It's
Your patient is on 4L of O2. What FiO2% is being administered?
31-38%
Your patient, who has a 30-pack year smoking history, is undergoing a lobectomy. During the case, he is satting 95%. You decide to get an ABG. The PaO2 is 55. What is your next step, and what could cause this discrepancy?
Increase O2 (PaO2 needs to be higher than 60)
False high reading from carboxyhemoglobin
What is an inverse I:E ratio and how can it affect circulation?
Inverse I:E is > 1:1
can impede venous return to the heart and increase pulmonary vascular resistance
The I:E ratio is typically _____.
Patients that can benefit from a longer expiratory time include _______ .
1:2
COPD - 1:3+
What is a downside for Pressure Control mode?
Tidal volumes can be inadequate, and there will be no alarms for it
- poor positioning
- kinked tube
- insufflation
List five benefits of adding humidity to oxygen
1. bronchial hygiene
2. hydration of secretions
3. prevention of heat loss
4. increased patient comfort
5. reduction of airway inflammation
Hypoxia from general anesthesia most commonly occurs for what reason?
A. Hypoxic FGF delivery
B. Increased intrapulmonary shunting d/t decreased FRC
C. Decreased diaphragm contraction from NMB
D. Altered Hgb carrying capacity
B. Increased intrapulmonary shunting d/t decreased FRC
Tidal volume is ______ proportional to lung compliance and _______ proportional to airway resistance
directly , indirectly
categorize the following into high or low flow systems:
- non-rebreather mask
- nasal cannula
- Venturi mask
- jet nebulizer
- simple mask
HIGH:
- non-rebreather mask
- Venturi mask
- jet nebulizer
LOW:
- nasal cannula
- simple mask
Pressure support
What is the P50 of Hgb?
27
electricity
gas (usually O2)
A Venturi mask uses what physics principle to accelerate gas into the O2 flow?
What ventilator mode would have this wave form for flow?
(see photo)
pressure control
What settings does the provider set in Volume Control Mode
- tidal volume
- I:E ratio
What is the risk of using an ultrasonic nebulizer, and why would this happen?
over-hydration (could also precipitate bronchospasm)
provides 100% humidity
work of breathing = compliance x resistance
You have a patient with COPD that is requiring extra O2 supplementation. Would you select a low flow or high flow system? why?
high flow d/t predictable FiO2 with a hypoxic respiratory drive
Which nebulizer can be used for continuous O2 therapy?
A. small-reservoir nebulizer
B. Large-reservoir jet nebulizer
C. Ultrasonic nebulizer
B. Large-reservoir jet nebulizer
What mode can be described as having a "shark fin" appearance when looking at the inspiratory flow?
Volume control
- softer, more consistent increase in volume
What are the two categories of O2 therapy systems?
Low flow (does not meet all of patient's MV)
high flow (flow rates meet all of the patient's MV)
Which humidifier should not be used for an ETT or trach?
A. Passover humidifier
B. Cascade humidifier
C. Bubble diffuser
C. Bubble diffuser
Which of the following are early signs of hypoxia? Select all that apply
- confusion
- hypotension
- tachycardia
- bradycardia
- cardiac irritability
confusion, tachycardia, and cardiac irritability
--- bradycardia and hypotension are late signs ---
What makes Volume Control Auto Flow different than Volume control or Pressure Control?
you can set TV, RR, I:E, and Peak pressure levels.
delivers breaths similar to pressure control but will alarm with a low tidal volume
"volume targeted, pressure limiting mode"
You've connected your patient to the circuit and dial-in settings for a peak airway pressure limit, respiratory rate, and I:E ratio. What mode have you selected?
Pressure Control