emergency medicine

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Author:
vanessasoto
ID:
262921
Filename:
emergency medicine
Updated:
2014-02-20 00:25:01
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Description:
notes on chapter 8
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  1. what are the respiratory cycle in 4 stages for ventilation
    • inspiratory flow
    • inspiratory pause
    • expiratory flow
    • expiratory pause
  2. what are the normal in ventilation
    • diaphragm pulls down
    • lungs fill due to negative pressure
  3. mechanical ventilation
    • assisting or controlling patients breathing
    • positive pressure forces air into lungs
    • reversing the normal is a stress to all body systems
    • techs must understand system used and perform consistent patient care
  4. "if the patient ____ _____ have the muscular ability and control to breathe __________ and _______, administering oxygen alone will be __________."
    • does not
    • effectively
    • efficiently
    • ineffective
  5. monitoring
    • pulse oximetry-limitations
    • arterial blood gas-best indicator of oxygen therapy effectiveness
    • pH=7.35-7.45
    • PaCO2=35-45mmHg
    • PaO2=94-100mmHg
    • HCO=22-26mEq/L
    • Base excess= -2 to +2
  6. PaCO2 key for
    ventilation
  7. PaO2 key for
    ventilation/perfusion
  8. CO2 and pH are
    • inversely proportional
    • increased CO2=decreased pH
    • decreased CO2=increased pH
  9. HCO3 and BE indicate
    • metabolic status
    • increased HCO3=alkalosis
    • decreased HCO3=acidosis
  10. Renal and respiratory balance
    respiratory response in few minutes
  11. indications for ventilation
    • lack of improvement or decline on O2
    • increase PaCO2 more than 45 mmHg
    • pH less than 7.4
    • hypoxia increases the work of breathing
    • total body and system fatigue can occur which leads to rapid death
  12. set up for ventilation
    • sedation-paralyze
    • airway-usually ET tube, tracheostomy
    • ventilator
    • monitoring-cuff pressure, O2/CO2, other
  13. controlled ventilation
    • total control of all activity
    • used in apnea
  14. assisted ventilation
    • intermittent control
    • used during episodes of suppressed activity
  15. positive end expiratory pressure (PEEP)
    • elevated pressure maintained in the lungs
    • increases functional residual capacity (FRC)
  16. continuous positive airway pressure (CPAP)
    • maintaining end expiratory pressure above ambient pressure
    • used during spontaneous breathing
  17. continuous positive pressure ventilation (CPPV)
    • applying positive pressure with every breath
    • used when no spontaneous respiration
  18. intermittent positive pressure ventilation (IPPV)
    • applies intermitted positive pressure breaths
    • used in depressed drives, period of apnea, anesthesia
  19. manual
    • manual compression bags that can be connected to¬† ET tube
    • advantage- portable and available
    • limited time; volume delivered and inspired O2 cannot be controlled
  20. pressure-cycled
    • inspiration stops at a present pressure
    • advantage-inexpensive and available
    • disadvantage- cannot ensure adequate tidal volume; with blender, O2 can reach 90%
  21. volume-cycled
    • inspiration stops at a present volume regardless of pressure
    • advantage-control of PEEP, CPAP, FiO2, and tidal volume
    • disadvantage- cost and availability
  22. time-cycled
    • inspiration stops after a present time
    • used for anesthesia delivery
  23. high frequency jet
    rapid small volume administration of O2 for shock lung or fibrosis
  24. troubleshooting
    • check all sources of gas and electricity
    • leak- main problem
    • excess humidification- pooling
    • airway-obstruction
    • true mechanical failure
  25. weaning off ventilator
    • decrease FiO2 by 10% increments q 20 min-monitor ABG at each step, room air FiO2 is 21%
    • decrease mandatory ventilation rate q2-4 min by couple of breaths-monitor for spontaneity, effort, and frequency
    • extubation when spontaneity with adequate efforts occurs-check blood gas after extubation, O2 therapy may be necessary
  26. complications to ventilation
    • serious commitment not to be entered lightly
    • expensive and labor intensive
    • complications- upper airway trauma(cuff, tube), pulmonary barotrauma and pneumothorax, inadequate ventilation, nosocomial infection, insufficient monitoring(hydration, infection)
  27. record keeping
    • one person per record per shift-keep forms and observations constant
    • accuracy and detail-ventilator settings and treatments
    • shift changes overlap 30 min
  28. conclusion
    • tech must understand how and why-understand the machine, blood gas analysis, respiratory therapy
    • owner MUST understand the cost and effort needed to manage a ventilator patient
    • mechanical ventilation-abnormal stress

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