliminate CO2)

What is hypercapnic resp failure type 2 caused by?

CNS disorders (ODs), neuromuscular disorders (ALS), disorders that increase WOB (asthma, COPD, PF, CF, secretions)

acute hypoxemic respiratory failure type 1

failure to provide adequate O2 to meet metabolic needs; most commonly recognized by comparing PaO2 w/ FiO2 (P/F ratio < 200 = intubate; >300 good for transplant)

What is acute hypoxemic resp failure caused by?

severe V/Q mismatch, diffusion defects, R to L shunt, alveolar hypoventilation, aging, inadequate inspired O2