1.  Readiness to wean from mechanical ventilation

2.  Strength and ability to cough

Signs and Symptoms

of

inadequate humidification

Atelectasis

Dry, non productive cough

Increased airway resistance

Increased infection

Increased WOB

Substernal pain/airway dryness

Thick, dry secretions

1.  Ensure flowmeter is turned on

2.   Pre-filled water bottles:  make sure resevoir has been pierced  and that gas can flow through it

3.  Check outlet for obstruction

4.  Check tubing for obstuction

5.  Replace humidifier

Significant Complication

of

Bronchoscopy

Catheter used to measure

PCWP

1.  Inflection point of a volume pressure loop graphic

2.  Acceptable oxygenation with no cardiovascular side effects

3.  Increasing static compliance with acceptable oxygenation

Hypokalemia

(low potassium)

Hemodynamic results associated with

1.  Right Heart Failure

2.  Cor Pulmonale

Increased CVP

Decreased PAP

Signs and Symptoms

of

Shock

1.  Cold and Clammy

2.  Sinus Tachycardia with occasional PVCs

3.  Low B/P

1.  Respiratory Stimulant

2.  Given to premature infants to treat apneic episodes

Correction Factor

for

80/20 mixture

Significant Bubbling in the water seal (chest tube)

compartment leads to

Pneumonia

(On X-Ray)

Pneumothorax

(on X-Ray)

1.  Right lower lobe atelectasis

2.  Hepetamegaly

3.  Pneumonia

1.  Flow

2.  Tidal Volume

3.  Airway Pressure

How to reduce CO2 on the ventilator

1.  Increase minute ventilation

2.  Remove tubing between the circuit wye and the patient interface

1.  Flow

2. Rate

3. Volume

1.  Increase the flowrate

2.  Decrease the I-Time

3.  Increase E-Time

1.  Bronchodilator

2.  Percussion

3.  Postural Drainage

4.  Cough Coaching

Treatment For Stiff Lungs: 

Decrease Static Compliance

ARDS/ALI

1.  Optimum PEEP

2.  Pressure Control Ventilation

3.  Inverse Positive Pressure Ventilation (IPPV)

CaO2=Hb*4/3

hemoglobin times four divided by 3

Kamen-Wilkinson Foam Bivona Cuff

(Bivona Cuff)

Large Volume Nebulizer--Puffs of aerosol coming from tubing when set at 28% or Kink in the aerosol tubing coming from nebulizer

IPPB Machine--Last part of delivered breath

1.  Identifies pneumothorax in infants

2.  Identifies ARDS in infants

Radiolucency

Sharp Costophrenic Angles

Dome shaped hemidiaphragms

Right hemidiaphragm higher than Left one

Trachea Midline

Medium Rales

(crackles)

Auscultated in the middle airways

Treatment:  CPT

Fine Rales

Auscultated in the lower airways (alveoli)

Treatment: 

Oxygen

IPPB

Heart Drugs

Diuretics

PaCO2

PeCO2

Venturi Mask

Large Volume Nebulizer

Some IPPB Machines

Some Ventilators

Epistaxis

Middle ear infections

Obliterated Costophrenic Angles

&

Concave Superior Border

(fluid filled organs)

Heart

Pleural Effusion

Liver

Pneumonia

pneumonia

pleurisy

tuberculosis

No nasal flow

No chest movement

Microatelectasis

ARDS

Chronic Bronchitis

Emphysemia

Apnea-Hypopnea Index (AHI)

less than 30

Fluffy Infiltrates

Butterfly Infiltrates

Batwing Infiltrates

Inverse positive pressure ventilation

Optimum PEEP Therapy

Pressure Control Ventilation

Mechanical Ventilation

Manual Resuscitation Bag

IPPB

BiPAP

Pressure Support Ventilation

Mouth to Mouth

Succinylchlorine Chloride

Anectine

Give prior to intubation

May cause muscle twitching if working properly

2-5cm above carina

or

level with aortic arch

(abnormal flows)

FEV1/FVC

FEV1

Chest Movement

RR

Tidal Volume

Breath Sounds

A mechanical ventilator patient's

end tidal CO2 is

zero

How are secretions mobilized

CPT

IPV

IPPB

PEP

Flutter Valve

Ultrasonic

Postural Drainage

(water is the best way to clear secretions)

Ideal for the measurement of CO2 and pH

Not a good monitor for O2

PFT Test:

SBN2

Expresses the eveness of gas distribution within the lungs

Phase I--Only deadspace gas

Phase II--Deadspace gas + Alveolar gas

Phase III--Shows eveness of distribution

Phase IV--Closing volume

Increased RBC

Increased Hb

Prevelant in COPD patients

Medications that aid in

the treatment

of

ARDS & Asthma

Albuterol

Atrovent

Surfactant

Patchy Infiltrates

Platelike Infiltrates

Correction Factor

for 60/40

1.  Transtracheal Catheter

2.  Pulse-Dose System

3.  Resevoir Cannula

Quick signs of

Respiratory Distress

(Adults)

Intercostal Retractions

Sternal Retractions

Use of Acessory Muscles

Conclusive Evidence of

Epiglotittis

If PAP is 16/8, what is mPAP

mPAP = (2*D) + S/3

mPAP = (2*8) + 16/3

16 + 16/3

32/3

11

Increase I-Time

Increase PIP

(Qs/Qt)

1st digit of AaDO2

Add 1

Multiply 5

Qs/Qt should be less than 20% for mechanical ventilation weaning

Presence of a

Transesophageal Fistula

Lab Findings for

Metabolic Alkalosis

low potassium

high bicarbonate

Right hemidiaphragm slightly elevated

(on X-Ray)

V/Q mismatch

Treatment:  Increase FiO2

Management of

ARDS/IRDS

Keep FiO2 low

Keep ventilator pressures down

Water

Mucomyst

Humidity

Cool Aerosol

Scattered Patchy Infiltrates

or the following patterns:

Ground glass

Honeycomb

Rectangular

Granular

Abnormal PFTs:

SVC

FVC

Normal FVC

Abnormal SVC

Preductal blood gas is good

Postductal blood gas is bad

1.  Deflate Cuff

2.  Remove inner cannula

3.  Cap the tube

Bronchospasm

Accumulation of secretions

Increasing airway resistance

Decreasing pulmonary compliance

Pulmonary Embolism

Decreased Cardiac Output

Cardiac Arrest

1. Decrease Flow

2.  Increase I-Time

3.  Decrease E-Time

1.  Sustained maximal inspiration

2.  Prevents atelectasis

3.  Encourages patients to take deep breaths

4.  Auscultate breath sounds before and after treatment to evaluate effectiveness

Decrease V/Q Mismatch

Improve cardiac efficiency

Resolve hypoxemia

A-a Gradient

A-a DO2

PAO2 - PaO2

Normal is 25-65mmHg

Infant = 60-80

Child = 80-100

Adult = 100-120

Instructions for

PEP Therapy

Intake deeply

Exhale actively

Fick Equation

normal = 4-7.8

Hypoxemia

Treatment:  give O2

Incentive Spirometers

(2 types)

1. Flow IS

2.  Volume IS

Pneumothorax

Pleural Effusion

Neck/Thyroid Tumors

Mass

Atelectasis

Pulmonary Fibrosis

Pneumonectomy

Diaphragmatic Paralysis

Equipment that Measures ICP

Ventricular Catheter

Subarachnoid Bolt

Epidural Sensor

Stridor

Obstruction

Vocal Cord Polyps

Mucosal Ulceration

Tracheomalacia

Tracheostenosis

Double Lumen Endotracheal Tube

(Carlen's Tube)

Oral = 21-25 @lips

Nasal = 26-29 @nares

Fluid Problems

CHF

Continuous Aspiration of Subglottic Secretions

(CASS)

Keeps tracheostomy open

Not indicated for emergencies

Cuff = deflated

Increased with hypoxia

Increased with pulmonary hypertension

Increased with lung disease

Mucosal Trauma

Contamination

Hypoxemia

Bradycardia

Bleeding

Chronic Hypercapia

can be seen in which patient population

CBC

WBC

1.  Foreign  Body Aspiration

2.  Croup

3.  Post extubation swelling

4. Epiglotittis

1.  Drug Overdose

2.  Asphyxiation

3.  Respiratory Arrest

1.  Drug overdose

2.  Carbon Monoxide Poisoning

3.  Increased ICP

1.  Hypothermia

2.  Alchohol/Drug Abuse

3.  Head Trauma

1. Pneumonia

2.  COPD

3.  Pleural Effusion

1.  Prolonged periods of apnea

2.  Drug Overdose/CHF

3.  CNS Disorder

Anterior Posterior

AP

Blood gas reveals compensated respiratory acidosis with moderate to severe hypoxemia is characteristic for which disorder

HPPV

HPOV

Drive Pressure

Oscillatory Amplitude

%I-Time

Frequency

ABGs on HFOV are

pH 7.26

CO2 64

O2 60

HCO2 28

The RT will recommend 

Characteristics of 

Methemoglobinemia

Central cyanosis

Fatigue

SOB

Headache

Airway resistance increases

Compliance decreases

Injector line

Flow Interrupter

EPAP = 10-12

IPAP = 4-6

FiO2 should be the lowest possible percentage to maintain an SpO2 level of 90% or greater

Right side atelectasis

Hepatomegaly

Ascites

1.  Untreated Pneumothorax

2.  Pulmonary Hemorrhage

3.  Active TB

1.  Decrease WOB

2.  Correct/Prevent Atelectasis

3.  Cough Effectiveness

4.  Mobilize Secretions

5.  Treat/Prevent Pulmonary Edema

1/2 of the volume achieved pre operatively

(1/2 of the inspiratory capacity)

Date

Time

Volume

Cause decrease in barometric pressure

Cause decrease in alveolar oxygen tension (PAO2)

Quickly  reads more than just O2

it will also read metHb, COHb, O2Hb

Bilateral hyperlucency 

( On X-Ray)

Kidneys

Heart

top of a flow volume loop

(Inflection point)

0.6 - 2.4

(nonintubated patients)

Arterial hypoxemia

Too much heparin in the syringe

air bubbles in the sample

How do you identify optimal PEEP

Atelectasis

Decrease in pulmonary compliance

ARDS

Oxygen 1st

Lidocaine

Indicates sterilization has been done

but does not indicate the presence pathological organisms

Determines if any pathogens survived the sterilization or disinfection process

if viable spores are found, resterilize the equipment

1.  Head of bed 35-45 degrees 

2.  Discontinue sedation

1.  Foreign body obstruction

2.  Cancerous mass in the upper airway

Deadspace Disease

or

Hyperventilation

Pneumonia (consolidation)

Atelectasis

HHyperventilation 

low CO2 and high pH

Third spacing

( fliud shifting disease )

COPD

overexposure

PaO2 is 50 

What is the SaO2

PaO2 is 45

What is the SaO2

Extubation

Disconnected from Vent

Monitor system Disconnect

Cardiogenic Shock

Rheumatoid Arthritis

Chronic Pulmonary Infection

Cystic Fibrosis

Minimal Occlusion Technique

(used to inflate cuff)

Minimal Leak Technique

(used to inflate cuff)

Inspection

Auscultation

Capnography

Chest X-Ray

20 mmHg

25 cmH2O

Stridor

Obstruction

Vocal Cord Polyps

Mucodal Ulceration

Tracheomalacia

Tracheostenosis

The patient is eating

The patient is on PPV

Ventilator Protocol

Asthma Patients

Low Tidal Volume (4-6)

RR (10-12)

Permissive Hypercapnia

Patient has an infection

Patient is on high PEEP

Patient desaturates during suctioning

Ventilator Protocol

Lobectomy Patients

Ventilator Protocol

ARDS Patients

Low Tidal Volume (4-6)

Plateau Pressures  (<30)

Sustained Inflation

CPAP (30-40)

PEEP (20)

PCV with Increased PEEP

Increased PIP

Sigh Breaths

Optimal PEEP

Definition

The Following Indicates PEEP/CPAP is working

Increased PaO2

Increased Static Compliance

Increased Cardiac Output

Stable Hemodynamics

Increased (PVO2/SVO2)

A-aDO2 (stable or decreased)

Decreased PaO2

Decreased Static Compliance

Decreased Cardiac Output

Increased Hemodynamics

Decreased (PVO2/SVO2)

A-aDO2 (stable or increased)

Inflation Hold

Do Not Use Inflation Hold On The Following

Closed Head Injury Patients

Hypotensive Patients

Fluids

Dopamine

Dobutamine

Adults (atropine, dopamine, epinephrine)

Children (atropine, epinephrine)

External Pacemaker

Oxygen

Lidocaine

In Order

Defibrillate (360)

CPR

Epinephrine

Amiodarone

Lidocaine

In Order

Debfibrillate (360)

CPR

Epinephrine

Amiodarone

Lidocaine

**Metabolic Acidosis==>Give Bicarbonate**

Confirm in 2 Leads

Epinephrine

Atropine

***DO NOT DEFIBRILLATE***

No chest movement

Apnea

Hypoventilation due to drug overdose

Persistent Hypoxemia 

Peak Pressures help Monitor

Deadspace that includes the tubing between the wye and the patient.  

HME included

No sedation 

Do not reduce FiO2 below 40

Do not reduce the PEEP below 5

Only wean with adequate staffing

ARDS

Refractory Hypoxemia

Lobectomy

Bronchopulmonary fistula