Ready-Set-Ventilate
With this type of ventilation, the ventilator delivers a fully supported breath that are volume targeted and mandatory.
What is Assist Control (AC) or APVcmv/CMV+
(controlled mandatory ventilation)
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 Hamilton 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)
This is the goal etC02 for a TBI patient-
*Name some signs of herniation.
What is: 35-45 mmhg (healthy adult lungs)
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.
What is SIMV?
*PSIMV+(pressure controlled)
*APVsimv/SIMV+ (adaptive pressure ventilation-volume targeted mandatory allowing pressure supported spontaneous)
If your patient needs more than ______cmH20 of PEEP, you will need to contact medical control.
What is 15cmH20 of peep.
*consider using Fio2/Peep table on Q25
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 ventilation.
What is- vent circuit, vent, oxygen source. Set up vent from bottom up.
(Things to consider- >15kg<?, what mode? height? 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 transport settings.
What is SIMV?
*Set pressure support to 10 (5-15 acceptable) to help patient overcome ETT resistance and dead space in vent circuit with spontaneous breaths.
With this type of ventilation, the ventilator delivers a fixed pressure at variable volumes.
What is Pressure Controlled Ventilation?
If this is not set directly it can and will drop your tidal volumes.
What is PLimit.
maximum allowed pressure to be applied during ventilation. *Changing this automatically changes your pressure alarm limits, as it's always 10cmH20 greater than your plimit.*
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 HME does this?
What is - Heat and moisture exchanger, that passively humidifies the airway and prevent drying of respiratory mucosa (ex-mucous plugging/ETT occlusion) **Can also filter/reduce infection risk to patient and provider.
Intended to replace the normal warming, humidifying, and filtering functions of the upper airway that is bypassed with ETT.
Describe how to determine Pplat on Hamilton T1?
What is:
(VTE/CSTAT) + peep
OR
/\ (delta) pressure + peep
This type of ventilation is noninvasive and provides continuous positive airway pressures to improve oxygenation.
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
**Pinsp set to 0
This (setting) is the time required for inspiratory pressure to rise to the set (target) pressure...
**prevents increased work of breathing and improving synchrony.
PRamp/pressure ramp
*lower pramp=rapid pressure rise, high initial flow, potentially higher tidal volume, useful for those needing strong support
*higher pramp= slower more gradual pressure rise, lower initial flow, mimics natural breathing, and improves patient comfort.
If you have a sudden/abrupt increase in PIP, what will you do?
What is assess -> sedation, ETT/circuit kinked, occlusion, obstruction, bronchospasm.?
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 started at 5 and adjusted as needed, fio2 100% and titrated based on o2 sat and needs
**bilateral rales->rule out STEMI/ obtain 12-lead within 10 minutes)
This is a type of ventilation that provides 2 different positive pressures to improve ventilation and oxygenation. (inspiratory and expiratory pressures).
(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-ventilation and oxygenation. Respiratory distress/failure, congestive heart failure. Remember-patient must be able to follow commands, maintain own airway.
Set up- set up vent,( NIV or NIV-ST, set your EPAP/PEEP, IPAP/PS (this is additive on the Hamilton *If hospital settings are 12/6 set your PINSP as 6) 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.
*do not set a rate in transport*
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?
*At or closer to 0 = easier to trigger breath.
*Further from 0 = more difficult to 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
**ETS-expiratory trigger sensitivity percentage of peak inspiratory flow at which the ventilator cycles from inspiration to exhalation... higher ETS-shorter inspiration (more expiratory time) lower ETS-prolongs inspiration (more inspiratory time)