patho summer 06
Terms
undefined, object
copy deck
- Lower lobe is a _____ structure, thus an infiltrate in the lower lobe will silhouette the ____, not the heart
-
1)posterior
2)diaphragm - Compliance curve--when compliance increases the curve shifts____
- Left
- When compliance decreases, the curve shifts___
- right
- Obesity, pregnancy,kyphoscoliosis, stiff chest muscles, increased FRC cause___
- respiratory system compliance to decrease
- PEEP was developed in the OR because
- when patients are sedatesd and paralyzed their respiratory muscles relax and FRC decreased, resulting in a lower FRC.
- Increased physiologic dead space and intrapulmonary shunting cause mismatch that requires____
- increased postive pressure ventilation and increased PEEP
- Tidal volume for an ARDS patient
- 6cc-kg
- Percentages of intubated patients who develop nosocomial pneumonia
-
1)20 percent after 4 days
2)40 percent after a week on the vent - Problems associated with invasive mechanical ventilation
-
1)upper airway is no longer intact
2)vocal cord damage, tracheal stenosis
3)expense
4)no communication
5)increased sedation
6)cough mechanism is compromised - Characteristics of pressure support
-
1)Patient is ventilated to a set pressure
2)flow is initially rapid, then varies to pt. compliance, inspiratory demand, or volume changes to deliver a set pressure
3)Tc, I time, and RR are all controlled by the patient
4)PSV reduces the load on inspiratory muscles, reduces WOB, 02 consumption, and improves synchrony between pts. and the ventilator - Why does PEEP work with ARDS people?
- Because it increases FRC, and creates a reservoir
- To help prevent aspiration, the cuff should be maintained at
- at least 18 cm H2O
- Problems associated with mainsterm intubation
-
1)Decreased ventilation of the left lung, possible atalectasis in the left lung
2)Increased PIPs with VC
3)decreased oxygentation due to shunting - Characteristics of a tension pneumothorax
-
1)Respiratory distress
2)Absence of BS
3)Hypertympanic
4)distended neck veins
5)unilateral absence of BS
6)Tracheal deviation
7)mediastinal shift
8)hypotension - Indications for acute NIV
-
1)alveolar hypoventilation
2)ventilatory muscle fatigue
3)early extubation
4)C-spine injury
5)end stage disease
6)extrathoracic inspiratory stridor
7)DNI's
8)Post op patients with OSA - Pathologies that respond well to NIV (Strong evidence for)
-
1)COPD
2)CHF
3)immunocompromised patients - Pathologies were there is less evidence of success with NIV
-
1)Ashthma
2)pneumonia
3)ARDS
4)Hypoxemic respiratory failure
5)DNI
6)post-ops - Why patients with CHF benefit from NIV
-
Patients who have COPD benefit from the effects of positive pressure on venous return
a)decreaased blood volume causes a decrease in ventricular filling pressures - Contraindiactions for NIV
-
1)hemodynamically unstable
2)need for intubate intubation
3)Swallowing dysfunction
4)Inability to protect the upper airway (OD, hemoptysis patients)
5)uncooperative patients (except for CO2 narcosis)
6)excessive secretions
7)facial trauma
8)active GI bleeding - Common predictors for worse outcome with NIV
-
1)Ph less than 7.25
2)APACHe scale greater than 29
3)GCS less than 11
4)RR greater than 36 - APACHE score chracteristics
-
compilation of physiologic and demogrpahis factors like age, chronic disease, and hemodynamic status
(The greater the no, the greater the risk for mortality - Pressure support should be at least ___ for patients on Bipap
- 4 cm H2O
- breathing for quadraplegis pts.
-
1)Abdomen moves up as diaphragm contracts
2)chest wall moves down, since he chest muscles are not innervated and do not contract - Kink in the tube
- Belly will move progressively downward
- Fine crackles heard at the end of inpiration
- Consistent with CHF or pneumonia
- Methods used to evaluate the adequacy oxygentation
-
1)Central cyanosis
2)mental deterioration
3)SPo2 - Compromises to sat probes
-
1)sunglobin
2)diagnostic dyes
3)hemoglobin abnormalities - Central cyanosis will occur when____
- When oxygen content is reduced by 5 ml per 100 cc of blood cyanosis will occur
- A patient with chronic bronchitis_______
- May be cyanotic with a relatively modest decrease in O2 saturation
- Increasing PCO2 will cause ______ in the brain
- vasodilation