Comprehensive Guide to Mechanical Ventilation, ARDS, and Cardiac Dysrhythmias

What criteria must be met before initiating a spontaneous breathing trial (SBT)?

Stable hemodynamics, improved condition, awake and following commands, calm, FiO2 ≤ 40%, PEEP ≤ 5

When should a spontaneous breathing trial be stopped?

Changes in hemodynamics, bleeding, neuro decline, worsening diagnostics

How often should SBTs be performed?

Daily

What ventilator settings indicate readiness for SBT?

FiO2 40% and PEEP 5

What positioning improves oxygenation in ARDS?

Prone or good lung down

What is the max suction time for endotracheal suctioning?

10 seconds

What must be done before suctioning?

Pre-oxygenate

What complication requires stopping suctioning immediately?

Vagal response or hypoxia

What is the main problem in ARDS?

Damage to alveolar-capillary membrane

What are the three phases of ARDS?

Exudative, proliferative, fibrotic

What defines hypoxemic respiratory failure?

PaO2 < 60 mmHg despite oxygen

What defines hypercapnic respiratory failure?

PaCO2 > 50 mmHg

What is V/Q mismatch?

Imbalance of ventilation and perfusion

What conditions cause V/Q mismatch?

PE, pneumonia, ARDS, asthma

What is a shunt?

Blood bypasses gas exchange

What are types of shunts?

Anatomic (VSD) and capillary (ARDS, pneumonia)

What is diffusion limitation?

Impaired gas exchange due to thick membrane

What disease causes diffusion limitation?

Pulmonary fibrosis

What unique description is used for diffusion limitation imaging?

Carrot-like density

What is alveolar hypoventilation?

Reduced ventilation causing CO2 retention

What is the main cause of hypercapnia?

Alveolar hypoventilation

When is mechanical ventilation indicated?

ARF, apnea, airway protection, hypoxemia, hypercarbia, fatigue

What are signs of hypoxemia?

Mental changes, dyspnea, cyanosis, tachypnea, low SpO2

What are signs of hypercapnia?

Decreased RR, shallow breaths, tripod position

How do you identify uncompensated ABG?

CO2 or HCO3 normal

What indicates partial compensation?

Both CO2 and HCO3 abnormal

What indicates full compensation?

Normal pH with abnormal CO2 and HCO3

What is the priority treatment for bradycardia?

Atropine or pacing

Why does tachycardia occur?

Compensation for underlying problem

What are the 3 goals of atrial fibrillation treatment?

Rate control, prevent stroke, convert rhythm

What is the priority in AFib management?

Rate control

What medications control AFib rate?

BB, CCB, digoxin, amiodarone

What must be considered before cardioversion?

Anticoagulation

What is treatment of atrial flutter?

Radiofrequency ablation

What is first-line SVT treatment?

Vagal maneuvers

What medication treats SVT if vagal fails?

Adenosine

What is treatment for unstable SVT?

Cardioversion

What is treatment for stable VT with pulse?

Amiodarone, lidocaine, procainamide

What is treatment for pulseless VT?

CPR and defibrillation

What is treatment for ventricular fibrillation?

CPR and defibrillation

What medication treats torsades?

IV magnesium

What is PEA?

No pulse but electrical activity

What are causes of PEA?

H's and T's (hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, hypokalemia, hypoglycemia, hypothermia, toxins (e.g., drug overdose), cardiac tamponade, thrombosis (e.g., MI, pulmonary embolus), tension pneumothorax, and trauma)

What is treatment for PEA?

CPR, epinephrine, treat cause

What defines PVCs?

Wide QRS, early beat

What causes PVCs?

Electrolytes, hypoxia, stimulants

What defines PACs?

Early P wave

What causes PACs?

Caffeine, stress, fatigue

What is multifocal dysrhythmia?

Different shapes, multiple foci

What is unifocal dysrhythmia?

Same shape, single focus

How do you calculate HR with 6-second strip?

R waves x 10

What does ST elevation indicate?

Infarction

What does ST depression indicate?

Ischemia

What is priority after cardioversion?

Airway, ECG, LOC, vitals

What complication should be checked after cardioversion?

Skin burns

What is HFrEF?

Systolic failure (poor contraction)

What is HFpEF?

Diastolic failure (poor filling)

What are HF compensatory mechanisms?

RAAS, SNS, hypertrophy

What are counterregulatory mechanisms in HF?

Natriuretic peptides, NO, prostaglandins

What is ADHF?

Sudden worsening HF with pulmonary edema

What is most sensitive sign of HF?

JVD

What are signs of pulmonary edema?

Pink frothy sputum, crackles, dyspnea

What is LVAD used for?

Support left ventricle

What must LVAD patients have?

Anticoagulation

What is IABP?

Counterpulsation device

What does IABP improve?

Coronary perfusion and decreases afterload

What is risk with IABP?

Rupture, migration

What must be monitored with IABP?

Urine output

What do anticoagulants do?

Prevent new clots

What do antiplatelets do?

Prevent platelet aggregation

What do thrombolytics do?

Break down clots

When are thrombolytics used?

STEMI without cath access

What is stable angina?

Predictable, relieved with rest

What is unstable angina?

Unpredictable, prolonged

Who is at risk for endocarditis?

IV drug users, prosthetics, dialysis

What are signs of endocarditis?

Fever, Osler nodes, Janeway lesions

What organs are affected by emboli?

Brain, kidneys, spleen, lungs

What is treatment for endocarditis?

Long-term IV antibiotics

What is a true aneurysm?

All vessel layers intact

What is a fusiform aneurysm?

Circumferential dilation

What is a saccular aneurysm?

Pouch-like bulge

What is a pseudoaneurysm?

Complete vessel wall disruption

What is biggest complication of AAA?

Rupture

What are signs of AAA rupture?

Back pain, Grey Turner sign

What is ABI?

Ankle pressure / brachial pressure

What is aortic dissection?

Tear creating false lumen

What is Type A dissection?

Ascending, surgical emergency

What is Type B dissection?

Descending, medical management

What is hallmark symptom of dissection?

Tearing chest/back pain

What is pre-op priority in dissection?

Lower HR and BP

What defines superficial burn?

Red, painful, no blisters

What defines deep partial burn?

Blisters, wet, very painful

What defines full-thickness burn?

Dry, leathery, painless

What is priority in emergent burn phase?

Airway and fluids

What complication occurs in burn shock?

Hypovolemia

What respiratory complication occurs in burns?

Smoke inhalation

What are signs of inhalation injury?

Soot, hoarseness, singed hair

What oxygen should be given in inhalation injury?

100%

What renal complication occurs in burns?

AKI from myoglobin

What urine output goal in electrical burns?

100 mL/hr