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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: O2 Therapy :Adult & Pediatric-Low flow - Nasal cannula Answer: 1.Delivered FIO2: 24%-45% 2.Flow: 1-6 L/M Question: O2 Devices:Adult & Pediatric-Low flow -Simple mask Answer: 1.Delivered FIO2: 40%-50% 2.Flow: 6-10 L/M Question: O2 Therapy Devices:Adult & Pediatric-Low flow -Partial Mask Answer: 1.Delivered FIO2:60%-65% 2.Flow: 6-10 L/M 4. no one way . Question: O2 Therapy Devices:Adult & Pediatric-High flow-Venturi Mask/Air-entrainment Answer: 1.DeliveredFIO2: 24%-55% 2. Works by mixing 100% O2 and room air. 3. Precise FIO2 delivery. 4. When FIO2 increases entraintment port is . 5. When FIO2 decreases the internal diameter of gas injector decreases. Question: O2 Devices:Adult & Pediatric-High flow- Non-breather Mask (NRB) Answer: 1.Delivered FIO2: 21-100% 2. It is a high flow device and keeps the bag from collapsing if the flow rate is High. 3. Used in Emergency cases. 4. it has one way valve that prevents from rebreathing CO2. Question: O2 Therapy Devices:Adult & Pediatric-High flow- In a non-breather Mask (NRB)-Why isa face seal ? Answer: 1. Face seal is important because reservoir should collapse slightly on each . A)If bag does not collapse - mask should be tightened and a better seal should be obtained. B)If bag collapses NBR valve may be stuck then - replace with a new mask. Question: O2 Therapy :Adult & Pediatric-High flow- Aerosol Mask Answer: 1. Trach collar - fits loosely, easy to tolerate- used when T-pieceis inconvinient for the pt. due to pt. movement. 2. Aerosol mask-is only good for high flow - otherwise air entrainment is too great and FIO2 will be decreased significantly. Question: O2 Therapy Devices:Adult & Pediatric-High flow- 's adapter (T-tube, T-piece) Answer: 1.Used to deliever aerosol. 2.requires a high flow supply/a pre-mixed gas. 3.Attaches @the end of an ET tube/trach tube. 4.Must see continues aerosol production during both inspiration&expiration, if cant see the flow the then Increase the flow. Question: O2 Therapy Devices: define Air-entrainment Answer: devices mix O2 and air to achieve an exact FIO2. Question: O2 Therapy : Equipments of Air-entrainment device- Answer: 1. Venturi mask. 2. Large volume nebulizers (LVN). 3. Small IPPB macines. 4. Some pressure . Question: O2 Therapy Devices: Complications of Air-entrainment Answer: 1. Impeded flow or back pressure- an increasein FIO2. 2. Occluded entraintment port - causes increase in FIO2. Question: O2 Therapy Devices: Air-entrainment -What all cases does FIO2 Increases? Answer: 1. when puff of aerosol coming from the tubing of a LVB set @ FIO2 28%. 2. The very last part of the delivered breath from a Bird IPPB machine. 3. A king in the aerosol tubing coming from a LVB. --> All cases FIO2 increases. Question: O2 Devices: Air-entrainment device- Air/O2 mixture Ratios Answer: 24%- 25:1 28%-10:1 30%-8:1 35%-5:1 40%-3:1 & 60%-1:1 Question: O2 Therapy Devices: Air-entrainment device- Calculate Flow- if O2%=28%, O2 flow meter setting=6 L/min. ? Answer: if O2%=28%, O2 flow meter setting=6 L/min. for 28%=10:1. Now add the ratio parts (10+1)=11. Then multiply by the flow (11 x 6L) = TOTAL FLOW = 66L/min. Question: O2 Devices: Pediatric O2 therapy device Answer: O2 Tent. This is used for both pediatric & Neonatal. 1.Useful when humidity/Aerosol environment is desired 2.Highest FIO2=40-50%. 3.Flow Rate=12Lpm to CO2. High fluid can cause fluid retention in pt.should monitor input-output pt. weight. Question: O2 Devices:Neonatal O2 therapy- O2 Tent Answer: 1. FIO2 is highest @ bottom 100% O2 is heavier than other gases. 2. If analyzed FIO2 near pt. face is difficult to keep may need to ensure the plastic walls are tucked into the bed wall. Question: O2 Therapy :Neonatal O2 therapy- O2 hoodAnswer: It is placed over infant's head. Flow=7-14Lpm can deliver upto 100% O2, with an O2 blender. It comes w/ temp. probe. If hot infant become apneic. If cool causes increase in O2 consumption. It is loud inside hood causes hearing loss-use a than LVN Question: O2 Therapy Devices:Neonatal O2 - Incubator Answer: 1. Only for neonates. 2. small, whole-body environment 3. precise control over environment FI02. 4. Red-flag warning sign when suing FIO2 100%. Question: O2 Devices:Neonatal O2 therapy- hazards of Incubator Answer: 1)Skin Burns 2) Hearing damage-very loud 3)Electrical shock Question: O2 Devices:Neonatal O2 therapy- Radiant Warmer Answer: 1)it is open to room air 2)Not a good for O2 delivery. 3. must be combined with an O2 delivery device. 4) allows RT to have access to the infant to provide care. 5. useful in controlling temp.& helpful in decreasing insensible water loss. Question: O2 Conserving Devices:Reservoir Answer: 1. It is like a regular cannula except with a small reservoir under the nasal prongs or as a medallion inline, chest level. 2)it allows O2 be set @ a lower flow rate. Question: O2 Conserving Devices: Transtracheal Catheter (TTO2) Answer: 1. It is surgically implanted thin catheter inserted thru the wall(b/w the 2nd & 3rd tracheal rings). Trachea acts a reservoir so flow may be reduce by as much as. 1/2. Question: O2 Conserving : Transtracheal Oxygen Catheter (TTO2)-Hazards Answer: 1)Bronchospasm 2)Trauma to the trachea including bleeding 3) Risk of at insertion site. 4) Pneumothroax & subcutaneous emphysema upon erroneous insertion 5)Poor cleaning technique 6) Catheter may be obstructed. Question: O2 Conserving Devices: Oxygen Catheter (TTO2)- What do we do if TT02 is Obstructed? Answer: Catheter may be obstructed need to flush with saline- 1st provide O2 by cannula. Then troubleshoot & find a remedy. Question: O2 Devices: Pulse-Dose O2 delivery Answer: It is Combined w/ specialized nasal-cannula.Humidification not required.50PSI gas source is required. System senses inhaltion,delivers pulse of O2. capable to switch to continous flow-uses continous mode when a problem is suspected. Used @homecare Question: O2 Conserving Devices: Gas & Bulk Delivery Systems: Cylinders-Procedure Answer: 1)Crack Valve open before mounting regulator.2)PISS regulator is used for E Cylinder. 3)ASSS regulator is used for H Cylinder. 4)Point any glass or plastic-faced regluators away from persons while opening - could burst and cause harm. Question: O2 Conserving Devices: Gas & Bulk Delivery Systems: Cylinders - Troubleshooting Answer: 1)Hissing leak sound - all connection. 2)No apparent flow-check flow using a calibrated flow sensing device Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Time Answer: E = .3 H = 3.00 G= 2.41, small tanks are good care for home care patients needing mobility and as backup supply in case of concentrator failure. Do not store tanks in hot place - like trunk of car Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders Flow Duration Answer: Tank Duration(in mins.) = (Tank Pressure x Tank ) / Liter Flow Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Bulk O2 system-1) Manifolds Answer: it requires 2 separate banks of tanks for Primary & .(several H tanks are mounted to single manifold.) Question: O2 Conserving Devices: Gas Containers & Bulk Systems: Cylinders- Bulk O2 system- 2)Bulk Liquid O2 Answer: Able to store mass quantity in small space compare to tanks. Requires a system. Ex. H tanks. Requires a Convestion Unit. Some units are so small & easier to carry than E tanks & last longer. Question: O2 Conserving Devices: Gas & Bulk Delivery Systems: Cylinders -O2 concentrator(molecular sieve device Answer: Requires electricity only. It produces 6L/min. Extracts O2 from room air. Must change filters & check flow regularly. Must ensure appropriate electrical load capacity of the home.Tank/a source of O2 is recommended. It is a device used for homecare. Question: O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders -Troubleshooting of O2 concentrator(molecular device Answer: Check Flow & Circuit breaker or fuse. Question: O2 Conserving Devices: O2 system: CPAP Answer: It increases surface area of the alveolar capillary . Prevents soft tissues from collapsing & obstructing the airway. It facilitates use of FIO2 to accomplish the same PaO2. It can be given w/ a face mask /Nasal mask/throug an artificial airway Question: O2 Conserving Devices: O2 system: Nasal CPAP Answer: Very Useful w/ infants easy & quick modality. Creates a huge leak if is crying. Use oral pacifier to prevent crying & keep mouth closed. It involves a nasal prongs, like a cannula. Question: O2 Conserving Devices: O2 system: PEEP Answer: Works like a CPAP except used in conjunction w/ backup ventilatory rate ( mechanical ) Question: O2 Conserving : O2 Enhancing system: Mechanisms to Achieve PEEP/CPAP Answer: 1) Wate column 2) Exhalation 3) Spring disk 4) Venturi Question: O2 Devices: O2 Enhancing system: Troubleshooting of PEEP & CPAP Answer: 1) Low Pressure = leak/insufficent flow to the sytem then increase flow. 2) High pressure = obstruction, bad CPAP/PEEP valve. Replace/Flow may be set too Question: O2 Conserving Devices: O2 Devices Answer: 1.Air O2 blender can accurately blend Air &O2 to exact %. Blenders will mix & deliver gas @ 50PSI 3. When using a blender & an Air-entrainment (LVN), must set the nebulizer @100%. Question: Humidification & Aerosol Delivery : Passover Answer: Gains humidity from a body of water thru as gas passes over its surface. It is not very effective. Not appropriate when using w/ mechanical vent. Or with incubated pts. Where the natural upper Airway is by passed. Question: Humidification & Aerosol : Bubble Humidifier Answer: The gas bubbles produce more surface area to pick up humidity. It is better than passover humidifier. depends upon water level. It involves an inlet tube w/ pop off alarm. If inlet tube is clogged pop off alarm wont funtion. Question: Humidification & Aerosol Delivery : How does Humidifier function can be checked? Answer: By occluding line on gasoutlet causing back pressure. If no pop-off alarm-system has a leak - tighten bottle/replace system if presists. If Pop-off alarm sounds w/out occlusion-check kink in the tube or for an obstruction such as H20 in the tube Question: Humidification & Aerosol Delivery :what in a Bubble Humidifier if the down tube become clogged? Answer: Pop-off will not , but flow meter will read zero (compensated flow zero). Question: Humidification & Aerosol Delivery : Heated Humidifier Answer: Most efficient device @ creating humidity. It is commonly used w/ meachical ventilation & w/ intubated pts. It must be heated to achieve any efficiency. It can produce particles which is undesirable because it risk of nosocomial infection. Question: Humidification & Aerosol Delivery : Wick Answer: It is efficient by expanding surface are for evaporation and humidification. It can accomplish 100% body's humidification needs. It does not produce so no nosocomial infections. Some of the most common wick devices are-Concha and Fisher-paykel. Question: Humidification & Aerosol : Heat moisture Exchanger (HME)- other name Answer: Artifical Question: Humidification & Aerosol Delivery : Heat Exchanger (HME)- looks like what? Answer: Sponge Filter- traps heat & moisture that comes from the during expiration & delivers it back to the patient during inspiration. Question: Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- Where is it ? Answer: placed between WYE and the on a mechanical ventilator circuit. Question: Humidification & Delivery : Heat moisture Exchanger (HME) - Is it considered as a deadspace? Answer: Yes. It will the PCO2 to rise (1-2 torr) Question: Humidification & Aerosol : Heat moisture Exchanger (HME)- Does it cause increased ventilator pressure? Answer: Yes it will increased Pressure. Question: Humidification & Aerosol : Heat moisture Exchanger (HME)- should be Remove before an in-line Aerosol or MDI therapy? Answer: Yes we must remove before a MDI Question: Humidification & Aerosol Delivery : Heat Exchanger (HME)-It is best used for ? Answer: short term humidification eg. transport. Question: & Aerosol Delivery : Heat moisture Exchanger (HME)- How do you dispose? Answer: Never to clean or rinse out an HME Question: Humidification & Aerosol Delivery : Heat Exchanger (HME)- What do we do if HME is clogged on a patient?Answer: It is best to to a cascade/wick type humidifier. If those are not available then replace w/ a new HME. Question: Humidification & Aerosol Delivery : Jet Answer: It is a handheld or small volume neb. Reservoir sizes are different. Each produces different dispositions of particle sizes. It uses high pressure gases to create particle sizes 2-10microns. Question: Humidification & Delivery : Reservoir Jet Nebulizer Answer: It uses the Jet Neb. Concept but combined w/ Large vol. . It is capable to deliver Aerosolized sol. w/ 1-2 Lpm flow. It is used for large doses of medications. Ability to meet humidity deficit of body is dependent upon the use of a heating source Question: Humidification & Delivery :Small particle aerosol generator(SPAG) Answer: It is used to treat RSV or bronchiolitis by Ribavirin(Virazole). Produces particle size - 1.3 microns. Problems related to crysallization of the drug can build up in circuits & clog output devices(tubing,etc) Question: Humidification & Delivery :Hydrodynamic Nebulizer Answer: 1. Very nebulizer but not popular 2. Example nebulizer is the hydrosphere. 3. Able to meet the humidity deficit but can cause fluid overload. Question: Humidification & Aerosol Delivery : Ultrasonic Answer: Creats particles by an vibrating device. Provides the most particle output but promotes fluid overload. Vibrating device is known as piezoelectric disc(clean w/ Acetic acid). Frequency of vibration cannot be set. Must have ground plug available Question: Humidification & Aerosol Delivery : How does Mist increase in Nebulizer? Answer: 1. Increasing blower 2. adequate fluind in reservoir. 3. Incresing amplitude of vibration . Question: & Aerosol Delivery : Hazards of Ultrasonic Nebulizer(Vibrating Device- Piezoelectric disc)? Answer: Cannot place a in the reservoir as the vibration can disrupt the molecular structure. FLUID OVERLOAD. Transient Dyspnea due to swelling of secretions(aerosol causes swelling of secretions). Question: Humidification & Delivery : Centrifugal Nebulizers Answer: 1. Least effective at producing uniform particle . 2. Not recommended for use . 3. Associated with high frequency of contamination. Question: Humidification & Delivery : Metered Dose Inhaler's (MDI) Answer: 1. It is portable. In mechanical ventilation -placed on inspiratory side of the circuit & b/w Y & pt. Gives uniform dosage&particle size pt. cooperation.Aerosol produced by pressurizing a gas or liquid in a closed canister. Spacer is recommended Question: Humidification & Aerosol Delivery : Why is spacer recommended for Metered Dose 's (MDI) Answer: It minimize particles that are large by allowing them to to wall of chamber. Requires less time coordination w/dose, pt. can squeeze&inhale. Pt. is to take several breaths to get all the particles.High inspiratory flow rate is not optimal for pt. Question: What is the vast Mechanical Ventilators used ? Answer: Positive Pressure Devices- they are classified according to how they are and how inpiratory and expiratory cycles are initiated and terminated Question: Mechanical : Define Volume-Cycled Ventilators Answer: 1) It will continue inspiration until a preset volume of gas is . 2)It ignores the amount of pressure/time it takes to deliver the volume. Question: Mechanical Ventilators: What limit does Volume-Cycled incorporate? Answer: 1)Pressue limit. Excessive pressure is harmful to pt. it Barotrauma. 2)i.e, inpiratory phase continues until a preset vol. is given UNLESS a predetermined pressure limit is reached 1st. 3)such vents. are called Vol.-cycled,Pressure-limited devices. Question: Mechanical Ventilators: -Cycled Ventilators-3 examples Answer: 1) Puritan-Bennett 7200 2) PB 840 3)Bear Question: Mechanical Ventilators: Pressure-Cycled Ventilators Answer: It will inspiration until a preset pressure is reached. 2) These machines will delivered the same pressure on every breathe regardless of the volume. Question: Mechanical : What is the reason when Pressure-Cycled Ventilators incorporate minimum volume alarms? Answer: The main reason for types of ventilators is that as lung compliance & airway resistance changes, volume is sacrificed. Question: Mechanical : How does Pressure-Cycled Ventilators powered? Answer: Electrically or by gas . Question: Mechanical Ventilators: In Pressure-Cycled Ventilators in pressure will result in what? Answer: an Increase in . Question: Mechanical Ventilators: In Pressure-Cycled Ventilators what at higher levels of pressure? Answer: Theres is a diminishing of volume . Question: Mechanical Ventilators: Pressure-Cycled - 2 Examples Answer: Bird Mark and Bennett PRII are . Question: Mechanical Ventilators: What treatments are given with a -Cycled Ventilator? Answer: IPPB Question: Mechanical Ventilators: What limit does Pressure-Cycled Ventilators ? Answer: Pressure-Cycled Ventilators are pressure limited. Question: Mechanical Ventilators: In Pressure-Cycled Ventilators what when flow increases? Answer: flow will decrease inpiratory time(Reverse is also true). Question: Mechanical Ventilators: In -Cycled Ventilators what needle shows us smooth rise to Pressure? Answer: a needle. If it does not show a smooth rise then Increase the Flow Rate. Question: Mechanical : In Pressure-Cycled Ventilators Air-mix on? Answer: Air mix knob is pulled out. Gas is mixed in a venturi device. FIO2 varies from 40-80%. The chamber surrounding the device will retain excess O2 from 1st breath & will then entrain that O2 on the next breath which causes increase in FIO2. Question: Ventilators: In Pressure-Cycled Ventilators Air-mix OFF? Answer: Air mix knob is in. FIO2=100% pure source gas. Since there is no air entrainment total achievable flow rate is less. When switching from air entrainment to 100% source gas must immediately increase the flow to compensate. Question: Mechanical : In Pressure-Cycled Ventilators what is Rate Control(Expiratory time control)? Answer: Device can set a time limit on the expiratory phase, thus indirectly allowing of rate. Question: Mechanical : In Pressure-Cycled Ventilators what is pressure control(the part that controls the pressure - NOT the ventilatory mode? Answer: Vol. is indirectly increased by increasing pressure. If cant reach a pressure indicates a leak -check for leaks starting @pt. (mask, lip seal). Examine for &holes. An increase in back pressure (coughing)causes pressure limit&will reduce volume Question: Mechanical Ventilators: In -Cycled Ventilators what is Sensitive Control? Answer: Lower set # -easier for pt. to initiate cycled breath. Higher #s cause an increase in pt. effort. If macine is rapidly-cycling, sensitivity may be set too low(too sensitive). If machine cycles w/o pt. effort - too sensitive. If so turn dial to #s. Question: Mechanical : In Pressure-Cycled Ventilators what is the characterestics of Bennett PRII? Answer: 1.Output Flow=15 Lpm. Neb. Has 2 controls- expriatory&inspiratory nebulization. Neb. Gas source-100% regardless of air on/off 3.Terminal flow control compensates for leaks but reduce flow & works thru air entrainment. Question: Mechanical Ventilators: In Pressure-Cycled Ventilators-In Bennett PRII rate control & control allows what? Answer: Rate control-allows time cycle. Pressure control will allow pressures upto 50cm Question: Mechanical Ventilators: In Pressure-Cycled Ventilators In PRII what is Air dilution ON/OFF allows/achieve? Answer: Air dilution ON-Allows FIO2 OFF 40-80%. Air OFF-achieves 100% O2. Question: Mechanical Ventilators: In Pressure-Cycled Ventilators- In Bennett PRII what to the Bennett valve? Answer: Bennett Valve is flow limited & will close if < 1 Lpm is detected. Question: Ventilators: In Pressure-Cycled Ventilators what is the characterestics of AP4 & AP5 ? Answer: It is electrically powered. It only has pressure& nebulizer control. It can deliver room air. It is good for COPD Pts. It volume & FIO2 when different controls are manipulated. Question: Ventilators: Define Time-Cycled Ventilators Answer: Inspiration for a specified number of seconds. And usually incorporates a specified pressure regardless of volume delivered. Thus a time-cycled vent. Will require a set inspiratory time & pressure. Question: Ventilators: Time-Cycled Ventilators are often used for? Answer: Infants Question: Mechanical Ventilators: In Time-Cycled Ventilator what does it incorporates to guard against exposure to excessive & consequent Barotrauma ? Answer: It incorporates a Pressure Pop-off Question: Mechanical Ventilators: In Time-Cycled Ventilators what is set to set an expiratory time? Answer: Rate maybe set indirectly by setting time. Question: Mechanical : Define Bilevel Ventilators? Answer: 1. Bilevel means that positive pressure is applied during both inspiratory and expiratory . 2. Breaths are flow triggered and also WOB is decreased. Question: Ventilators: In Bilevel Ventilators what settings does it requier? Answer: Inspiratory and expiratory settings. Question: Mechanical Ventilators: In Bilevel Ventilators what must be than expiratory pressures? Answer: Inspiratory pressure must be higher than expiratory . Question: Ventilators: In Bilevel Ventilators what is the actual ventilatory pressure and give eg.? Answer: The actual ventilatory pressure = (Inspiratory pressure - Expiratory pressure) Eg. Inspiratory Pressure = 15 cmH2O and Expiratory pressure = 8 cm H2O 15-8 = 7 cmH2O. Question: Mechanical Ventilators: Bilevel can be used for what all reasons? Answer: It can be used for 1. Non-invasive ventilation 2. does not need intubation. BUT, only for those that requier some assistance ww/ ventilation and NOT for those who require full support. Question: Ventilators: In Bilevel Ventilators what is an Inspiratory pressure and expiratory pressure called? Answer: pressure - IPAP and expiratory pressure - EPAP Question: Mechanical : In Bilevel Ventilators what is the brand name and the therapy name? Answer: Brand name - BIPAP and Therapy name - Bilevel Question: Ventilators: Bilevel Ventilators is not a good device for what patients? Answer: It is not good for pt. requiring High levels of pressure because most machines are only capable of 20-25 cmH2O Question: Mechanical : Home-use Ventilators Answer: 1. These are electricall powered vent & maybe vol./pressured cycled. 2. If pt. vent. More thatn 50% then a back up ven is needed. 3. Family education on CPR & vent. Operations is required. 4. Common Home vents. Are - PLV100, L6 etc. Question: Mechanical : Transport Ventilators Answer: 1. Suitable for a period of time only 2.easy to carry. 3. It is fluidically powered 4. Problems in vent. Vol. & rate when gas supply gets low. Not good for weaning,long term/home vent. Needs physical assesment skills during use. Only operated by RT Question: Mechanical Ventilators: Pressure Ventilators Answer: 1. Do not require invasive devices. 2. More than PPV. 3. Less negative effects compared to PPV. 4. Involves a large suction device attached to the chest wall. 5. Requires a vaccum source. Question: Mechanical Ventilators: what in Negative Pressure Ventilator work when it is applied to the chest wall? Answer: It causes the diaphragm to lower and ventilation to occur. Since diaphragm has its of excursion, high levels of vaccum will have diminishing return on volume. Question: Mechanical Ventilators: In what cycle does the Negative Pressure ventilates and what is Rate and tidal volume controlled by? Answer: pressure ventilation is Time-cycled. Rate is controlled by - time of inspiration. Tidal volume is controlled by - amout of pressure applied. Question: Mechanical Ventilators: In a Negative Pressure Ventilators what occur to get a good seal? Answer: Leak b/w the chest and the . Question: Mechanical Ventilators: In Preoperational Tests what all needs to be done in a ventilator connecting to a patient?Answer: 1) Check return Tidal Volume 2) if Tidal Volume is less than delivered look for a leak & connection points in the circuit. 3) also ensure alarms are working. Eg. High & Low volume or pressure. Question: Airways: Airway Types-ET tubes Answer: It can be inserted throught the oral/nasal . Question: Artificial Airways: Airway Types- Oral ET route?Answer: Oral route insertion is dacilitated by the use of a Laryngoscope an . Question: Artificial Airways: Airway Types-Nasal ET route?Answer: Nasal is performed using a Mgill forceps. Question: Artificial Airways: Airway Types-what are the ET tubes cm markings? Answer: 1. Oral - 20-24 cm @ the lips(low 20's) 2. Nasal intubation - 25-29 cm @ the naris (High 20's) Question: Artificial Airways: Airway -what about ET tubes cuffs? Answer: Tubes may or may not have a cuff depends on the size. Tubes below 6 usually do not have cuffs. Question: Artificial Airways: Types-what are Tracheostomytubes? Answer: Long term method of airway resistance. Question: Artificial Airways: Airway Types-different configurations of a tubes Answer: 1. 2. Jackson Trach tube. 3. Bivona foam cuff. Question: Artificial Airways: Airway Types- what is a Tracheostomy tubes? Answer: A hole in the outercannula.Helps in talking&weaning.Inserts innercannula for resuscitation.It caps tube closed&1st deflate cuff-remove innercannula&cap the tube.deflate while talking, remove innecannula& capping.Best for pts. partially dependent on a Question: Airways: Airway Types- what is Jackson Tracheostomy tubes?Answer: 1. Used for home care and Long term pt. 2. No cuff (cannot mech. ) 3. Tube is made of silver. Question: Artificial Airways: Airway Types- what is a bivona foam tube cuff?Answer: 1. Also called Kamen-wilkinson. 2. The cuff is oassively full means leave pilot open to amnient air to keep cuff expanded. 3. To deflate/inflate or / removal of a cuff use a syringe. Question: Artificial Airways: Types-what is the complications with a Tracheostomy tubes? Answer: Subcutaneous Emphysema-occurs when tracheostomy tube is dislodged&adding air to subcutaneous layers of skin. It feels like crackling when palpating air. Remedy by adjusting tube back to the trachea. This happens while pt. is moved for a bath or so. Question: Artificial Airways: Airway Types- Double-lumen ET Answer: 1. Tube has 2 w/the opening of one lumen @ the end of the tube and another opening b/w the 2 cuffs. 2. One lumen(distal) will ventilate the lung side in which it is inserted. The other lumen (proximal) will ventilate the other lung side. Question: Airways: Airway Types- what is Double-lumen ET tube good for and with? Answer: Good for Independent lung ventilation with 1. Bronchopleural fistulas. 2. During surger to of the lung (lobectomy, esophageal resection.) Question: Airways: Airway Types-Laryngeal Mask AirwayAnswer: 1. short ET w/an inflatable mask(cuff)@the end.Cuff part is inserted in the deflated mode in the hypopharnx above the trachea&then inflated. It facilitates good breathing.Not to use w/PPV gastric innsufflation.Pt. cooperation needed for LMA removal Question: Airways: Airway Types- CombitubeAnswer: 1. Dual lumen tube w/ 2 cuffs. 2.Used for quick 3. Tube is intended to insert in Esophagus, Proximal opening in the tube gives access to the lungs. 4. It can be inserted blindly. 5.Larges cuff serves as an anchor against hard palate. Question: Airways: Airway Types-Oral airway Answer: 1. Usually plastic do not enter the keeps airway open even if pt. is biting. 2. Proper size is distance b/w angle of jaw &tip of chin. 3. Inserted 180 Degrees from it final position then twisted into place. 4. Should not secure w/ a tape. Question: Artificial Airways: Airway Types- airway Answer: 1. Also called Nasal trumphet. 2.Sizes - a. Outer diameter of the airway should match inside diameter of outer naris. B.lenth should be equal todistance b/w the earlobe & the nasal septum. When too long pt. coughs - to short tube after insertion Question: Artificial Airways: Airway Types- Define ? Answer: Airways may or may not come w/inflatable cuffs. This varies according the tube's size, and function. Question: Artificial Airways: Types- 2 Types of cuffs?Answer: 1.Large volume,Low pressure-minimizes pressure on the wall of trachea&avoids impedance of capillary blood flow& reduces the incidence of tracheal tissue damage.2. Low volume,High pressure-used on tubes that 2cuffs. (combitubes & lumenn tubes) Question: Artificial Airways: Types- What is a cuff pressure?Answer: 1.Cuff Normal is 20 mmHg. Higher than 20 mmHg could impede blood-flow&promote tissue death. It can be using a pressure manometer. If NO pressure-check connections then add air&observe a pressure rise. If NO pressure rise - then replace the tube Question: Artificial Airways: Types- What is Minimum Occluding Technique ? Answer: MOV - adding & removing air from the cuff ausculting over the neck. Enough air is added to stop the sound of air passing around the cuff. Question: Artificial Airways: Types- What is Minimum leak Technique ?Answer: MLT - It is performed like the MOV. Enough air is subtracted from the cuff to a very small leak at the top of inspiration. Question: Artificial Airways: Airway Types- Insertion equipment - ? Answer: It attaches to varies blade sizes, usually batteries to power a light on the blade. Question: Artificial Airways: Airway - Insertion equpiment- 2 types of Larngoscope BladesAnswer: 1. Miller blade(straight )- a. Fits under epiglottis. B. only used for infants. 2. Macintosh blade (curved blade)- fits into the vallecula. Question: Artificial Airways: Airway Types- Insertion equpiment- what are the Larngoscope ? Answer: 1. Light should turn on when blade is snapped into place. 2. If it does not turn on then a. First tighten the bulb b. try a blade. C. change handle/handle batteries. Question: Artificial Airways: Airway - Insertion equpiment- what are the Blade sizes of a larngoscope? Answer: 1. Adult- size 3. 2. Pediatric- size 2 3. Full-term - size 1. 4. Pre-term infant- size 0 Question: Artificial Airways: Airway - Insertion equpiment- What are other intubation assisting tools?- Stylet? Answer: 1. ONLY fot Oral intubation. 2. Insert it into the ET tube to help it and ease insertion. Question: Artificial Airways: Airway Types- Insertion equpiment- What are intubation assisting tools?- Magill forceps Answer: 1.ONLY for nasal intubation. 2. Insert into the mouth to direct tip of a nasally inserted ET tube into the trachea 3.If asked to gather equipment for an ORAL intubation - DO NOT include magill forceps. If performing nasal intubation do not stylet Question: Artificial Airways: Airway Types- What are the ET sizes? Answer: 1. Adult- use the 1st number of the pts. Wght. In kg. eg. Pt weighs 72 kg then use - 7 ET tube. If 84 kg then use 8 ET tube. 2.Pre-term - size 2 3.Full term infant - size 3. Question: Pulmonary Equipments: Define Blood gas analyzers Answer: Used to make measurement of PCO2, PO2 an pH. Question: Assessment Equipments: Electrode Types of Blood gas analyzers Answer: 1. pH - sanz electrode. 2. PCO2 - Servinghaus electrode. 3. PO2 - electrode. Question: Pulmonary Assessment : Calibrations of Blood gas analyzers Answer: 1. Low pH solution- 6.84 High pH - 7.38 2. PCO2 calibration - 5% CO2 gas. 3. Low PO2 calibration - 0% O2. High PO2 calibration - 12%/20% O2. Question: Assessment Equipments: How many hours does a QC material should be run? Answer: 8 hrs. Question: Pulmonary Assessment Equipments: Blood gas quality control - 3 introduced for a QC material? Answer: 1. acidodic. 2. and 3. Alkalotic materials. Question: Pulmonary Assessment Equipments: Types of graphical on a QC device? Answer: 1. In 2. Also in control 3. Trend 4. Shift 5. Random error. 6. Not in control. Question: Assessment Equipments: what is a CO-Oximeter? Answer: 1. It determines the amount of CO in the blood. 2. Acceptable range - 1-3% (smokers b/w - 5-15%) 3. Above 20% - CO requires treatment. 100% O2, Hyperbaric therapy etc. 4. Since analyzed in the machine, data is a spot check value. Question: Pulmonary Assessment : What is a Pulse-Oximeter? Answer: 1. It is a non-invasive way to measure O2 saturation. 2. It determines saturation by examining light wave lengths transmitted the finger/ ear lobe etc. Question: Assessment Equipments: When is a Pulse-Oximeter show low accuracy or poor function? Answer: 1. High light. 2. Finger nail polish. 3. Very low BP&perfusion (shock) 5.Erythema. -If suden fall is indicated SaO2 is noted-then suspect a problem w/ the probe 1 st - DO NOT increase the flow/ other intervention decision based on that data alone Question: Assessment Equipments: What is a Capnography (PECO2/PetCO2)? Answer: Measures CO2 from expired gas.It is not invasive. Uses -red technology. Varies about 10mmHg w/ arterial CO2(reads lower).If reading low/0 pt. needs vent. support. If capnography has no plateau on the waveform, then think about Airway resistance-COPD Question: Pulmonary Equipments: What is Inflection points in a Capnography (PECO2/PetCO2)? Answer: Any part of graph that changes is called an inflection point. 1.Normal capnograph. 2. capnograph w/ a dead space - pulmonary embolism. 3. capnograph w/ poor ventilatoion/ventilatory failure. Question: Pulmonary Assessment Equipments: What is Pulmonary Testing (PFT)? Answer: Collins water-sealed spirometer is the most effective w/meausrements of flow and . Question: Pulmonary Assessment Equipments: What is an O2 ? Answer: 1. Used to measure FIO2. 2. requires calibration. 3. Should be used any time a in FIO2 is made. Question: Pulmonary Assessment Equipments: What are the of electrodes? Answer: 1. 2. galvanic fuel cell Question: Pulmonary Equipments: what is a polargraphic? Answer: 1. It requires battery and a n electrolyte solution. 2. If analyzer read 100% - then change battery. 3. If analyzer don’t read and battries are good - then change electrolyte solution. ex: clark electrode. Question: Pulmonary Assessment Equipments: What is a fuel cell? Answer: Its a cell batery & is good & common.If not working-it could be fuel cell is consumed so change cell.DON'T change solution/battery bcoz CELL is the battery.It is affected by high pressures changes in altitude, H20 on the . PAP causes high reading Question: Pulmonary Resuscitation : Desired characterstics? Answer: 1. self-inflating. 2. NBR valve. 3. Adjustable relief valve on models, fixed 25cmH2O on adult models. 4. Internal diameter connector of 15mm,outer diameter22mm. 5.Reservoir to maximize FIO2. 6.Shapeable, transparent& inflatable mask. Question: Pulmonary Resuscitation : Troubleshooting Answer: If bag collapses easily when squeezed & no chest rise replace bag & If bag is to squeeze, ensure pt. valve isnt stuck, check if the problem is low pulmonary compliance. If bag is suspected faulty replace bag dont fix the problem unless no option Question: Pulmonary Resuscitation : Mouth-to-valve mask Answer: 1. serves as a barrier b/w pt. and provider. 2. Cross contamination from pt.s expelled air is prevented through a one-way valve. 3. to mouth-to-mouth ventilation. Question: Pulmonary Resuscitation Equipments: valve (Pneumatically powered) Answer: 1. Deliever 100% FIO2. 2. Triggers by manual button & negative inspiratory pressure produced by the pt. 3. Not to changes in lung compliance-risks a pneumothorax. 4. Too powerful for infants. 5. Associated w/ gastric insufflation. Question: Suctioning Equipment: Suctioning Catheter- system suction catheter Answer: 1. Ballard is an eg. For closed suction device. 2. allows repeated used of the catheter-bags keep catheter sterile. 2. No discontinuance of FIO2/mechanical ventilations. 3. when pt. is on high PEEP levels (no break in PEEP). Question: Suctioning Equipment: Suctioning Catheter- Standard Answer: 1. Must maintain sterile technique when using. 2. one-time use only. (no ) Question: Equipment: Suctioning Catheter- Coude Tip Catheter Answer: 1. Tip of catheter is bent slightly to facilitate entrance and of the left mainstem bronchous. 2. Can be twisted to direct into either bronchus. 3. requires sterile technique. Question: Equipment: Catheter Size- Length Answer: 1. Nasal/Oral suctioning- 20 inches. 2. suctioning- 15 inches. Question: Suctioning Equipment: Size- Diameter Answer: 1. should not exceed 1/2 of the internal of the ET/Trach tube. Question: Suctioning : Catheter Size- Diameter in French Units Answer: 1. 1mm/ID of ET/Trach tube = 3 French. Ex. If Id = 6.0 mm, catheter shouldnt exceed 3.0mm i.e. 3.0mm*3 = 9 French catheter. 2.If comes in 8-10 french & catheter needs to be 9 (choose smaller of 2 (8 fr.) 3. 10 & 12 Fr. Most common for adults. Question: Suctioning : Suction Pressure- Answer: 1. Adults: 100-120 mmHg. 2. : 80-100 mmHg 3. Infant: 60-80 mmHg. Question: Suctioning : If suction not adequate what do we do? Answer: 1. connections 2. check collection bottle - change if full. Question: Equipment: Other suction Devices Answer: 1. In-line specimen trap (luken's trap) 2. Tonsil suction devices- a. Know as a yankauer(brand) b. also know as oral suction device. C. Useful in mouth and throat. Question: Cleaning- Define Disinfection?Answer: pathogenic organisms. Question: Cleaning: Disinfection- Steam autoclave Answer: 1. No . 2. Involves placement in packages prior to prodcedure. Question: Equipment : Disinfection- Pasteurization Answer: 1. Done with pre-washing and hot-water soak. 2. Best to use with used on patients with infectious disease such as hepatitis. Question: Equipment Cleaning: Disinfection- Answer: 1. and isopropyl are effective. 2. 70-90% concentrations. Question: Equipment Cleaning:Define ? Answer: Kill all organisims Question: Equipment : Sterilization- Irradiation Answer: 1. Uses radioactive gamma rays. 2. DO NOT follow irradiation with oxide (ETO). Question: Equipment Cleaning: - Incineration Answer: 1. Destroys equipment. 2. for disposable items. Question: Equipment Cleaning: Sterilization- Ethylene (ETO) Answer: 1. Gas sterilization 2. Good for devices that have components. Question: Equipment : Sterilization- Cidex (Alkaline Gluteraldehyde) Answer: 1. Liquid. 2. Not good for electrical components. 3. Will kill all bacteri in 10 mins. 4. Will kill in 10 hrs. 5. Tuberculocidal in 20 mins. 6. Works by using a caustic (alkaline) pH (7.5-8.5) Question: Equipment Cleaning: Sterilization- (Acid Gluteraldehyde) Answer: 1. Kills in 10 minutes. 2. Kills everything in 1 hr. 3. Uses acidic pH (2.5-3.5) Question: Special equipment : Answer: 1.Bronchoscope - Cidex ( Alkaline gluteraldehyde) 2. IPPB - ETO Question: control: Answer: 1.disposable method of determining pathogens survived a sterilization/disinfection procedure such as pasteurization. 2. If (able to live) spores are found, then equipments requires re-sterilized. Question: Control: a therapist have to use what precautions? Answer: Always use at Universal precautions. Question: Infeection Control: How do we an equipment? Answer: In a bio-hazard waste bag. |
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