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intermittent positive pressure breathing

therapy assisting patients in breathing utilizing a mask connected to a ventilator that introduces a positive pressure to the lungs.

Physiologic effects of IPPB

acts as a mechanical bronchodilator, Increases MAP, Increases Vt, decreases WOB, Alters I:E ratio, Alters cerebral blood flow.

Corrective actions for IPPB patients that HYPER-ventilate

Coach the patient to breath slowly and to pause between breaths.

Indications for IPPB

Increased WOB, HYPO-ventilation (^PaCO2), increased Raw, pulmonary edema, weaning from mechanical ventilation, inadequate cough, treatment of atelectasis.

Hazards of IPPB

Hyperventilation (reduced PaCo2 leads to vasoconstriciton), hyperoxygenation of COPD patients (knock out the drive to breath), Decreased cardiac output, Increased ICP (closed head injuries/CNS diseases), Pneumothorax, Hemoptysis, Gastric distention, nosocomial infections.

Absolute contrindications to IPPB

untreated pneumothorax, pulmonary hemorhage.

Powersource for the Bennet AP-5

the IPPB unit which is powered by AC, and the flow is powered by a compressor.

Powersource for the Bennet PR-2

the IPPB unit which is powered pneumatically, and the flow is powered by a compressor.

Factors which can increase Vt with IPPB

Decreased Raw, Increased static compliance, Increased inspiratory pressure.

Factors which can decrease Vt with IPPB

Increased Raw, Decreased static compliance, Decreased inspiratory pressure.

Recomended sensitvity to cycle IPPB in cmH20

Patient has to generate between (-0.5 to -2.0 cmH2o) to cycle intermittent positive pressure breathing therapy

Sustained maximal inspiratory therapy AKA

Incentive Spirometry AKA

Goals of Incentive Spirometry

to prevent atelectasis, treat preexisting atelectasis, improve cough mechanism, used pre-operatively to strengthen and mobilize secretions in the airway. most cost effective device

How should an IPPB treatment be modified for a closed head injury?

by increasing the Ti (flow), and/or decreasing (PIP) Peak Inspiratory Pressure. (increasing Ve by ƒ not PIP(Vt))

"High risk Infant" defined..

any newborn or young infant who has a high probability of manifesting in childhood a sensory, motor, cognitive/language or social deficit (Domains). SHOULD BE FOLLOWED FOR 1 YEAR in a high risk clinic.

Maternal factors of "High Risk Infant"....

.....Age <16 or >35. DM, history of ETOH, Hypertensive, Lack of prenatal care, previous C-section, sepsis, previous birth with respiratory anomolies.

PROM

Premature Rupture of Membranes. Risk of meconium aspiration,

factors of "High-risk infant", other than maternal

Premature <38 weeks gestation; post-mature > 42 weeks gestation (risk of meconium aspiration); prolapsed cord; prolonged labor; abnormal presentation.

Ballard Scoring system

The most common scoring system used to determine gestational age of a newborn.

APGAR scoring system

assessment of 5 characteristics of the newborn: Appearance-color, Pulse-heart rate, Grimace-irritability, Activity-muscle tone, and Respirations-respiratory effort. The lower- the more severe.

APGAR scale of severity

APGAR 7 - 10:dry, warm, clear airway w/bulb syringe; APGAR 4 - 6: indicates moderate asphyxia, stimulate and administer O₂; APGAR 0 - 3:severe asphyxia, immediate resuscitation w/ventilatory assistance

Silverman scoring system

system of assessment to determine severity of respiratory distress. The higher the number the more severe

Normal values for newborns

Respiratory rate:40 - 60 bpm; Heart rate 130 - 150 bpm; Blood presuure 60 - 90 mmHg / 30 - 60 mmHg; Temperature 97.6° ±1°(axillary), 99.6° ±1°(rectally)

Signs and symptoms of hypoxemia

Dyspnea, tachycardia, cyanosis, headache, change of mental status, slight hyperventilation.

Complications of FiO2 > 0.60

Increased O2 levels can wash out nitrogen reducing surfactant production (atelelctasis), high O2 can lead to increased O2 free radicals (lung tissue toxicity), increased FiO2 reduces cillia activity (reduced mucocilliary activity), premature infants exposed to high FiO2 (ROP)

Etiology of Anemic Hypoxia

Decreased hemoglobin, CO poisoning, Excessive blood loss, increased MetHemoglobin levels, Iron deficiency.

Blood carries O2 in two ways

bound to Hgb (1g of Hgb can carry 1.34 ml of O2

PCWP (also called PAWP and PAOP)

an indirect measurement of pressure in the heart's left atrium.
Directly monitored during pulmonary catheterization

tactile fremitus

vibration palpated with the hand on the chest during vocal fremitus

Galvanic cell

oxygen analyzer which requires no external power source, results take > 60 Secs.

Clark Electrode

oxygen analyzer which records the potential difference in chemical current, results 10 - 30 Secs

Severinghaus electrode

an electrode which records carbon dioxides transport through a membrane.

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