Cardiac and Airway Management Quiz

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Questions and Answers

What are the two primary reasons for checking armband information, and what method should be used to verify this information?

Two reasons for checking armband information are to ensure patient identification and to confirm allergies. The information should be verified by checking both the IeMR and the patient monitor.

What is the correct procedure for measuring and inserting a Guedel airway?

Measure from the corner of the patient's mouth to the earlobe. Insert the Guedel tip into the mouth, reaching the roof, and then rotate it 180 degrees.

Describe the purpose and proper placement of a 14-gauge cannula in the context of potential pneumothorax.

A 14-gauge cannula can be used for decompression of a tension pneumothorax. It is inserted at the second intercostal space, mid-clavicular line.

What is the primary action of Metaraminol, and what is a common side effect?

<p>Metaraminol is an alpha-1 receptor agonist, leading to vasoconstriction. It can cause bradycardia, a slowing of the heart rate.</p> Signup and view all the answers

Explain the role of the manometer in patient care, and describe the proper frequency for its use.

<p>The manometer measures the pressure within the suction system. It should be checked at the start of a shift and after every patient turnover, ensuring it is functioning correctly at a pressure of 30 mmHg.</p> Signup and view all the answers

What fluid does the pericardium produce, and what is its primary function?

<p>The pericardium produces serous fluid, which lubricates the heart to reduce friction during contractions.</p> Signup and view all the answers

Describe the pathway of blood through the heart, starting with the superior and inferior vena cava.

<p>Blood enters the heart through the superior and inferior vena cava, flows into the right atrium, then the right ventricle, through the pulmonary valve, into the pulmonary trunk, and lastly, to the lungs via the right and left pulmonary arteries.</p> Signup and view all the answers

What is the function of the SA node in the heart's electrical conduction system?

<p>The SA node is the primary pacemaker of the heart, initiating the electrical impulse that triggers heart contractions.</p> Signup and view all the answers

Explain the difference between depolarization and repolarization in the context of the heart.

<p>Depolarization refers to the electrical activation of heart muscle cells, causing contraction, while repolarization is the return to a resting state, leading to relaxation.</p> Signup and view all the answers

What specific electrical event in the heart does the P wave on an ECG represent?

<p>The P wave on an ECG represents atrial depolarization, which leads to atrial contraction.</p> Signup and view all the answers

What is the normal heart rate range in beats per minute (BPM)?

<p>The normal heart rate range is 60-100 BPM.</p> Signup and view all the answers

What are the three primary categories of inotropes, and what is their general mechanism of action?

<p>The primary categories of inotropes are catecholamines, phosphodiesterase inhibitors, and cardiac glycosides. They all work by increasing the force of heart muscle contractions by acting on different cellular mechanisms.</p> Signup and view all the answers

What is the primary indication for using dobutamine as an inotrope?

<p>Dobutamine is indicated for cardiogenic shock due to its direct stimulation of beta 1 receptors, which increases cardiac output without causing vasoconstriction.</p> Signup and view all the answers

Explain why vasopressin is a useful medication in cases of refractory vasodilatory shock.

<p>Vasopressin is effective in refractory vasodilatory shock due to its potent vasoconstrictive action, especially in the systemic, splanchnic, renal, and coronary circulations.</p> Signup and view all the answers

What is the primary action of metaraminol, and how does it achieve its effect?

<p>Metaraminol is a synthetic sympathomimetic that acts as both a direct and indirect alpha 1 receptor agonist, leading to vasoconstriction and an increase in blood pressure.</p> Signup and view all the answers

Describe the difference between positive pressure and negative pressure ventilation.

<p>Positive pressure ventilation uses external pressure to push air into the lungs, while negative pressure ventilation relies on creating negative pressure in the chest cavity to pull air inward.</p> Signup and view all the answers

What does lung compliance refer to in the context of mechanical ventilation?

<p>Lung compliance represents the degree of ease with which the lungs expand during inhalation. A low compliance indicates a stiff lung that requires more pressure to inflate.</p> Signup and view all the answers

What is the normal CVP range for a ventilated patient?

<p>8-12 mmHg</p> Signup and view all the answers

What is the main difference between volume-controlled ventilation and pressure-controlled ventilation?

<p>In volume-controlled ventilation, each breath delivers a fixed volume of air, regardless of pressure, while pressure-controlled ventilation delivers a predetermined pressure for a set time.</p> Signup and view all the answers

What does the "a" wave represent on a CVP waveform?

<p>Atrial contraction</p> Signup and view all the answers

What is the role of PEEP in mechanical ventilation, and how does it affect the lungs?

<p>PEEP (Positive End-Expiratory Pressure) maintains a positive pressure in the airways at the end of expiration, helping to prevent lung collapse and improve oxygenation.</p> Signup and view all the answers

What is the significance of the dicrotic notch on an arterial waveform?

<p>It indicates the closure of the aortic valve</p> Signup and view all the answers

What is the primary purpose of capnography?

<p>To measure exhaled carbon dioxide levels</p> Signup and view all the answers

How does the level of H+ ions relate to blood pH?

<p>Higher H+ levels result in lower pH (acidosis), while lower H+ levels increase pH (alkalosis)</p> Signup and view all the answers

What is the normal range for PaO2 and what does it indicate?

<p>Normal range is &gt;60 mmHg, reflecting the efficiency of oxygen uptake in the lungs</p> Signup and view all the answers

What is the primary cause of lactate buildup in the body?

<p>When cells lack sufficient oxygen (hypoxia), they switch to anaerobic metabolism, which produces lactate</p> Signup and view all the answers

Explain the concept of "compensation" in relation to acid-base imbalances.

<p>Compensation occurs when the body attempts to restore normal pH by adjusting other acid-base parameters</p> Signup and view all the answers

What is the major difference between respiratory acidosis and metabolic acidosis?

<p>Respiratory acidosis is caused by inadequate CO2 elimination, while metabolic acidosis results from an excess of acids or a loss of bicarbonate</p> Signup and view all the answers

List at least three potential causes of metabolic acidosis.

<p>Renal failure, Lactic acidosis, Ketoacidosis, Diarrhoea. (Any three).</p> Signup and view all the answers

What are two common causes of respiratory alkalosis?

<p>Anxiety, Hypoxaemia (caused by heart failure).</p> Signup and view all the answers

What does "RIPE" refer to in the context of a chest X-ray?

<p>Rotation, Inspiration, Penetration, Exposure</p> Signup and view all the answers

Describe the appearance of pneumothorax on a chest X-ray.

<p>Pneumothorax will show as a lack of lung markings, appearing black in the affected area</p> Signup and view all the answers

What is the expected location of the endotracheal tube (ETT) on a chest X-ray?

<p>The ETT should be positioned 2 cm above the carina (the point where the trachea splits into bronchi)</p> Signup and view all the answers

What is the significance of the mediastinum on a chest X-ray?

<p>The mediastinum should not be wider than 8 cm, and any abnormalities can indicate underlying issues.</p> Signup and view all the answers

What two measurements are monitored on a ventilator in PRVC mode?

<p>Volume and pressure</p> Signup and view all the answers

What is the purpose of the 'Standby' function on a ventilator?

<p>To disconnect and stop ventilation.</p> Signup and view all the answers

What does the "Alarm History" tab display on the ventilator?

<p>Recent alarm events, including date and time.</p> Signup and view all the answers

Why is "compensation" included in the ventilator settings?

<p>To account for gas compression in the tubing and ventilator system.</p> Signup and view all the answers

What are the potential risks if the patient circuit is changed without a new patient circuit test?

<p>Incorrect volume delivery in volume-based modes and incorrect volume measurement in pressure-based modes.</p> Signup and view all the answers

What is the purpose of the "Expiratory Hold" function on the ventilator?

<p>To provide an exact measurement of end expiratory pause pressure.</p> Signup and view all the answers

What is the default setting for the 'O2 Boost Level' in the ICU?

<p>100%.</p> Signup and view all the answers

What is the purpose of the "100% O2 Boost" function?

<p>To provide a 1 minute boost of 100% oxygen for pre-oxygenation and suctioning.</p> Signup and view all the answers

What is the recommended action when using a closed-suction system?

<p>Use the O2 boost function for oxygenation purposes instead of the 'Disconnection/Suction' function.</p> Signup and view all the answers

What does the 'SIMV rate' setting on the ventilator represent?

<p>The number of mandatory controlled ventilation breaths delivered per minute by the ventilator.</p> Signup and view all the answers

What does the 'PS above PEEP' setting represent in pressure support ventilation?

<p>The inspiratory pressure support level for triggered breaths.</p> Signup and view all the answers

What does the 'Ti/Ttot' value on the ventilator display indicate?

<p>The ratio of the inspired time to the total time of the respiratory cycle.</p> Signup and view all the answers

What is the purpose of the 'Trigger' setting on the ventilator?

<p>To determine the level of patient effort required to trigger the ventilator to inspire.</p> Signup and view all the answers

What does the 'Pplat' value on the ventilator display represent?

<p>The measured pause airway pressure.</p> Signup and view all the answers

Explain how the 'Ti' setting on the ventilator impacts the flow rate of the delivered breath.

<p>A longer 'Ti' setting results in a slower flow rate, while a shorter 'Ti' setting results in a faster flow rate.</p> Signup and view all the answers

What is the main physiological principle behind the use of Positive End Expiratory Pressure (PEEP) in mechanical ventilation?

<p>PEEP helps maintain alveolar patency by preventing complete collapse of the alveoli at the end of expiration, thus improving oxygenation and reducing atelectasis.</p> Signup and view all the answers

Describe the relationship between inspiratory resistance (Ri) and dynamic compliance (Cdyn) in the context of mechanical ventilation.

<p>High inspiratory resistance (Ri) means increased airway obstruction, while low dynamic compliance (Cdyn) indicates stiff lungs. Both can indicate a problem with gas exchange and require further investigation.</p> Signup and view all the answers

What are the two main mechanisms by which increased intracranial pressure (ICP) can lead to a decrease in cerebral perfusion pressure (CPP)?

<p>Increased ICP directly reduces CPP by compressing cerebral blood vessels, decreasing blood flow. Additionally, ICP can elevate systemic blood pressure, which further reduces the pressure gradient driving blood into the brain.</p> Signup and view all the answers

Why is proper management of body temperature crucial in patients with increased ICP?

<p>Elevated body temperature can exacerbate ICP by increasing cerebral metabolic demands and potentially causing cerebral vasodilation, leading to further increases in ICP.</p> Signup and view all the answers

Explain the significance of the "Cushing's Triad" in recognizing and managing increased ICP.

<p>Cushing's Triad, characterized by elevated systolic blood pressure, bradycardia, and irregular respirations, indicates severe intracranial hypertension and indicates an urgent need for intervention.</p> Signup and view all the answers

Describe the potential problems associated with overly high peak inspiratory pressure (PIP) during mechanical ventilation.

<p>High PIP can indicate airway obstruction or a kink in the ventilator tubing, but also carries the risk of barotrauma (lung injury) due to excessive lung inflation.</p> Signup and view all the answers

How does positive pressure ventilation potentially contribute to the development of nosocomial pneumonia in mechanically ventilated patients?

<p>Positive pressure ventilation bypasses the natural airway defense mechanisms, making it difficult for the body to clear secretions and increasing susceptibility to bacterial infections.</p> Signup and view all the answers

What are some of the potential psychological concerns associated with mechanical ventilation, and how might nurses address these?

<p>Prolonged mechanical ventilation can cause anxiety, fear, and isolation. Nurses can alleviate these concerns by providing consistent reassurance, clear explanations, and involving the patient in care decisions as much as possible.</p> Signup and view all the answers

Explain the difference between hypovolemic and cardiogenic shock, including their primary causes.

<p>Hypovolemic shock is caused by a loss of circulating blood volume, while cardiogenic shock is caused by the heart's inability to pump blood effectively.</p> Signup and view all the answers

What is the main physiological principle behind the use of vasopressors in the management of shock?

<p>Vasopressors work by constricting blood vessels, increasing systemic vascular resistance and thereby improving blood pressure and tissue perfusion.</p> Signup and view all the answers

Why is monitoring fluid balance crucial in patients with shock, and what are some potential signs of excessive fluid administration?

<p>Fluid overload can worsen shock by increasing cardiac workload and creating a detrimental pressure gradient. Monitoring signs like weight gain, peripheral edema, and lung sounds is essential.</p> Signup and view all the answers

Describe the clinical utility of trigger flow settings in mechanical ventilation.

<p>Trigger flow settings allow patients to initiate breaths based on their own respiratory effort, promoting patient comfort and encouraging participation in the breathing cycle.</p> Signup and view all the answers

Explain the significance of the "Inspiratory:Expiratory (I:E) ratio" in mechanical ventilation settings.

<p>The I:E ratio influences the duration of inhalation and exhalation, impacting gas exchange, patient comfort, and the risk of complications like hypercapnia.</p> Signup and view all the answers

What are the three main components that contribute to intracranial pressure (ICP)?

<p>The three components that contribute to intracranial pressure (ICP) are: 1. Cerebral spinal fluid (CSF), 2. Brain tissue, and 3. Blood.</p> Signup and view all the answers

What is the primary purpose of a hypertonic saline solution in the management of increased ICP?

<p>Hypertonic saline solution draws fluid out of the brain cells into the bloodstream, decreasing cerebral edema and ultimately reducing intracranial pressure.</p> Signup and view all the answers

What are the three main categories of causes for Acute Kidney Injury (AKI) and briefly describe the mechanism of each category.

<p>The three main categories of AKI are pre-renal, intra-renal, and post-renal. Pre-renal AKI is caused by decreased blood flow to the kidneys, reducing filtration and urine output. Intra-renal AKI involves direct damage to the nephrons, leading to impaired filtration. Post-renal AKI occurs when a blockage in the urinary tract prevents urine drainage.</p> Signup and view all the answers

Describe the main difference between unstable angina and a non-ST elevation myocardial infarction (NSTEMI) in terms of cardiac biomarkers.

<p>Both unstable angina and NSTEMI present with ST depression or T wave inversion on ECG. However, NSTEMI is characterized by elevated troponin levels, indicating myocardial damage, while unstable angina does not show elevated troponin levels.</p> Signup and view all the answers

What is the primary indication for using the nutritional formula Nepro, and why is it a suitable choice for that specific patient population?

<p>Nepro is primarily indicated for patients with renal failure who are not on Renal Replacement Therapy (RRT). It is formulated to be low in protein and phosphorus, making it suitable for patients with impaired kidney function.</p> Signup and view all the answers

Explain the two main types of chest tubes and their distinguishing characteristics.

<p>The two main types of chest tubes are underwater seal drains (e.g., Thora-Seal drain) and dry seal drains (e.g., Atrium Express). Underwater seal drains use a water column to create a one-way valve system, allowing air or fluid to drain but preventing air from flowing back into the chest. Dry seal drains utilize a valve system that does not require water for operation.</p> Signup and view all the answers

Describe how the bubbling pattern in a chest tube can guide clinical decision-making.

<p>Bubbling in a chest tube is a normal finding at the end of expiration in unventilated patients. In ventilated patients, bubbling should occur during peak inspiration. Continuous bubbling in an unventilated patient or absence of bubbling during peak inspiration in a ventilated patient indicates a possible leak in the system or a blockage in the tube, requiring immediate attention and investigation.</p> Signup and view all the answers

What is the purpose of the intubating stylet, and how does it facilitate endotracheal intubation?

<p>The intubating stylet is a flexible, rigid rod inserted into the endotracheal tube (ETT). It provides rigidity and control for the ETT, making it easier to pass the tube through the vocal cords and into the trachea. This is especially helpful in cases of difficult intubations.</p> Signup and view all the answers

Name two medications used for intubation, and explain their respective roles in the process.

<p>Two commonly used medications for intubation are propofol and vecuronium. Propofol is a sedative-hypnotic agent used for induction of anesthesia, promoting a state of unconsciousness and facilitating the intubation procedure. Vecuronium, a neuromuscular blocker, causes muscle paralysis, relaxing the vocal cords and allowing for easier intubation.</p> Signup and view all the answers

Why is suxamethonium (succinylcholine) considered a neuromuscular blocker of last resort, and what specific caution should be taken when using it?

<p>Suxamethonium is a rapid-acting, depolarizing neuromuscular blocker with a short duration of action. However, it can cause a significant increase in potassium levels, a potentially life-threatening complication in patients with certain conditions such as burns or muscle injury. This risk makes it a last resort medication, reserved for specific clinical situations where other alternatives are not suitable.</p> Signup and view all the answers

Flashcards

Safety Checks for Armbands

Verify DOB, Name, and Allergies on IeMR and the monitor.

Guedel Airway Measurement

Measure from mouth to ear lobe; insert tip to roof then turn 180 degrees.

14g Cannula Use

Insert for decompression of tension pneumothorax at 2nd intercostal space mid-clavicular line.

Central Venous Pressure (CVP)

Pressure from the right atrium or superior vena cava indicating right heart filling pressure.

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Ventilator Checks

Ensure connections, humidification water, temperature, settings, and alarms are functional.

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CVP Monitoring

Measurement used to evaluate fluid therapy and cardiac function.

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Normal CVP Values

Normal Central Venous Pressure is 0-6mmHg in non-ventilated patients and 8-12mmHg in ventilated patients.

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Phlebostatic Axis

Reference point for zeroing a pressure transducer for CVP measurement, located at the 4th intercostal space in mid-axillary line.

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CVP Waveform

Describes phases of cardiac function including a, c, x, v, y waves during the cardiac cycle.

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Dicrotic Notch

Point on an arterial waveform representing the closing of the aortic valve.

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Capnography

Technique measuring exhaled carbon dioxide, confirming ETT placement and guiding resuscitation.

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pH Levels

pH indicates acidity or alkalinity, with normal range 7.35 - 7.45; affected by H+ ion concentration.

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HCO3 Normal Value

Bicarbonate concentration in blood, normal range is 22-26mmol/L; altered levels indicate metabolic issues.

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PCO2 Normal Value

Partial pressure of carbon dioxide in blood, normal range is 35-45mmHg; reflects alveolar ventilation.

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PaO2 Normal Value

Arterial oxygen tension; goal is to have levels greater than 60mmHg for adequate oxygenation.

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Lactate and Acidosis

Elevated lactate indicates anaerobic metabolism due to hypoxia; normal lactate is 0.5-2mmol/L.

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Acid/Base Compensation

Evaluation of pH to determine if acidosis/alkalosis is due to metabolic or respiratory issues and if compensatory mechanisms are active.

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Chest X-ray Interpretation

RIPE method: Rotation, Inspiration, Picture, Exposure; helps assess airways and lungs.

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Cardiac Anatomy Layers

Includes endocardium (inner), myocardium (muscle), pericardium (outer layer enclosing heart).

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Cardiac Space Evaluation

Heart occupies 2/3 on the left and 1/3 on the right; check overall size and shape in imaging.

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PRVC

Pressure Regulated Volume Control mode that delivers set volume with minimal pressure.

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Pressure Support (PS)

A mode where all breaths are initiated by the patient; provides support for inhale.

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PEEP

Positive End Expiratory Pressure; maintains pressure in the airways at the end of expiration.

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FiO2

Fraction of Inspired Oxygen; the percentage of oxygen in the gas mixture delivered to the patient.

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Manual Breath

Initiates a new breath cycle according to current ventilator settings.

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Inspiratory Hold

Closes valves to measure end inspiratory lung pressure for 30 seconds.

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Expiratory Hold

Closes valves to measure end expiratory pause pressure for 30 seconds.

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Alarm History

Displays recent alarm events with date and time for reference.

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Circuit Compensation

Adjusts delivered air volume due to gas loss in tubing and compressor.

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Patient Circuit Test

Measures resistance and compliance in the ventilator circuit to activate compensation.

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Tidal Volume (VT)

The volume of gas delivered to the patient per breath in ml.

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O2 Boost Level

Provides 100% O2 for 1 minute, silencing nearby alarms for 2 minutes.

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SIMV Rate

Set number of mandatory breaths delivered per minute in synchronized mode.

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Peak Airway Pressure (Ppeak)

Measured maximum airway pressure during inhalation.

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O2 Concentration (%)

The set percentage of oxygen concentration being delivered to the patient.

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Serous Fluid

A lubricating fluid that reduces friction around the heart.

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Vena Cava

Large veins that carry deoxygenated blood to the heart.

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ECG

A test that measures the electrical activity of the heart.

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SA Node

The primary pacemaker of the heart located in the right atrium.

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AV Node

The secondary pacemaker of the heart, it delays conduction between atria and ventricles.

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QRS Complex

Represents ventricular contraction on an ECG.

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P Wave

Represents atrial contraction on an ECG.

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Aortic Valve

Valves that control blood flow from the left ventricle to the aorta.

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Noradrenaline

Hormone that stimulates blood vessel constriction and increases blood pressure.

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Dopamine

Drug acting on receptors to improve blood flow and heart function.

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Dobutamine

Medication that directly stimulates Beta 1 receptors to increase heart function.

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SIMV Mode

Ventilator mode that provides synchronized breaths with patient efforts.

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Pulmonary Veins

Veins that carry oxygenated blood from the lungs to the heart.

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Vasopressin

Hormone that causes vasoconstriction to elevate blood pressure.

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Respiratory Rate (RR)

Number of breaths taken per minute by the patient.

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Minute Ventilation (MVe)

Total amount of air in and out in one minute (Vt x RR).

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PIP (Peaked Inspiratory Pressure)

The maximum pressure during inhalation; usually < 35 cmH2O.

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Plateau Pressure (PPlat)

Pressure measured at the end of inspiration; reflects lung compliance.

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Cerebral Perfusion Pressure (CPP)

Pressure needed to push blood to the brain; normal range is 60-70 mmHg.

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Intracranial Pressure (ICP)

Pressure inside the skull; normal range is 5-15 mmHg.

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Signs of Increased ICP

MINDCRUSHED - describes symptoms such as headache, seizures, and changes in breathing.

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Barotrauma

Alveolar rupture caused by overdistention; can be monitored via PIP.

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Positive Fluid Balance

Condition to monitor for fluid retention; check weight and edema.

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Work of Breathing (WOBvent)

Measure of effort required to inhale; usually expressed in Joules/liter.

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Shock Types

Four types: distributive, hypovolemic, cardiogenic, obstructive.

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Acute Kidney Injury (AKI)

Sudden decrease in renal function causing reduced urine output and waste buildup.

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Pre-renal AKI

Caused by reduced blood flow to the kidneys due to heart or renal artery issues.

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Intra-renal AKI

Injury to the kidneys' nephrons affecting their function.

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Post-renal AKI

Result of a blockage in the urinary tract preventing urine drainage.

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STEMI

ST elevation in 2 or more leads with positive troponin indicating heart attack.

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Unstable Angina

Characterized by ST depression or T wave inversion with negative troponin.

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Nutrison Plus

An isomolar feed designed for patients needing nutritional support.

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Intubation Trolley Essentials

Key items include ETT, laryngoscope, and bougie for airway management.

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Study Notes

Safety Checks

  • Armbands: Double-check armbands for DOB, name, and allergies. Verify information on IeMR and the monitor.
  • Draw checks: Verify tubing (nasal prongs, Hudson mask, green tubing). Measure Guedel (mouth to earlobe; insert and turn 180 degrees). Insert 14g cannula (2nd intercostal space, mid-clavicular line) for tension pneumothorax decompression.
  • Metaraminol (Hypotension): 0.5mg/ml, 1ml every 5 minutes. Alpha 1 receptor agonist; vasoconstrictor. Increases systolic and diastolic blood pressure (S&DPB). Side effect: possible bradycardia. Affects peripheral vasoconstriction, not heart rate directly.
  • Manometer: Check at 30mmHg, at the start of the shift and after every turn.
  • Extras: 10ml syringe and needle, ETT foam and ties, and emesis bags.
  • Suction: Negative 80 or 300mmHg. Check Yankeur fullness and suction water cannister.
  • Ambu-bag: Use peep valve if PEEP >5. Check for inflation with 15L O2.
  • O2 Cylinder: Ensure cylinder is in the green zone (fullness).
  • Extra checks: Confirm all plugs are in and on. Know the location of the blue button.

Lines

  • Bags: Ensure bags are within their expiration dates; check lines expiry dates.
  • Propofol: 12-hour expiry.
  • Insulin, TPN, Nimodipine: 24-hour expiry.
  • Amiodarone: 72-hour expiry.

Monitor

  • Alarm Limits: Check and adjust alarms as needed; keep them tight (justify changes) and ensure arrhythmia monitoring is active.

Ventilator

  • Connection: Verify connections.
  • Humidification: Check water for humidification.
  • Temperature: Check humidifier temperature.
  • Settings and Alarms: Ensure appropriate settings and alarms are in place.

CVP (Central Venous Pressure)

  • Definition: Pressure in the right atrium or superior vena cava, reflecting right heart filling pressure. Used to assess fluid balance, cardiac function, and monitor complications like heart failure.
  • Traditional Belief: While widely used, the traditional belief that CVP reflects ventricular preload and predicts fluid responsiveness is now challenged by evidence.
  • Measurement: Measured at the end of expiration and using a transducer positioned at the phlebostatic axis (typically 4th intercostal space, mid-axillary line). Transducer is zeroed at the level of the right atrium.
  • Waveform: The CVP waveform shows key waves: a (atrial contraction), c (tricuspid valve closure), x (atrial relaxation), v (atrial filling), and y (tricuspid valve opening).
  • Normal values: 0-6 mmHg in non-ventilated patients and 8-12 mmHg in ventilated patients.

ART Line

  • Level: Zero the line at the phlebostatic axis (level of the top of the heart) or at the tragus for TBI patients.

ECO2 (Capnography)

  • Definition: Measurement of exhaled carbon dioxide (CO2).
  • Placement Confirmation: Confirms endotracheal tube (ETT) placement.
  • Resuscitation Guidance: Guides cardiopulmonary resuscitation (CPR).
  • Physiological Monitoring: Monitors cardiac and pulmonary physiology.
    • Note: ETCO2 usually lower than PaCO2 due to circuit dead space.

ABG's (Arterial Blood Gases)

  • pH: Hydrogen ion concentration (high H+ = acidosis, low H+ = alkalosis); normal range: 7.35-7.45.
  • HCO3: Bicarbonate concentration (abnormal values suggest metabolic issue); normal range: 22-26 mmol/L.
  • PCO2: Carbon dioxide partial pressure (abnormal values suggest respiratory issue); normal range: 35-45 mmHg (opposite acid/alkalosis correlation to pH).
  • PaO2: Arterial oxygen tension (how well the lungs absorb oxygen); goal: >60 mmHg.
  • Lactate: Measures anaerobic metabolism/inadequate oxygenation to cells; normal range: 0.5-2 mmol/L.
  • Hb: Haemoglobin, measuring O2 carrying capacity.

Interpreting ABGs (3 steps)

  1. Assess pH (acidosis/alkalosis).
  2. Determine if respiratory or metabolic issue.
  3. Evaluate compensation (no, partial, or full).

Causes of Acid-Base Imbalances

  • Metabolic Acidosis:* Increased acid, or loss of base (HCO3). Causes include renal failure, lactic acidosis, ketoacidosis, and diarrhea.
  • Metabolic Alkalosis:* Increased HCO3, or loss of metabolic acid. Causes include prolonged vomiting, GI suctioning, and hypokalemia.
  • Respiratory Acidosis:* Increased CO2, leading to increased H+ (acid). Causes include hypoventilation (sedation, opioids), brain stem depression, pneumonia, and pulmonary edema.
  • Respiratory Alkalosis:* Hyperventilation (excessive CO2 loss). Causes include anxiety, and hypoxemia (caused by heart failure).

Chest X-Ray Interpretation

  • Details: Patient name, DOB, date, film type.
  • RIPE Image: Correct rotation, inspiration (8-10 ribs visible), picture (costophrenic angles visible), exposure, and soft tissues.
  • Airway & Mediastinum: Look for trachea, bronchi, and mediastinum size.
  • Breathing (vascularity): Note lung markings, infiltrates, fluid, and pneumothorax.
  • Circulation: Evaluate heart size (2/3 left and 1/3 right), cardiac space (half thoracic), and aortic knob.
  • Diaphragm: Check for air under diaphragm (bowel obstruction) and costophrenic angles.
  • Everything else: Check for unusual findings and note specific findings (ETT level, NGT placement, CVL position, pacemaker presence).

Cardiac Anatomy

  • Endocardium: Inner lining of heart chambers; holds valves.
  • Myocardium: Muscular layer; contracts.
  • Pericardium: Thin outer covering; produces serous fluid for lubrication.

Blood Flow Through the Heart

Blood enters via vena cava, moves to atria, ventricles, through pulmonary/aortic valves, to lungs and then back to the heart, finally leaving through the aorta.

ECG Interpretation

  • ECG: Electrical impulses through the heart.
  • SA Node: Primary pacemaker (60-100 bpm).
  • AV Node: Secondary pacemaker (40-60 bpm).
  • Bundle of His + Purkinje Fibres: Conducts signal (20-40 bpm).
  • Depolarization: Contraction.
  • Repolarization: Relaxation.
  • P-Wave: Atrial contraction.
  • QRS Complex: Ventricular contraction.
  • T-Wave: Ventricular relaxation.
  • U-Wave: Purkinje fiber relaxation (often not present).
  • Squares: Little squares = 0.04 seconds, big squares = 0.20 seconds.

Inotropes (Adrenaline, Noradrenaline, Dopamine, Dobutamine, Vasopressin)

  • Action, Indications, Dosage, Infusion, Side Effects: Detailed information for each of these inotropes is provided, including general strengths, specific actions, intended use, typical dosages, potential infusion methods, and adverse effects.

Ventilator Modes

  • SIMV: Synchronised intermittent mandatory ventilation (mandatory breaths at set tidal volumes, spontaneous breaths allowed; user controlled).
  • Volume Control: Mandatory and spontaneous breaths at a set tidal volume.
  • Pressure Control: Mandatory and spontaneous breaths at a set inspiratory pressure and time.
  • PRVC: Pressure regulated volume control - Delivers set volume at lowest effective pressure.
  • PS: Pressure support; patient-initiated breaths with pressure support.

Ventilator Display

  • Left Side: Standby, alarm history, compensation, alarm limits, layout, manoeuvres (manual breath, static measurements).
  • Nebulizer, O2 Boost Level, Patient data, 100% O2 boost, disconnection/suction.
  • Right Side: Ppeak, PEEP, Pplat, RR, Ti/Ttot, O2 conc., VTe, VTi, MVe, Cdyn, VT/PBW.
  • Flowee, MVi, RRsp, MVe sp, Ri, WOBvent, Ti, Pmean.

Ventilator Settings

  • Tidal Volume (Vt): Set amount of air per breath (based on ideal body weight, 6-8 liters/kg).
  • Respiration Rate: Breaths per minute.
  • Minute Ventilation: Air in/out in a minute (Vt x RR).
  • FiO2: Fraction of inspired oxygen.
  • PEEP: Positive end-expiratory pressure (keeps alveoli open).
  • PS: Pressure support (assists spontaneous breaths).
  • Flow Rate/Volume: Gas speed (60-120 L/min).
  • Peak Inspiratory Pressure (PIP): Highest lung pressure.
  • Plateau Pressure (PPlat): End-inspiratory pressure (reflects lung compliance).

Potential Complications of Mechanical Ventilation

  • Malfunction: Manually ventilate.
  • Cardiovascular compromise: Monitor vital signs.
  • Barotrauma: Monitor PIP, lung sounds.
  • Infection: Good handwashing, tube/mouth care.
  • Psychological Stress: Reassurance, calming explanations.
  • Oxygen toxicity: Keep FiO2 low, PaO2 high.
  • Fluid balance: Monitor weight, edema, FBC, and I/O.
  • Gastric distension: Monitor bowel sounds & NG tube use.

Intracranial Pressure (ICP)

  • Definition: Pressure within the skull (normal: 5-15 mmHg, action required if >22 mmHg).
  • Monro-Kellie Hypothesis: Compensatory mechanism maintaining CPP (Cranial content volume - Blood, brain, cerebrospinal fluid).
  • Factors influencing ICP: Temperature, oxygenation, body position, arterial/venous pressures, abdominal/thoracic pressure changes.
  • Conditions causing ICP: TBI, increased CSF, bleeding, hematomas, tumors, hydrocephalus, infection (meningitis).

Signs and Symptoms Increased IC

  • MINDCRUSHED: Mental status changes, Irregular Breathing (Cheyne-Stokes), Nerve changes (pupils), Decerebrate/decorticate posturing, Cushing’s Triad, Reflex changes, Unconscious, Seizures, Headache, Emesis, Deterioration of motor function.

Nursing Interventions of increased ICP (PRESSURE)

  • PRESSURE: Position (HOB 30°), Respiratory, Elevated Temperature, Straining activities, Systems to monitor (neuro assessment), Unconscious; care (lung sounds, suction, skin care, nutrition).
  • Prescriptions (vasopressors, antihypertensives, anti-convulsants, anti-emetics, hyperosmotics).
  • Edema Management (avoid swelling, hypertonic saline).

Shock

  • Types: Distributive (septic, anaphylactic, spinal), hypovolemic (hemorrhage, burns), cardiogenic (massive MI), obstructive (tamponade, tension pneumothorax).
  • Low BP in Shock: Low cardiac output, high/low systemic vascular resistance.
  • Consequences of low BP: Tissue ischemia & cell death.

AKI (Acute Kidney Injury)

  • Definition: Sudden decrease in kidney function; waste buildup (BUN, creatinine), fluid retention, electrolyte imbalance.
  • Oliguria: Reduced urine output.
  • Causes: Pre-renal (poor perfusion), intra-renal (nephron damage), post-renal (urinary tract obstruction).

ACS (Acute Coronary Syndrome)

  • Causes: Blocked coronary arteries; leading to myocardial ischemia.
  • Types: STEMI (ST elevation, positive troponin), NSTEMI (ST depression/T wave inversion, positive troponin), unstable angina (ST depression/T wave inversion, negative troponin).

Nutritional Feeds

  • Nutrison Plus: Isomolar feed.
  • Isosource 2.0: For fluid-restricted patients.
  • Nepro: Alternative for renal failure (not on RRT).
  • RRT (Renal Replacement Therapy): Nutrison needed for higher protein demand.
  • Seafood Allergy: Nepro or Isosource 2.0.

Chest Tubes

  • Indications: Pneumothorax, hemothorax.
  • Types: Underwater seal, thora-seal, Atrium Express.
  • Assessment: Bubbling/no bubbling, swinging/no swinging, drainage (hourly monitoring; alert MO if >200ml/hr).
  • Leak/Kink: Check connections.

Intubation Trolley

  • Top: Portable ETCO2 (sidestream), charging.
  • Sides: Masks (SM/L, paediatric).
  • Front: Bougie, Cook airway exchange catheters;
  • First draw: ETT, Laryngoscope, Guedel, Stylet, Magill forceps, Syringe.
  • Pt piece: Tape & foam for ETT.
  • Drugs: Propofol, Vecuronium, Succinylcholine.

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