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What does PEEP do?
Holds alveoli open after expiration. A little left over in lungs to allow for longer gas exchange.
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PEEP stands for:
Positive end expiratory pressure
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Normal PEEP setting:
5cm of H2O (but can go up to 15-20cm)
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PSV stands for
Pressure support volume
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PSV used for
Augment pt's inspiratory pressure (effort).
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What we want inspiratoy pressure to be at least
-20
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Ideal ispiratory pressure
-70 to -100
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ABGs are checked q__ when pt first put on vent
30 mins
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We can decrease __ if PEEP is added
FiO2, bc pt ventilates better
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What does the same thingas PEEP, but during spontaneous breaths?
CPAP
- Most common cause of high pressure alarm?
- Pt needs to be suctioned
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Ventilatory asynchrony is
Pt breathing aginst the vent. Tx by changing method or sedation
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Most common cause of low pressure alarm?
Pt disconnection. PEEP can pop off, or pt can extubate themself.
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If high pressure alarm isn't r/t increased secretions, may also be r/t
development of tension pneumothorax. ASSESS pt.
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What barotrauma gets bigger w/each breath?
Tension pneumothorax
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Tension pneumothorax can lead to what heart-related complication?
Decrease cardiac output
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When pt on PEEP, what cardiac issues may develop?
decreased BP r/t increase interthoracic pressure and impaired venous return.
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Measure __ when pt on PEEP
MAP
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3 Methods for weaning off vent
IMV/SIMV, CPAP, T-piece
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How to wean when pt on IMV/SIMV:
(1) lower resp rate, (2) lower FiO2, (3) continue.
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Hallmark of respiratory failure is:
Hypoxemia
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Tx for V/Q mismatch
O2 therapy, b/c not all gas exchange units are effected
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What is shunting?
When blood passes thru pul circulation without participating in gas exchange
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Failure of utilization occurs w/___ and means
Septic shock; o2 is delivered to cells but not extracted
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Pathophys of ARDS
increased pulmonary capillary membrane permeability, destruction of elastin and collagen, and microemboli and pulmonary artery vasoconstriction. The fluid in the caps leave the caps and fill up the alveoli
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Define refractory hypoxemia
As you increase FiO2, the PaO2 goes down. Hallmark of ARDS
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Classic symptom of ARDS
refractory hypoxemia
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Classic tx for ARDS
PEEP. PEEP holds alveoli open and pushes fluid back into circulation. They can be on higher levels of PEEP (like 10 cms). Also tx w/vasopressors to maintain MAP.
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ARDS timeline
First week: injury, then pul edema, atelectasis. V/Q mismatch. Then, lungs become fibrous and decreased compliance.
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White out/White lung is a late manifestation of
ARDS; early CXR look normal or have a few infiltrates
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If infants reach original due date and still having problems breathing they're dx w/
BPD
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ARDS is
Sudden progressive form of respiratory failure; stands for Adult Resp Distress Syndrome
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Dx criteria for ARDS (PaO2)/(FiO2)
Less than 200
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