Resp: 21. Killeen : Respiratory Failure, Vasopressors, Hemodynamic Monitoring

Front 1

Hypoxemic

Back 1

Inability to oxygenate (present and delivery of O2)

Front 2

Hypercarbic

Back 2

Inability to ventilate (clear CO2)

Front 3

what are the 4 Clinical Signs of Respiratory Failure

****

Back 3

Tachypnea

Accessory muscle use

****Paradoxical respirations – abdominal contents rise up and into chest during inspiration and outwards during respiration = failure/fatigue of diaphragm

****Decreased respiratory rate and apnea

Front 4

what are paradoxical respirations

****

Back 4

abdominal contents rise up and into chest during inspiration and outwards during respiration = failure/fatigue of diaphragm

Front 5

5 pathologic mechanisms for hypoxemia

Back 5

Low inspired oxygen – altitude

Hypoventilation – CVA, neuromuscular weakness and drugs

Low V/Q (ventilation/perfusion) matching – PE, pneumonia, atelectasis

Right to left shunt – PFO, VSD, pulmonary AVM

Diffusion impairment – CHF, IPF

Front 6

What is Respiratory Quotient (RQ)?

what is it normally?

Back 6

The amount of O2 an individual requires to burn one millimole of carbohydrate, fat and protein

normally RQ=.8

Front 7

discuss left and right shift of the oxygen disassociation curve

Back 7

left shift: O2 stays on Hemoglobin (PO2 goes down)

Right shift: O2 comes off Hemoglobin (PO2 goes up)

Front 8

What 4 things will shift the O2 curve to the left?

Back 8

Temp
pH,
CO2,
2,3 BPG

Front 9

when do you administer mechanical ventilation?

Back 9

Once a patient is determined to be in respiratory failure

, then the decision to establish a “definitive airway” is made as well

Front 10

when intubating where do you stop the tube?

Back 10

just past the vocal cords

Front 11

on a ventilator, what do you set the tidal volume to?

***********TEST

Back 11

6-8ml/Kg ideal body wt

Front 12

discuss volume and pressure control with use of a ventilator

Back 12

Volume control – set volume, pressure independent (most comfortable, but doesn't let pt choose how much they can take in)

Pressure control – set pressure and volume is independent

Front 13

what is PEEP?

Back 13

Positive end expiratory pressure (PEEP) – (0 -20 cm H2O)

Front 14

describe Assist control (A/C) ventilation

when is it used

Back 14

Machine breath or patient breath always same amount of tidal volume (no matter what you want, you get what we give you, and you will like it)

Least work for patient

Least comfortable

Usually requires sedation

Used early in the ventilatory process

Front 15

describe Synchromized intermittent manditory ventilation (SIMV)

when is it used

Back 15

Set number of breaths receive fixed tidal volume

“breathe over” the ventilator and the tidal volume is dependent on the patients effort

Commonly receive pressure support to augment spontaneous breaths

Can be used as a weaning mode and for those patients waking up but still too weak to shoulder most of the ventilatory mode

Front 16

what is statistically the most successful weaning mode of ventilation?

Back 16

Pressure support

Front 17

please describe pressure support ventilation

Back 17

Generally no set rate or tidal volume

Patient awake and spontaneously breathing

Patient has pressure support breath and PEEP with needed FiO2

Statistically the most successful weaning mode

Front 18

what is Minute Ventilation?

equation?

Back 18

direct descriptor of your clearance of CO2

RR x VT

Front 19

what do you use for beat-to-beat hemodynamic monitoring of blood pressure

Back 19

Arterial Lines

Front 20

when placing a central venous line why should you never let go of the wire?

Back 20

it can get sucked into the body

Front 21

what vasopressor do you use for sepsis?

Back 21

NE

Front 22

what is the action of vasopressin?

Back 22

Increases cyclic adenosine monophosphate (cAMP) which increases water permeability at the renal tubule resulting in decreased urine volume and increased osmolality;

Front 23

what effect on the heart does vasopressin have?

****

Back 23

direct vasoconstrictor without inotropic or chronotropic effects

Front 24

2 major types of vascular monitoring devices

****

Back 24

a lines or PA catheters

Front 25

5 types of vasopressors


****

Back 25

Dopamine

Epi

NE

Vasopressin

Phenylephrine

Front 26

what are the 2 types of respiratory failure?

***

Back 26

Hypoxemic
Inability to oxygenate (present and delivery of O2)

Hypercarbic
Inability to ventilate (clear CO2)

Front 27

when do you use vasopressors?

Back 27

Indicated when volume resuscitation fails to restore adequate arterial pressure/organ perfusion

Front 28

phenylepherine MOA?

Back 28

Synthetic selective alpha 1 adrenergic receptor agonist