AH3 Exam 1: O2

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Last updated 1:09 AM on 9/23/26
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19 Terms

1
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Whats CPAP? (3)

  1. same pressure for both inhale and exhale

  2. does NOT affect tidal volume

  3. Used for HYPOxemic resp. failure


<ol><li><p>same pressure for <span style="color: rgb(28, 204, 170);"><strong>both inhale and exhale</strong></span></p></li><li><p>does <span style="color: rgb(218, 46, 46);"><strong>NOT </strong>affect <strong>tidal</strong></span><strong> </strong>volume</p></li><li><p>Used for <span style="color: rgb(110, 130, 219);"><strong>HYPOxemic</strong></span> resp. failure</p></li></ol><p></p>
2
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Whats BiPAP?

  1. 2 diff. pressure settings

  2. useful for hypercapnic resp. failure

  • COPD pt retains CO2, so needs to blow off acidic gas= prolonged expiratory pressure


<ol><li><p><span style="color: rgb(247, 56, 56);"><strong>2 diff</strong></span>. pressure settings</p></li><li><p>useful for <span style="color: rgb(47, 64, 193);"><strong>hypercapnic </strong></span>resp. failure</p></li></ol><ul><li><p>COPD pt retains CO2, so needs to blow off acidic gas= prolonged <strong>expiratory </strong>pressure</p></li></ul><p></p>
3
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Whats Rapid Sequence Intubation? (RSI)

  • whats a key feature of RSI?


giving a sedative + paralytic quickly to secure airway while minimizing aspiration risk

  • ex: (decreased LOC, not NPO, ARF etc)



→ key feature: NO BMV between meds and tube placement bc we assume pt has “full stomach” and could aspirate if we ventilate

<p>giving a <span style="color: rgb(53, 159, 207);"><strong>sedative + paralytic</strong> quickly to secure <strong>airway </strong>while <strong>minimizing aspiration</strong></span> risk</p><ul><li><p>ex: (decreased LOC, not NPO, ARF etc)</p></li></ul><p></p><p></p><p>→ key feature: <span style="color: rgb(224, 27, 27);"><strong><mark data-color="#f5e6e6" style="background-color: rgb(245, 230, 230); color: inherit;">NO BMV</mark></strong> </span><span style="color: rgb(6, 5, 5);">between meds and tube placement bc we assume pt has</span><span style="color: rgb(224, 27, 27);"> “<strong>full stomach</strong>” </span><span style="color: rgb(9, 8, 8);">and could aspirate if we ventilate</span></p>
4
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Mechanical Vent terms to know:

  1. FiO2 (and RA %)

  2. Tidal Volume


  1. FiO2

  • concentration of O2 inhaled

  • normal = 21%

  1. Tidal Volume

  • amt of pre-set air delivered w/ each ventilator breath

  • 8-10 ml/kg


5
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Whats PEEP?

whys it used: (2)

  • normal range?


  • Positive End Expiratory Pressure: pos pressure used @ end of exhale

→ Uses: (2)

  1. keep alveoli open (lungs dont deflate all the way)

  2. allows FiO2 levels to be lower


→ normal range: 3-5 cm

6
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Complications of PEEP: (3)

  1. Hypotension

  • ⬆Intrathoracic pressure = ⬇venous return to heart→ hypotension

  1. ⬇CO

  • d/t ⬇venous return

  1. barotrauma

  • pressure > 5 cm can cause alveoli to over inflate → lung tissue tears → pneumothorax


<ol><li><p><span style="color: rgb(67, 114, 186);"><strong>Hypotension</strong></span></p></li></ol><ul><li><p><span data-name="arrow_up" data-type="emoji">⬆</span>Intrathoracic pressure = <span data-name="arrow_down" data-type="emoji">⬇</span>venous return to heart→ hypotension</p></li></ul><ol start="2"><li><p><span data-name="arrow_down" data-type="emoji">⬇</span><span style="color: rgb(209, 51, 51);"><strong>CO</strong></span></p></li></ol><ul><li><p>d/t <span data-name="arrow_down" data-type="emoji">⬇</span>venous return</p></li></ul><ol start="3"><li><p><span style="color: rgb(43, 150, 127);"><strong>barotrauma</strong></span></p></li></ol><ul><li><p>pressure &gt; 5 cm can cause alveoli to over inflate → lung tissue tears → pneumothorax</p></li></ul><p></p>
7
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What are the 2 ventilator alarms?

  1. High pressure: increase in peak airway pressure (occlusions)

  • biting the tube (oral airway)

  • secretions

  • kinked tube

  • pneumothorax

  • ⬇lung compliance (elasticity)

  1. Low pressure: decrease in pressure/loss of volume (leak)

  • cuff not tight

  • disconnected


<ol><li><p><span style="color: rgb(195, 68, 68);"><strong>High </strong>pressure:</span><span style="color: rgb(29, 17, 17);"> increase in peak airway pressure</span><span style="color: rgb(195, 68, 68);"> (<strong>occlusions</strong>)</span></p></li></ol><ul><li><p><span style="color: rgb(195, 68, 68);">biting the tube (oral airway)</span></p></li><li><p><span style="color: rgb(195, 68, 68);">secretions</span></p></li><li><p><span style="color: rgb(195, 68, 68);">kinked tube</span></p></li><li><p><span style="color: rgb(195, 68, 68);">pneumothorax</span></p></li><li><p><span style="color: rgb(195, 68, 68);"><span data-name="arrow_down" data-type="emoji">⬇</span>lung compliance</span> (elasticity)</p></li></ul><ol start="2"><li><p><span style="color: rgb(26, 146, 80);"><strong>Low </strong>pressure: decrease in pressure/loss of volume (<strong>leak</strong>)</span></p></li></ol><ul><li><p><span style="color: rgb(26, 146, 80);">cuff not tight</span></p></li><li><p><span style="color: rgb(26, 146, 80);">disconnected</span></p></li></ul><p></p>
8
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Ventilator Associated Pneumonia prevention measures: (6)

  1. HOB 30-45

  2. oral/ETT care (chlorhexidine)

  3. daily SAT/SBT

  4. early mobilization

  5. VTE prophylaxis

  • bed bound → clots = give heparin

  1. GI prophylaxis

  • stress ulcers = reduce stomach acid (Pantoprazole)


<ol><li><p><span style="color: rgb(234, 92, 92);"><strong>HOB 30-45</strong></span></p></li><li><p><span style="color: rgb(189, 130, 54);"><strong>oral/ETT care</strong> (chlorhexidine)</span></p></li><li><p>daily <span style="color: rgb(62, 172, 41);"><strong>SAT/SBT</strong></span></p></li><li><p>early <span style="color: rgb(80, 157, 207);"><strong>mobilization</strong></span></p></li><li><p><span style="color: rgb(237, 40, 242);"><strong>VTE </strong></span><strong>prophylaxis</strong></p></li></ol><ul><li><p>bed bound → clots = give heparin</p></li></ul><ol start="6"><li><p><span style="color: rgb(43, 200, 176);"><strong>GI </strong></span><strong>prophylaxis</strong></p></li></ol><ul><li><p>stress ulcers = reduce stomach acid (Pantoprazole)</p></li></ul><p></p>
9
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considerations for weaning: (4)

  1. SBT

  • can they breathe w/o vent?

  1. SAT

  • decrease sedation and see if they can follow commands


  1. PO4 (electrolyte replacement)

  • strength muscle


  1. + cuff leak

  • deflate ballon & hear air move around tube

    • no noise = maybe airway edema


10
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Whats ARF?

normal ranges:

  • pH

  • CO2

  • O2

  • HCO3



body cant exchange O2 and CO2 (bad ventilation)

  • pH: (a) 7.35-7.45 (b)

  • CO2: (b) 35-45 (a)

  • PaO2: 80-95

  • HCO3: (a) 22-26 (b)


11
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2 major ARF types:

  • criteria for each


I: Hypoxemic/ failure to oxygenate

  • PaO2 < 60 mmHg

II: hypercapnic/ failure to ventilate (exchange O2 and CO2 efficiently)

  • pH < 7.35 & PaCO2 > 45 mmHg (acidic)


12
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How to manage ARF: (5)

  1. BiPAP

  • T2 ARF (hypercapnic)

  1. CPAP

  • T1 ARF (hypoxemic)

  1. NR mask (100% FiO2)

  2. check ABG

  3. check H&H


<ol><li><p><span style="color: rgb(42, 132, 217);"><strong>BiPAP</strong></span></p></li></ol><ul><li><p><span style="color: rgb(42, 132, 217);">T2 ARF (<strong>hypercapnic</strong>)</span></p></li></ul><ol start="2"><li><p><span style="color: rgb(220, 19, 19);"><strong>CPAP</strong></span></p></li></ol><ul><li><p><span style="color: rgb(220, 19, 19);">T1 ARF (<strong>hypoxemic</strong>)</span></p></li></ul><ol start="3"><li><p><span style="color: rgb(111, 35, 189);"><strong>NR mask</strong></span> (100% FiO2)</p></li><li><p>check ABG</p></li><li><p>check H&amp;H</p></li></ol><p></p>
13
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early impaired O2 findings: (8)

late: (6)

early:

  1. restless

  2. anxious

  3. fatigue

  4. HA

  5. dyspnea

  6. air hunger

  7. tachycardia

  8. ⬆BP

late

  1. confused

  2. lethargic

  3. central cyanosis

  4. diaphoresis

  5. accessory muscles

  6. diminished breath sounds


14
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Clinical manifestation specific to ARDS (2)

  1. Progressive Refractory Hypoxemia: O2 keeps dropping even though ⬆O2

  • increases in FiO2

  • worsening P/F ratio

    • PaO2/FiO2

  1. CXR Bilateral Pulmonary Infiltrates (aka P. Edema)

  • CXR gets cloudy each day


<ol><li><p><span style="color: rgb(235, 72, 72);"><strong>Progressive Refractory Hypoxemia</strong>: O2 keeps dropping even though <span data-name="arrow_up" data-type="emoji">⬆</span>O2</span></p></li></ol><ul><li><p>increases in FiO2</p></li><li><p><span style="color: rgb(243, 61, 61);"><strong>worsening P/F</strong></span> ratio</p><ul><li><p>PaO2/FiO2</p></li></ul></li></ul><ol start="2"><li><p>CXR <span style="color: rgb(30, 149, 181);"><strong>Bilateral Pulmonary Infiltrates</strong> (aka P. Edema)</span></p></li></ol><ul><li><p>CXR gets cloudy each day</p></li></ul><p></p>
15
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P/F ratio ranges (3)

PaO2 (from ABG)/ FiO2 (amt O2 given)

  • < 300= mild ARDs

  • < 200= moderate ARDs

  • < 100= severe ARDs!!!


16
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Tx for ARDs:(6)

  1. Mechanical Vent w/ high PEEP to keep alveoli open

  • barotrauma

  • hypotension

  1. high flow NC (acts as CPAP)

  2. ECMO (lung bypass)

  3. lay in PRONE position early!!

  • recruit alveoli (re-opening collapsed alveoli)

  1. Paralytics for Intubated pts: patient can't fight the ventilator

  • Ventilator desynchrony

  1. No excess fluids! (p. edema)

  • just enough for hydration


<ol><li><p><span style="color: rgb(246, 137, 137);">Mechanical Vent w/ high <strong>PEEP </strong>to keep alveoli open</span></p></li></ol><ul><li><p>barotrauma</p></li><li><p>hypotension</p></li></ul><ol start="2"><li><p><span style="color: rgb(153, 130, 35);"><strong>high flow NC</strong> (acts as CPAP)</span></p></li><li><p><span style="color: rgb(52, 164, 19);"><strong>ECMO</strong> </span><span style="color: rgb(22, 6, 6);">(lung bypass)</span></p></li><li><p>lay in <span style="color: rgb(48, 156, 228);"><strong>PRONE </strong></span>position early!!</p></li></ol><ul><li><p>recruit alveoli (re-opening collapsed alveoli)</p></li></ul><ol start="5"><li><p><span style="color: rgb(53, 38, 217);"><strong>Paralytics </strong></span>for Intubated pts: patient can't fight the ventilator</p></li></ol><ul><li><p>Ventilator <strong>desynchrony</strong></p></li></ul><ol start="6"><li><p><span style="color: rgb(183, 20, 200);"><strong>No excess fluids!</strong> (p. edema)</span></p></li></ol><ul><li><p>just enough for hydration</p></li></ul><p></p>
17
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Why is low tidal volume used in ARDS?

  • to protect lungs bc of ⬇lung compliance

    • if too high, can rupture lung → pneumothorax


18
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ARDs complications: (4)

  1. barotrauma

  • can cause stiff, wet lungs so ⬇compliance

  • high PEEP

  1. renal failure

  • due to hypotension and nephrotoxic meds

  • kidneys 1st organ to fail!!

    • assess urine output

    • BUN, Cr

  1. multisystem organ dysfunction syndrome (MODS)

  • prolonged hypoxemia and sepsis

  1. VAP


19
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What assessment finding alerts nurse intrathoracic pressure in mechanically vented pt is too high?

hypotension

  • ⬆pressure = ⬇venous return = tanks BP