1
Q
A
Multivent Mask:
- fixed –> total flow exceeds patients peak inspiratory flow demands
- more expensive
- flow rate 3-15L/min
- FiO2: green = 0.24-0.30, white = 0.35-0.50
2
Q
A
Rebreather mask
3
Q
A
Plain face mask:
- variable
- inexpensive
- vent holes on side for release of exhaled gases and to mix with room air
- flow rate ≥5L/min
- FiO2 = 0.40-0.60
4
Q
A
Nasal prongs:
- variable –> FiO2 varies according to patients breathing rate/depth/PIF
- inexpensive
- comfortable, can eat/drink
- flow rate = 1-4L/min
- FiO2 = 0.24-0.36
5
Q
Dangers of O2 therapy
A
- COPD
- decreased drive to breathe
- O2 toxicity
- long periods of FiO2 0.5-0.6 leads to pulmonary changes
- depression of ciliary function
- thickening of secretions, further retention
- absorption atelectasis
- nitrogen moved out, causing collapse
6
Q
O2 therapy - PT implications
A
- Check devices is being worn correctly
- Check correct concentration os being delivered
- Monitor SpO2 with pulse oximeter
- Mobilise post-op patients with portable O2 (if appropriate)
- If removed to mobilise, use portable pulse oximeter and ensure replaced on return
7
Q
A
Swedish nose/thermavent:
- attached to tracheostomy tube
- maintains humidity
- prevents adverse effects of ciliary function
- blockage of secretions
- should not be used if productive of secretions
8
Q
Humidification indications:
A
- FiO2>0.35
- thick secretions
- consolidation
- major infection
- following surgery
- artificial airway
- diuretic therapy
- dehydrated
9
Q
A
Nebuliser
- delivers respiratory medications via fine droplets
- used to moisten upper airway of surgical patients
- prevents adverse ciliary function
- deposition depends on:
- particle size
- method of inhalation
- degree of airflow obstruction
Application:
- flow rate = 6-8L/min
- slow deep breaths interspersed with TV
10
Q
A
Metered Dose Inhaler:
- Shake canister ~10 times
- Hold conister upright
- Sit upright
- Expire gentle but not fully
- Slight neck extension
- Seal mouth around mouthpiece
- Slow, deep inspiration, simultataneuosly press canister to release medication
- Inspiratory hold (up to 10s if possible)
- Expire gently through nose
11
Q
A
Turbuhaler:
- Unscrew and remove the protective cover
- Hold canister upright
- Load by turning grip to the right as far as it goes then back to the left until it clicks
- Sit upright
- Expire gently but not fully
- Seal mouth around mouthpiece
- Slow deep inspiration
- Inspiratory hold (up to 10s)
- Expire gently through nose
- Replace the cover
12
Q
A
Handihaler:
- Open cap
- Open the mouthpiece
- Insert medication capsule
- Close mouthpiece
- Press green piercing button then release
- Sit upright
- Expire gently but not fully
- Slight neck extension
- Seal mouth around mouthpiece
- Slow, deep inspiration
- Inspiratory hold
- Expire gently through nose
- Open mouthpiece then tip to discard capsule
- Close the mouthpiece and cap
13
Q
A
Nasopharyngeal airway:
- soft silastic tube to pharynx
- inserted with lubricant
- changed several times per day
14
Q
A
Oropharyngeal airway:
- short plastic tube to pharynx
- keeps airway open
- facilitates suction
- insertion can cause patient to gag or vomit
- care with loose teeth and bite reflex
15
Q
A
Endotracheal tube:
- often requires sedation
- condition must be reversible
16
Q
A
Suction indications:
- artificial airway
- unconscious
- inability to cough and effectively expectorate secretions
17
Q
A
Tracheostomy
18
Q
A
Trachy tent
19
Q
A
Yankeur
20
Q
A
Sputum trap
21
Q
A
Mini tracheostomy:
- no need for humidification
- may need NaCl 0.9% during suction
- size 8 or 10 FG catheter to suction
- inserted for secretion removal only
- maintain own airway, eat, talk
22
Q
Spacer
A
- increases deposition of drug in lungs instead of oropharynx by 15%
23
Q
Aerosol therapy mechanism
A
- topical deposition of drugs
- gravitational sedimentation = time dependent and enhanced by breath holding
- large particles carry more medication but do not go far
- small particles go further but do not carry much medication
24
Q
PEP indications
A
- impaired airway clearance
- prevents airway collapse
- CF
- COPD
- bronchiectasis
- chronic bronchitis
- restrictive lung disease
- post-op secretions or atelectasis
- collapsible airways
- productive asthma
25
PEP precautions
* active haemoptysis
* lung surgery
* pneumothorax
* undrained empyema or lung abscess
* emphysematous bullae
* increased WOB
* haemodynamic instability
* facial fractures or surgery
* middle ear infection
* sinusitis
26
O2 therapy indications
* hypoxaemia
* increased WOB
27
Nasal prongs complications
* pressure areas
* mucosal damage
28
Partial rebreather
* variable
* exhaled O2 from anatomic dead space is conserved
* flow rate = 6-10L/min
* FiO2 ≤0.60
29
Non-rebreather
* variable
* one-way valve prevents exhaled gases re-entering, prevents room air entering
* flow rate = 10-15L/min
* FiO2 = 0.80-0.90
30
Rebreather indications
* very hypoxaemic
* severe respiratory distress
31
Rebreather complications
* drying of secretions
* risk of retaining CO2 (partial rebreather)
32
Turbuhaler indications
* suitable if unable to coordinate MDI
33
Inhalation of steroids
* decrease oral candidiasis by rinsing mouth following inhalation of steroids and using a spacer device
34
Nasopharyngeal airway precautions
* nasal/facial fractures
* CSF leak
* torn dura
* coagulopathy
* anticoagulant therapy
* hypotension
35
ETT indications
* airway obstruction
* inadequate oxygen
* inadequate ventilation
* elevated WOB
* airway protection
* facilitation of tracheobronchial suctioning
* facilitation of mechanical ventilation
36
Cuffed ETT indications
* unconscious
* unable to swallow
* requires full mechanical ventilation
37
Cuffed ETT advantages
* prevents aspiration of gastrointestinal contents
* provides good seal for ventilation
* prevents movement/holds tube in
38
Cuffed ETT complications
* can cause damage to vocal chords
39
Uncuffed ETT indications
* awake or able to swallow
* paediatric use
* able to speak
40
Uncuffed ETT complications
* may cause increased secretions due to irritation and movement
41
ETT complications
* trauma
* malposition
* obstruction
* disordered physiology
* increased secretions
* decreased cilial activity
* inability to cough
* infection
* inability to talk/swallow
* lack of humidification (so need to humidify)
42
ETT - PT implications
* need to suction/other ACTs
* infection control
43
Suction contraindications
* pulmonary oedema
* haemoptysis
* respiratory burns
* head injuries
* high levels PEEP, FiO2
* severe infection
44
Suction complications
* hypoxaemia
* cardiac arrhythmias
* haemodynamic alterations
* increased ICP
* gastric aspiration
* trauma
* distress
* atelectasis
* reflex bronchospasm
* infection
45
Tracheostomy indications
* long term intubation
* prevent laryngeal damage and oedema from ETT
* ETT not well tolerated if patient not sedated
* URT obstruction
* facilitation of suctioning
* permanent bypass obstruction or tumour
46
Tracheostomy complications
* operative risks
* placement in pre-tracheal tissues
* haemorrhage of innominate artery
* tracheal stenosis
* tracheomalacia
* trachea-oesophageal fistula
* surgical emphysema
* blockage with secretions
47
Closed-suction system
* prevents disconnection from ventilator (prevents loss of FRC and O2)
* prevents pathogens sprayed into air
* not always effective if thick secretions
48
MHI indications
* secretion removal
* prevent/reverse atelectasis
* improve compliance
* hyperoxygenation prior to suction (rare)
49
MHI contraindications
* pulmonary oedema
* severe haemoptysis
* undrained pneumothorax
* nitric oxide
* severe bronchospasm
* acute septic shock
* low BP
50
MHI precautions
* bullae (use manometer)
* PEEP ≥10 (use VHI)
* FiO2 ≥0.7 (use VHI)
* low lung compliance
51
MHI complications
* pneumothorax
* barotrauma, volutrauma
* desaturation
* decreased venous return
* decreased cardiac output
52
Flow rates
* nasal prongs = 1-4L/min
* face mask = ≥5L/min
* partial rebreather = 6-10L/min
* non-rebreather = 10-15L/min
* MVM = 3-15L/min
* nebulizer = 6-8L/min
* MHI = 10L/min
53
FiO2
* nasal prongs = 0.24-0.36
* face mask = 0.40-0.60
* partial rebreather ≤0.60
* non-rebreather = 0.80-0.90
* MVM: green = 0.24-0.30, white = 0.35-0.50
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