Clinical Orientation week 1
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Created by:
Rnkimmyjo Plus on February 13, 2011
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33 terms
Terms | Definitions |
|---|---|
 First bifurcation | Scrubber vs. Machine. Closed circuit rebreathing system. Soda lyme or bara-lyme used to scrub CO2 out of system. Allows patient to rebreath their own gas. |
| What can be done if the bara-lyme turns purple and you don't have time to change it? | Increase the inspiratory flow rate to 3 x the MV. If the MV is 3 L/min you increase it to 9 L/min. The gas flows out of the scavenger system. |
| Second Bifurcation | Ventilator vs Bag. Pull handle towards you to manually ventilate pt. Push the handle away from you to ventilate the patient with the ventilator. |
| Third Bifurcation | Bag vs. Scavenger. Airway pressure release valve (APRV) or "pop off" valve. Turned to right (tighten) all the gas goes to bag and patient. Turned to left (loosen), more gas goes out the scavenger system. |
| How can you detect that the inspiratory or expiratory valve is stuck open? | End tidal CO2 changes. CO2 present in the bag and anesthesia machine. |
| What are the reasons for changes in ETCO2? | Expiratory valve stuck open, exhausted CO2 absorber, scavenger system failure. |
| Describe the wright respirometer? | Measures flow directly. DOES NOT measure volume directly. Prone to errors. |
| Why is the wright respirometer prone to errors? | Inertia, friction, water condensation. |
| Describe ultrasonic measurement? | Highly accurate, not affected by low flow situations. Ideal for children. |
| Describe the bellows on the anesthesia machine. | Ascending bellow design, increased safety, elevates on expiration by pts recoil of lung, if there is a break in the circuit anywhere the bellows will be flat. Volume preset ventilator. Time cycled. |
| Where should you maintain ETCO2 and why? | 32-36 mmHg. You don't want patient to breath. |
| What is the rule of 10 with CO2? | When you double the MV you decrease CO2 by 10. |
| Why is important to have adequate inspiratory time? | Maintain alveoli open, do not over-distend alveoli. |
| How do you achieve adequate inspiratory time, safe delivery of MV and prevention of lung injury? | Set rate and I:E time. Set TV, look at pressure monitor. Fine tune by changing the flow control. Make sure inspiratory relief valve is open: PIP (~50). |
| What would the I:E time and inspiratory time be with a RR of 10? | 1:2; 2 seconds. |
| What would the I:E time and inspiratory time be with a RR of 8? | 1:3; 1.88 seconds. |
| What would the I:E time and inspiratory time be with a RR of 6? | 1:4; 2 seconds. |
| What 2 things have to be done when trying to wake a patient? | Blow the gas off, decrease MV to make the CO2 rise. |
| When increasing flow rates what also must be adjusted? | Drop the TV being delivered. |
| What would keep the patient from waking up? | High TV delivery increases the MV and CO2 will fall. |
| What is optimal inspiratory time? | 2 seconds. |
| What is TV dependent on? | Flow rates of all gases (increased flow rates leads to increased TV). The longer the inspiratory time the more TV is delivered. Increasing flow speed increases the plateau phase leading to increased TV. |
| What is the flow control dial? | Controls speed of injection of gas around the bellows. Gas is a combination of O2 and air. |
| What increases with faster flows? | Faster flows increase the PIP. |
| What happens with flows that are too low? | Leads to inadequate alveolar ventilation. |
| What is the pressure relief valve? | Used to convert the ventilator to a pressure control format. Not usually a good idea. Lose the ability to diagnose increasing PIP. |
| When is it helpful to use the pressure relief valve to convert ventilator to a pressure control format? | Trying to reduce PIP. Remember that your TV may fluctuate d/t lung or chest compliance changes. ICU pts. on PCV. |
| What is the switch for all gases used for? | Turns a air on. Has nothing to do with vaporizers. Disables the ORMC alarm (may lead to hypoxic mixtures). |
| What are pressure alarms for? | Used most of the time! Detects drops in pressure of the system. Threshold number. |
| What are volume alarms for? | Not usually used. Spirometer, reverse flow, low flow. |
| What should pipe line pressure be? | 45-55 PSI |
| How long should you occlude the circuit and flush O2 valve for? | Till pressure 30 cm H2O on bourdon pressure gauge and make sure it stays at 30 cm. |
| How do you test the flow meters and ratio protection system? | Attempt to set a hypoxic ratio of N2O/O2 (greater than 3:1) Turn O2 to 1 L. Turn N2O as high as dial permits and observe concentration. Turn O2 off and observe N2O flow. Turn N2O off. Note floats and steady hold position. Ensure flow controls are off. |
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