116 terms

Critical Care Exam

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why are patients on mechanical ventilation?
life support and treatment
t/f: every patient has a unique vent setting based on goals and status
true
A tube that is inserted from the mouth or nose into the trachea in order to provide optimal ventilation and suctioning is defined as a(n):
endotracheal tube
what are the 2 types of endotracheal intubation tubes?
Orthotracheal and nasotracheal
ET tubes seal off what two systems?
GI and Respiratory
Risks of ET tubes
Infection, uncomfortable, prevents verbal communication, and many more.
what is one infection seen with ET tubes?
ventilator acquired pneumonia
How do you confirm placement of an ET tube?
Bilateral breath sounds
End-tidal Carbon Dioxide reading
Bilateral chest wall expansion
Chest x-ray (Gold standard)
consistent measurement from initial intubation
what s a End-tidal Carbon Dioxide reading?
a reading that should show NO CO2 during inhalation and have 2 % CO2 at end of exhalation
What are indications that the ET tube needs suctioning?
Patient is coughing
Breathe and tube sounds i.e.:wheezing
why do we suction?
to prevent mucous plugs
The number of breaths per minute the vent is set to deliver is defined as
Rate
what is a normal rate for an adult?
12-20 BPM
what is a normal rate for a child?
20-30 BPM
what is a normal rate for an infant?
30-50 BPM
if you increase the RR what will happen to the serum CO2 level?
it will decrease
if you decrease the RR what will happen to the serum CO2 level
it will increase
Volume of air in mLs per breath is termed as
tidal volume
what is a normal tidal volume?
10mL/kg
usually around 500
what occurs if the tidal volume is too large?
barotrauma
damage to the lung tissue
the positive-End Expiratory Pressure OR the amount of pressure needed to keep the alveoli open after expiration is defined as
PEEP
what is the normal range for PEEP?
3-5 cmH2O
higher the peep indicates
the sicker they are
The concentration of oxygen in the air that is being ventilated is defined as
FiO2
what is the FiO2 in the air we breathe normally?
21% (room air)
what vent setting mode provides the most respiratory support and gives the ability to control RR, PEEP, TV and Fi02 and vent will deliver a set number of breathes each minute if pt does not self-initiate?
Assist control
what vent setting mode will deliver a set number of breaths if the patient doesn't self-initiate, tidal volume is dependent on whether it is a ventilator breathe or pt breathe, and is a good mode for weaning?
Synchronized Intermittent Mandatory Ventilation (SIMV)
which vent mode setting is used a lot in acute respiratory distress and diseases with decreased lung compliance and it allows the expiratory phase to be longer than normal to keep pressure in the lung higher and Most of the time used in conjunction with high PEEP settings to improve ventilation?
Pressure Release Ventilation (PRV)
which vent setting mode is considered a weaning mode with no set respiratory rate, pt initiates their own breathe and the vent applies pressure to make sure the air gets through the ET tube?
Pressure support
the sickest patient is usually on what vent setting mode?
assist control AC
if your patient is having a gas exchange issue what would you expect their vent setting to be set on?
pressure release ventilation (PRV)
it is used in conjunction with a high PEEP
what are the two types of ventilator alarms?
high-pressure alarm and low-pressure alarm
which vent alarm goes off when the pressure increase? for example the patient is coughing or secretions are building up?
high-pressure alarm will go off
how do you trouble shoot the high-pressure alarm?
check tubing for condensation, check tube position, auscultate lung sounds for wheezing, barotrauma (too much oxygen, too fast of breathing), look for secretions in airway
which vent alarm goes off when the pressure decreases? For example there is spontaneous extubation or disconnection of tubing for ET tubing
low-pressure alarm
how would you trouble shoot the low-pressure alarm?
Reconnect the tube to the ventilator, check tube placement, make sure all connections are intact.
what is usually performed when transporting a patient, during difficult intubation, spontaneous extubation or code blue situation?
manual ventilation
what do you use in manual ventilation?
AMBU connected to a mask or the ET tube
how do you perform manual ventilation
Squeeze the bag in short, gentle intervals. You want enough pressure to see chest expansion but NOT enough to see abdominal expansion. Space intervals to ever 6-8 seconds
what is mandatory equipment every ICU room needs to have available?
AMBU bag and oxygen set up
normal BUN levels
10 to 20
normal creatinine levels
.5 to 1.1
normal hemoglobin levels
12 to 16
normal red blood cell range
male: 4.3 to 5.7
female: 3.8 to 5.1
normal platelet count
150,000 to 400,000
normal WBC count
5,000 to 10,000
normal Na
135 to 145
normal K
3.5 to 5.1
normal Ca
8.5 to 10.2
normal Mg
1.5 to 2.5
normal glucose
below 120
Norepinephrine (Levophed) is what type of medication
Cardiac medication
major complication of Norepinephrine (Levophed)
cardiac irritability and tachycardia
what is the most preferred vasopressor for the treatment of septic shock
Norepinephrine (Levophed)
Phenylephrine (Neo-Synephrine) is what type of medication
Cardiac/Vasoactive
Phenylephrine (Neo-Synephrine) major complication
tachycardia
what medication is the first line treatment for anaphylactic shock and for treating hypotension
Epinephrine (Adrenalin)
Vasopressin (antidiuretic hormone) is what type of medication
Cardiac/Vasoactive
Vasopressin (antidiuretic hormone) major side effects/complications
increases vascular sensitivity to norepinephrine. (used in combo with 1st line agent)
Dopamine (Intrepid) is what type of medication
Cardiac/Vasoactive
Dopamine (Intrepid) does what in all doses
small = increase renal blood flow
moderate = increase cardiac output
large = increase systemic vascular resistance
Dobutamine (Dobutrex) is what type of medication
Cardiac/Vasoactive
Dobutamine (Dobutrex) function:
increased strength and rate of heart with vasodilation. used in heart failure.
Milrinone is what type of medication
Cardiac/Vasoactive
action of Milrione is
open calcium channels and increases heart rate. used in heart failure
Nicardipine (Cardene) is what type of medication
Cardiac/Vasoactive
Nicardipine (Cardene) function is
decrease HR and contractility. slows down the heart.
Nitroprusside (Nitropress) is what type of medication
Cardiac/Vasoactive
Nitroprusside (Nitropress) function is
potent vasodilator used in hypertension crisis or for reduced bleeding in surgery
Esmolol (Brevibloc) is what type of medication
Cardiac/Vasoactive
Esmolol (Brevibloc) function is
decrease heart rate and contractibility. treats tachycardia and acute supra ventricular tachycardia
Atropine is what type of medication
Cardiac/Vasoactive
Atropine function is
increases heart rate. treats severe bradycardia.
Propofol (Deprival) is what type of medication
sedative
Propofol (Deprival) function is
general anesthetic . used for surgical procedures and sedating the intubated patient
Midazolam (Versed) is what type of medication
Benzodiazepine. used to sedate and keep intubated patient sedated
Midazolam (Versed) major complication
prolonged sedation may occur with patients that have renal impairment and patients that have a high fat percentage in their body
Dexmedetomidine (Precedex) is what type of medication
sedative
Dexmedetomidine (Precedex) function
mild sedation in the intubated patient. Has shorter half-life than Versed
Cisatracurium (Nimbex) is what type of medication
Neuromuscular blocker
Cisatracurium (Nimbex) function
paralytic that is ALWAYS used in combination with sedation. paralyzes patient.
Rocuronium (Zemuron) is what type of medication
neuromuscular blocker
Rocuronium (Zemuron) function
paralytic used for intubation
Succinylcholine is what type of medication
neuromuscular blocker.
Succinylcholine function is
paralytic used for intubation
Fentanyl is what type of medication
intravenous analgesic
Fentanyl is used for
severe pain
Morphine is what type of medication
intravenous analgesic used for severe pain
Hydromorphone (Dilaudid) is what type of medication
intravenous analgesic. strenger than morphine
Insulin continous drips require
Finger stick blood sugar checks every hour
Heparin continuos drip requires a new PTT every
6 hours
Right Atrial pressure normal range OR central venous pressure
2 - 8 mmHg
Continuous venous pressure normal range
2 - 8 mmHg
(lower because venous pressure is low)
Pulmonary artery wedge pressure normal range OR left atrial pressure
6 - 12 mmHg
(higher bc right OUT of ventricle)
Right ventricular end-diastolic volume
100 - 160 mL
EKG characteristics of a P wave
atrial depolarization - the atria contract
EKG characteristics of a PR interval
starts at P wave ends at R, onset of atrial depolarization to onset of ventricular depolarization
EKG characteristics of a QRS complex
contraction of ventricles (ventricular depolarization)
EKG characteristics of a ST segment
End of S wave and beginning of T wave, interval between ventricular depolarization and repolarization, ventricles empty and begin refilling up with blood
EKG characteristics of a T wave
ventricular repolarization = refill = relax
A flat line (straight line)
Asystole
no ventricular contraction, so no QRS complex is known as
Ventricular Fibrillation
no atrial contraction, so no P wave present is known as
Atrial Fibrillation
atriums beat to fast sawtooth pattern is known as
Atrial Flutter
normal sinus rhythm with PQRST all present & identifiable is known as
Sinus Rhythm
below 60 bpm is known as
Sinus Bradycardia
above 100 bpm is known as
Sinus Tachycardia
what measures the pulmonary artery wedge pressure and central venous pressure?
pulmonary artery catheter (Swan-Ganz)
What does the Arterial line do:
provides a beat by beat reading of systemic arterial blood pressure. It is good for determining the mean atrial pressure (MAP)
Benefits of arterial line
an be used to measure in real time blood pressure and obtain arterial blood for samples
how to calculate MAP
SBP + DBP + DBP / 3
normal range for arterial line
120/80 mm Hg
the Somasensor called cerebral pulse oximetry does what
tells how much oxygen your brain is getting. It is normal for it to run in the 60%
Intraaortic balloon pump (IABP) is
invasive, for sick patients, inserted into femoral artery or aorta, Balloon inflates during diastole, deflates during systole to increase perfusion to the coronary arteries and periphery.
The benefit of Intraaortic balloon pump (IABP) is
it gives the heart some rest and Increases myocardial oxygen perfusion and increase cardiac output.
Benefits for using a syringe pump
good for delivering small amounts of liquid medications, tube feedings, and PO medications