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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: failureAnswer: inability to maintain normal delivery of O2 to tissue or normal removal of CO2 from . PaO2 <60 and or a PaCO2 >50 on room air Question: Type I Answer: Hypoxemic respiratory , PaO2 <60 on R/A, caused by VQ mismatch, shunt, diffusion impairment, perfusion/diffusion impairment, altitude Question: *Three most common causes of Type I hypoxemic resp Answer: V/Q mismatch (COPD), (atelectasis, pulm ed, pneumonia), secondary to hypoventilation Question: V/Q Answer: (type 1) perfusion in excess of ventilation, COPD is most common cause, blood flow is good but airtrapping, swelling, mucus etc. decrease in ventilation, Responds to FIO2 Question: S&S of V/Q Answer: increased HR, increased RR, use of muscles Question: What is the most cause of V/Q mismatchAnswer: COPD Question: Answer: (type 1) aka Refractory Hypoxemia, complete block of ventilation to alveoli, most common cause atelectasis, pulm ed and . Does not respond to FIO2, refractory to O2 Question: *Decreased P/F Answer: shunt Question: Most extreme Answer: Question: Diffusion Answer: (type 1) usually not a when pt at rest, but exertion causes hypoxemia. Most often caused by interstitial lung disease, pulm fibrosis, asbestosis, sarcoidosis Question: Most common seen in diffusion impairmentAnswer: exertional Question: Perfusion/diffusion Answer: (type 1) rare of hypoxic resp failure caused by anatomical shunt secondary to liver disease, causes impaired gas exchange, FIO2 can help Question: Altitudes on FIO2Answer: (type 1) increased altitude decreases BP, this causes press in alveoli and not enough press to oxygenate, decreases PaO2 Question: *Type II Answer: hypercarbia, PaCO2 >50 on R/A, caused by decreased vent drive, resp muscle fatigue or increased Question: *Decreased vent Answer: (type II) chemoreceptor’s responding to increased CO2 stimulate drive to breath, decreased by CNS depression (OD, brain lesion, hypothyroidism, obesity, cent apnea, hypothermia) hallmark is brandypnea Question: S&S of decreased vent areAnswer: bradypnea is and ultimately apnea, decreased RR causes a decreased LOC Question: *Resp muscle /failureAnswer: (type II) neuromuscular, resp pump fails, caused by ALS, GB, MG, dystrophy. Question: *What effect does an increased RR (VE) have on Answer: decreases VT and off CO2 Question: Increased Answer: (type II) pt has normal drive to breath, normal nerves and muscles, but workload to great. Most common causes are COPD and Asthma, also in pneumo, rib , pleur effusion, severe burns & Obs Sleep Apnea Question: What is the most common cause of Type II vent Answer: WOB Question: What is the most common cause of increased Answer: COPD and Question: What is the relationship between RAW and Answer: conditions that increased RAW make pts work harder to exhale Question: Answer: Positive End Exp Press, norm 5-15, application and maintenance of at the airway throughout the exp phase of pos press ventilation. Question: Intrinsic Answer: aka autoPEEP, inadvertent buildup of poss press in the alveoli due to exhale, results in progressive hyperinflation rise in end-expiratory press Question: PEEPAnswer: Set by RT on Vent Question: Why do severe burns cause increased Answer: severe burns over large area of body hypermetibolic state which causes increased CO2 production which in turn causes increased VE Question: *Chronic vent Answer: (type II) develops over days, weeks or months, COPD (hypercapnia), Obesity (hypoventilation) and are most common causes. Kidneys compensate w/incr HCO3 (50-50club) Question: *How does RT measure PH for or chronic vent failureAnswer: (Type I&Type II) in chronic PH will drop .03 for every 10mmHg rise in PaCO2, acute PH will drop .08 for every 10mmHg rise in Question: *How does RT Type I from Type II from ABG on R/AAnswer: add PaO2 and PaCO2, if between 110-130 then Type II, less than 110-then Type Question: What is significance of PaCo2Answer: Body is to blow off CO2, so incr CO2 equals inc RR, so inc CO2 suggests hypoventilation and acidosis Question: What are the 3 of acidosisAnswer: resp center not responding to incr in CO2, Resp center responding but signal not getting through, or brain & nerves working but are not (contractile failure). Question: Acute failureAnswer: PaCO2 >50 with bicarb. Thoracic pump or bellows failure Question: *Acute on ventilator failureAnswer: aka combined Type I Type II failure, chronic respiratory with an acute complication. Emphysema pt with bacterial or viral infection Question: Complications of acute respiratory Answer: secondary to ARDS (sepsis, multiorgan failure) secondary to TX(emboli, barotraumas, infection) non pulm (arrhythmias, hypotension, GI ailment, renal) Hosp acquired (bacterial, malnutrition, ) Question: Indications for vent areAnswer: severe refractory hypoxemia, inadequate alv vent, inadequate lung expansion, inadequate muscle and increased WOB Question: a/A Answer: norm is 74% Question: *A-aDO2 Answer: 10-20 on room air, 25-65 on 100% O2, 50 is approx 2% shunt above norm of 2-5% Question: *P/F value Answer: 350-450 Question: *Indication for vent w/refractory Answer: A-aDO2 >350 on 100% or P/F <200 Question: *VT Answer: 5-8mL/Kg Question: *VC Answer: 65-75mL/Kg Question: *Indications for vent w/inadequate lung Answer: VT <5mL/kg, VC <10mL/kg, RR >35/min Question: *Indications for vent w/inadequate alv Answer: >55torr and or PH <7.20 (or 7.25) Question: *MIP Answer: -80 to -100 Question: *Indications for vent w/inadequate strengthAnswer: MIP ≥-20, VC<10mL/kg, MVV <2L/minxVE Question: *MVV Answer: 120-180L/min Question: *VE Answer: 5-6L/min Question: *VD/VT Answer: 25 to 40% Question: *Indications for vent w/increased Answer: VE>10L/min, VD/VT >60% Question: *Bedside of resp muscles areAnswer: MIP (most ), VC, MVV (not often) Question: *MIPAnswer: max inspiration press (bedside test), norm 80-120, manometer measures neg press, not pt dependent, can be done w/mask, most reliable bedside Question: Answer: max voluntary , bedside test with hand held spirometer, not often used because pt dependent. Question: *Imposed Answer: press created by endotracheal tube, vent circuit or autopeep that causes pressure and therefore increases WOB Question: *What is the cardinal sign of WOBAnswer: tachypnea (causes VT which causes decreased CO2) Question: *VD/VT Answer: used as indicator for vent support in WOB, norm is 25 to 40%, >60% indicates need of support Question: Increased WOB shallow breathing, signs areAnswer: decr VT, decr VC, incr VE, decr Question: 3 types of respiratory weakness areAnswer: central failure, transmission , contractile failure Question: failure/fatigueAnswer: exertion-induced, reversible decrease in respiratory drive Question: Transmission /fatigueAnswer: exertion induced, reversible in the transmission of neural impulses Question: *Contractile /fatigueAnswer: reversible impairment in the response to a NEURAL IMPULSE IN AN OVERLOADED MUSCLE (COPD) Question: *Most reversible respiratory muscle weakness isAnswer: , (overworked) Question: *Vent support with Answer: hyperventilate to CO2 to 25 -30mmHg causing alkalosis to reduce ICP Question: Managing COPD’er on Answer: COPD incr RAW and decreases exp flow, can easily cause autoPEEP aka hyperinflation and over distension, manage w/ decreased VT & rates and exp time Question: AutoPEEPAnswer: dynamic hyperinflation, causes over distention, decr CO, incr intra-thoracic , and decr venous return |
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