Ready-Set-Ventilate
With this type of ventilation, the ventilator delivers a fully supported breath whether time or patient triggered. Primary mode of ventilation used in respiratory failure. Decreases work of breathing.
What is Assist Control (AC)?
All patients on the ventilator should have a minimum of _________ cmH2O fo peep.
What is peep?
What is 5?
At the end of mechanical or spontaneous exhalation, PEEP maintains the patient's airway pressure above the atmospheric level by exerting pressure that opposes passive emptying of the lung.
If need improvement in oxygenation, what ventilator adjustments would you consider?
What is increasing fiO2 and increasing PEEP as tolerated?
Describe equipment needed and set up of the zoll/impact ventilator for an adult patient in respiratory failure from congestive heart failure that is 72inches tall and will utilize volume control ventilation.
What is- vent circuit, vent, oxygen source. Set up vent from bottom up
(Things to consider-what mode?calculate IBW or reference IBW chart-what starting tidal volume, rate? peep?fio2? other settings...make this a group discussion if needed)
Goal end tidals for a TBI patient-
-With no signs/symptoms of herniation
-With signs/symptoms of herniation.
Name some signs of herniation.
What is:
With no signs/symptoms of herniation 35-40
With signs/symptoms of herniation 30-35
What is -unequal pupils, widened pulse pressure, hypertension, bradycardia...
With this mode of ventilation, the ventilator will deliver a mandatory set number of breaths but at the same time allowing spontaneous breaths. Patient will determine spontaneous breath tidal volume.
What is SIMV?
If your patient needs more than ______cmH20 of PEEP, you will need to contact medical control.
What is 15cmH20 of peep.
If ETCO2 is less than 35, what ventilator settings would you consider adjusting to meet you end tidal goals of 35-45.
What is decreasing vent rate, decreasing tidal volume?
Describe equipment and set up of ventilator for a pediatric patient requiring pressure ventialtion.
What is- vent circuit, vent, oxygen source. Set up vent from bottom up
(Things to consider-what mode?calculate IBW or reference IBW chart-what is starting PIP, what are desired tidal volume, rate? peep?fio2? other settings...make this a group discussion if needed and can review at aircraft.)
This type of ventilation mode is recommended for acidosis.
What is assist control?
*simv is recommended in alkalosis.
With this type of ventilation, the ventilator delivers a fixed pressure at variable volumes.
What is Pressure Controlled Ventilation?
This is a complication of mechanical ventilation with air trapping.
Describe ways to identify that your patient may have air trapping.
What is auto peep?
Signs of autopeep/air trapping-increasing pPlat, incomplete exhalation -look at inspiratory/expiratory waveform-should return to baseline on expiration, increase use of accessory muscles on expiration-active expiration, shark finned co2 waveform, drop in blood pressure
In volume control ventilation, how can you lower the PIP if greater than 40.
What is reduce the tidal volume, reduce rate and assess for causes of increasing/increased PIP?
The infant vent tubing can deliver a tidal volume of __________ml.
What is 50-300ml?
Describe how to determine tidal volume needs for a patient.
What is:
IBW chart
or
Formula: 50kg + 2.3kg for each inch over 5 foot.
This type of ventilation is noninvasive and provides continuous positive airway pressures to improve oxygenation and ventilation.
Name this type of ventilation and also, name contraindications to this type of ventilation.
What is CPAP?
Contraindications include: apnea, inability to protect airway, uncorrected hypotension, active vomiting, Active upper GI bleed, Facial injuries/burns
A goal for PIP is to maintain it at _____?
What is equal to or less than 40cmH20?
If you have a sudden/abrupt increase in PIP, what will you do?
What is assess for obstruction?
DOPE!
This determines the rate at which the ventilator achieves a target pressure (in pressure control modes) or flow rate (in volume control modes).
What is rise time?
You have a patient with pulmonary edema. What mode of ventilation is recommended and what other vent settings would you consider when setting up the vent.
What is:
NIV first, if needed then AC or SIMV depending on patient needs.
other settings: Consider rate based on patient's needs, peep would be added at 5 and adjusted as needed, fio2 100% and titrated based on o2 sat and needs
This is a type of ventilation that provides 2 different positive pressures to improve ventilation and oxygenation. (inspiratory and expiratory pressures). Name this type of ventilation.
Describe equipment needed, indications for this type of ventilation and how to set up a patient on this type of ventilation.
What is bipap?
Equipment needed-vent circuit, ventilator, patient.
Indications-respiratory distress/failure. Remember-patient must be able to follow commands, maintain own airway.
Set up- set up vent,( bi level or cpap+PS, Rise time-start at 3, may need adjusting, EPAP/PEEP start at 5, IPAP/PS start at 5 and adjust accordingly, fiO2-adjust to meet O2 sat goals-generally >94% but patient dependent. Set alarms on rate and tidal volume) connect circuit/select appropriate sized mask and head strap. coach patient, let them hold the mask to face.
A goal for pPlat is ___________cmH20.
What is less than 30cm20?
If you have a sudden/abrupt decrease in PIP-what will you do?
What is check for disconnect?
DOPE!
The sensitivity of this determines how much effort the patient has to exert before his inspiration is augmented by the ventilator.
What is the trigger?
You have a patient with asthma and is needing to be placed on the vent. What settings would you consider with this patient?
What is Mode- SIMV or AC
rate-will need to be slower to allow for exhalation. Pt will need to be adequately sedated and/or paralyzed to help control rate.
peep-at least 5 but dependent on O2 sats. Consider increasing PEEP to keep splint the airway open.
Fio2-titrate as needed-oxygenation is primary goal
Allow Hypercapnea