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39 Cards in this Set
- Front
- Back
Define acute respiratory failure |
Any condition in which respiratory activity is completely absent or is inadequate to maintain oxygen uptake and carbon dioxide clearance. PaO2 and SpO2 are the key indicators of the severity of acute hypoxemic respiratory failure |
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Recall specific examples of diseases associated with impaired neuromuscular function (8) |
intracranial hemorrhage cerebrovascular accidents central alveolar hypoventilation syndromediaphragmatic paralysis severe respiratory muscle failure high spinal cord injury end-stage pulmonary interstitial fibrosis end-stage neuromuscular disorders |
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Acceptable and critical values for MIP |
MIP: acceptable: -50 to -100cmH20 critical: 0 to -20cmH2O |
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Acceptable and critical values of MEP |
MEP: acceptable: > 100cmH2O critical: < 40cmH20 |
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Acceptable and critical values is PaCO2 |
PaCO2:acceptable: 35-45mmHg critical: >50mmhg and rising |
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Acceptable and critical values of vital capacity |
VC: acceptable: 65-75ml/kg
critical: <15ml/kg |
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Acceptable and critical values of dead space (VD/VT) |
VD/VT: acceptable: 0.3-0.4 critical: >0.6 |
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Acceptable and critical values of PaO2 |
PaO2: acceptable: 80-100mmHg critical: <60-70mmHg |
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Acceptable and critical values of pH |
pH: acceptable: 7.35-7.45 critical: <7.25 |
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Acceptable and critical values of tidal volume |
VT: acceptable: 5-8ml/kg critical: <5ml/kg |
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Acceptable and critical values of FEV1 |
FEV1: acceptable: 50-60ml/kg
critical: <10ml/kg |
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Acceptable and critical values P(A-a)O2 |
P(A-a)O2: acceptable: 3-30mmHg critical: >450mmHg (on O2) |
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Acceptable and critical values of PaO2/PAO2 |
PaO2/PAO2: acceptable: >0.75 critical: <0.15 |
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Acceptable and critical values of PaO2/FIO2 |
PaO2/FIO2: acceptable: >475 critical: <200 |
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Define refractory hypoxemia, and explain how it may best be treated |
Refractory Hypoxemia: A PaO2 less than 70 mm Hg (or SpO2 less than 90%) on an oxygen mask (FIO2 >0.6) (hypoxemic respiratory failure.)Can be treated with PEEP or CPAP |
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Signs and symptoms of mild-to-moderate hypoxemia |
Respiratory: tachypnea, dyspnea, paleness Cardiovascular: tachycardia, mild hypertension, peripheral vasoconstriction Neurologic: restlessness, disorientation, headaches, lethargy |
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five goals of the therapy for the mechanically ventilated patient |
1. maintain an adequate level of alveolar ventilation 2. Reduce the work of breathing 3. Restore arterial and systemic acid–base balances 4. Increase oxygen delivery 5. Prevent complications associated with mechanical ventilation |
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Technique associated with measurement of MIP |
MIP: 8-10 consecutive breaths are monitored, may take up to 20 seconds to reach most negative value, should be performed at RV, effort dependent |
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Situations which may lead to airway narrowing, or occlusion |
aspiration of food, liquids and GI contents, foreign objects loss of muscle tone excessive secretions airway smooth muscle constriction bilateral vocal cord paralysis laryngospasm swelling of the laryngeal tissues (epiglottitis, submucosal or retropharyngeal hemorrhage, allergic reactions, head or neck trauma, and post extubation) |
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differentiate partial from complete airway obstruction |
Absence of breath sounds may indicate complete airway obstruction |
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Maintenance and monitoring of ETT |
Position and depth Security Appearance of Surrounding Tissue Cuff Pressure Disconnect and Apnea alarms set appropriately Ease of suctioning Looking for Necrosis/Pressure Sores |
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How, and where to “needle” a life-threatening pneumothorax. |
Prep skin palpate 2nd intercostal space, mid-clavicular line on affected side insert needle/valve, over the top of the rib |
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Write out the formula for CaO2 |
CaO2 = ([Hbx1.34]xSaO2)+(PaO2x0.003 |
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Write out the formula for PAO2 |
PAO2 = ([PB-PH2O]xFIO2)-PaCO2(1.25) |
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Write out the formula for P(A-a)02 |
P(A-a)02= PAO2-PaO |
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Left chamber of Pleur-evac |
LEFT: suction control, height of water (20cmH2O) determines negative pressure Additional suction -60 to -80, too high can lead to evaporation |
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Middle chamber of Pleur-evac |
MIDDLE: water seal chamber, water level 2cm, spontaneous inspiration = H2O rises, expiration = H2O falls
Tidaling = patent chest tube |
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Right chamber of Pleur-evac |
RIGHT: collection chamber for fluid <25ml/hr and no leak = remove chest tube 500-1000ml of bright red = report |
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problems with long-term intubation (5) |
Infection Vocal cord paralysis Trachial stenosis Tracheoesophageal fistula Tracheal erosion: sudden hemoptysis or pulsating trach tube |
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Cause of re-expansion pulmonary edema |
Fluid pouring into alveolar spaces after rapid re-expansion (thoracentesis: draining of pleural effusion) Occurs most frequently when negative pressure is used to evacuate the pleural space rapidly |
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conditions associated with altered chest wall movement (5) |
Abdominal paradox, sometimes with respiratory alternans Accentuated abdominal breathing Paradoxical chest wall movement Accessory muscles augmenting inspiration and sometimes expiration Unilateral decrease in chest expansion |
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conditions that may cause tracheal deviation towards (2) |
atelectasis pneumonectomy |
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conditions that may cause tracheal deviation away (3) |
pleural effusion tension pneumothorax unilateral hyperinflation secondary to ball-valve obstruction of main bronchus |
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Disorders associated with transudative pleural effusions (9) |
CHF pericardial disease pulmonary embolism cirrhosis hypoalbuminemia nephrotic syndrome hydronephrosis acute glomerulonephritis peritoneal dialysis |
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Disorders associated with excudative pleural effusions (9) |
pulmonary infections malignancy gastrointestinal collagen-vascular disease (lupus, rheumatoid) trauma iatrogenic disorder radiation therapy uremia drug induced |
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Problems which may cause stridor |
Laryngospasm |
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Problems which may cause wheezing |
Bronchial narrowing |
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Problems which may cause gurgling |
Presence of excessive secretions or foreign matter in the airway |
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Problems which may cause snoring |
Partial occlusion of pharynx |