Review A
Which therapy focuses on lung expansion which requires positive pressure and the patient to passively exhale.
EzPAP!
What is the recommended suction pressure range for adults, pediatrics, and infants?
i) 120 -150 mm Hg for adults
ii) 100-120 for pediatrics
iii) 80-100 for infants
What is the purpose of performing an operational check on a manual resuscitator before use?
The purpose is to ensure the bag functions properly, check for leaks, and verify that the valves open and close correctly to deliver adequate ventilation.
What are two reasons to collect an ABG?
- PaO2, PaCO2, pH, electrolytes, lactate
If compliance decreases, and volume stays the same, what happens to alveolar pressure?
Increases
A 45-year-old female with cystic fibrosis presents with increased sputum production, worsening cough, and decreased air movement on auscultation. Her chest X-ray shows mucus plugging, and she reports difficulty clearing secretions. She is compliant with her current bronchodilator regimen and uses a flutter valve at home. Which of the following bronchial hygiene therapies would be the best additional intervention to improve secretion clearance?
Vest therapy would be the next therapy to try for this patient. It is non-invasive, safe, does not change her day to day treatment plan. IPV would be the next following step but is generally reserved if the patient is unable to perform more non-invasive ACT.
How do you select the appropriate suction catheter size based on an endotracheal tube’s internal diameter?
Tube ID x 2 then down one size (-2)
What are some stratgies to increase oxygen concentration delivered to the patient?
"Ride the bag"
"Increase O2 flow rate"
"Slower ventilation rates"
A 65-year-old male with a history of COPD and recent abdominal surgery is experiencing decreased breath sounds and mild hypoxemia (SpO₂ 91% on room air). A chest X-ray reveals bibasilar atelectasis. The patient reports mild discomfort when taking deep breaths. Which lung expansion therapies is the best initial choice for this patient?
Incentive spirometry is the best initial choice for post-operative atelectasis, particularly in a cooperative patient. It encourages deep breathing, improves lung expansion, and is well tolerated.
If airway resistance increases, and volume stays the same, what happens to alveolar pressure?
Stays the same
Which therapy would be most appropriate for an intubated quadrapelgic who has an intact cough, tenacious secretions and atelectasis?
IPV/Metaneb
Where do we place a sputum trap?
Between the suction catheter port connector and the suction tubing.
List three parts of the BVM (besides the mask) that are crucial for patient survival and safety.
In regards to IPV, which setting is used for hyperinflation
"Faster or higher frequency"
If complaicne increases, and pressure stays the same, what happens to volume?
Increases
What is the proper postural positioning would be appropriate in order to drain the RML
Trendelenburg position 12-18in, supine with pillow under right side.
What strategies can help advance a nasotracheal suction catheter past the vocal cords into the trachea?
What are the potential complications of prolonged manual resuscitation without an airway, and how can they be minimized?
Gastric inflation. Slow delivery of tidal volume. Ensuring to only provide enough ventilation to ensure chest rise.
Hyperinflation due to lack of knowledge of delivered tidal volumes and air trapping.
What are the two golden rules for using cough assist?
Pressures less than 30(+-) cmH2O, and insufflation should never be higher than exsufflation.
If airway resistance increases, and pressure stays the same, what happens to volume?
Decreases
Name the segments of the left lung:
What are the key differences between open and closed suction systems, and how do they impact patient oxygenation and PEEP maintenance?
What physiological effects does increasing PEEP have on alveolar pressure, FRC, and cardiac output during manual resuscitation?
Increased PEEP improves alveolar recruitment and increases Functional Residual Capacity (FRC), enhancing oxygenation. However, excessive PEEP can raise alveolar pressures, reduce venous return, and lower cardiac output.
What is the appropriate tidal volume you should deliver to a 6'0" male patient?
465-620 mL
Name two reasons each why airway resitance might increase, and why compliance might decrease.
Raw: Secretions, bronchoconstriction, increased flow rates, adjunct airway devices
Cst: Atelectasis, pneumothorax, edema, etc.