Troubleshooting

Question 1

Define the “problem”

Answer 1

any situation causing discord or the loss of comfort for the patient

Question 2

What 4 things are associated with discord or loss of comfort for the patient?

Answer 2

• subjective
• personal perspective
• solving ventilation problems
• protecting the patient

Question 3

Define problem solving

Answer 3

determining a solution to a problematic situation

Question 4

Define troubleshooting

Answer 4

identification and resolution of technical malfunctions in the patient ventilator system. purposeful resolution of inappropriate and potentially dangerous situations

Question 5

Solving the problem

Answer 5

• assess the situation
• gather and analyze pertinent data
• examine viable solutions
• attempt solution
• monitor response
• repeat if necessary

Question 6

Protect the patient

Answer 6

• auscultation
• SpO2
• general assessment, accessory muscles

Question 7

Advantages of disconnect and bag

Answer 7

• insurance that the patient is being ventilated
• ability to assess (feel) the patient’s lung compliance and airway resistance
• ability to determine whether the problem lies with the patient or the ventilator

Question 8

Disadvantages of disconnect and bag

Answer 8

• increased risk of barotrauma because of inappropriate patterns of ventilation and excessive pressures
• derecruitment of the lungs when PEEP is lose, leading to desaturation
• increased risk of ventilator-associated pneumonia from contamination of the airways

Question 9

Causes of distress?

Answer 9

• patient related

- ventilator related

Question 10

Clinical manifestations of sudden distress

Answer 10

• use of accessory muscles to breathe
• pursed-lip breathing
• minimal or absent cough
• leaning forward to breathe
• barrel chest
• digital clubbing
• dyspnea om exertion (late sign)

Question 11

Patient related problems

Answer 11

• airway problems
• pneumothorax
• bronchospasm
• secretions
• pulmonary edema
• dynamic hyperinflation
• abnormalities in resp dis
• change in body position
• drug-induced distress
• abdominal distension
• pulmonary emboli
• anxiety

Question 12

Ventilator related problems

Answer 12

• leaks
• circule malfunction or disconnection
• inadequate FiO2
• patient-ventilator asynchrony

Question 13

What could cause patient-ventilator asynchrony?

Answer 13

• inappropriate mode
• inadequate ventilator support
• trigger sensitivity
• inadequate flow setting
• inappropriate cycle variable
• inappropriate PEEP setting
• problems with close loop ventilation

Question 14

What are the 7 steps of managing sudden distress?

Answer 14

• disconnect the patient from the vent
• begin manual ventilation on 80-100% O2
• manually evaluate compliance and resistance through bag ventilation
• perform a rapid physical examination and assess monitored indexes and alarms
• check the patency of the airway by passing a suction catheter
• if death appears imminent, consider and treat the most likely problems (pneumothorax and airway obstruction)
• once the patient’s condition has stabilized, perform a detailed assessment and provide any additional treatment required

Question 15

Common alarm situations

Answer 15

• low pressure alarm
• high pressure alarm
• low CPAP/PEEP alarm
• apnea alarm
• low source gas pressure or power alarm
• ventilator inoperative alarm
• operator settings incompatible with machine parameters
• I:E ratio
• other alarms

Question 16

What alarms go off if in volume control and there’s a leak?

Answer 16

• low VTe
• low pressure
• low MVe
• low peep

Question 17

High pressure alarms indicate what?

Answer 17

an obstruction

Question 18

What is the normal drive to breathe?

Answer 18

CO2

Question 19

Normal MV

Answer 19

5 L/min

Question 20

Unexpected ventilator responses

Answer 20

• unseated or obstructed expiratory valve
• excessive PEEP/CPAP
• nebulizer impairment
• high VT delivery
• altered alarm function

Question 21

Management of patient-ventilator asynchrony begins with several specific steps. The initial step is to ___

Answer 21

disconnect the patient from the vent and perform manual ventilation

Question 22

Rupture of the innominate artery can occur and is most often noticed with

Answer 22

tracheostomy tubes

Question 23

True/false: the description of patients as “fighting the ventilator” means that they were doing well but suddenly developed distress

Answer 23

true

Question 24

True/false: some patient-ventilator asynchrony may result from a patient’s feelings of panic and can be relieved by manually ventilating and instructing the patient on how to relax while breathing with the ventilatory

Answer 24

true

Question 25

If a tension pneumothorax is strongly suspected and death is imminent, the appropriate next step is to ___

Answer 25

insert a 14- or 16-gauge needle into the second intercostal space at the midclavicular line

Question 26

Abdominal distension during mechanical ventilation can be caused by ___

Answer 26

pneumoperitoneum

Question 27

True/false: the rapid onset of hypoxemia from a pulmonary embolus leads to the increases in heart rate, blood pressure, and respiratory rate with high ventilator rates and flows; however, disconnection from the ventilator and manual ventilation do not help the condition

Answer 27

true

Question 28

The occurrence of low pressure, low volume and low alarms indicate that ___ is causing the problem

Answer 28

a leak

Question 29

During ventilation with VC-CMV, pleural drainage leaks sometimes can be compensated by increasing ___

Answer 29

VT setting

Question 30

True/false: auto-PEEP may interfere with the ventilator's ability to detect patient efforts. This is corrected by decreasing the sensitivity setting

Answer 30

false

Question 31

True/false: during volume ventilation, a concave appearance on the inspiratory pressure curve indicates active inspiration with inadequate flow

Answer 31

true

Question 32

Asynchronous breathing may occur when patients with COPD are ventilated with PSV. These patients are known to have an active short inspiration. If the patient begins to actively exhale during the inspiratory phase of PSV, this can be corrected by ____

Answer 32

switching to a ventilator with adjustable pressure-cycling characteristics

Question 33

True/false: when externally powered nebulizers are used with ventilators, they add extra flow, which can increase the delivered VT and give artificially high readings of exhaled

Answer 33

true

Question 34

A patient on a volume cycled ventilator suddenly becomes very anxious and motions that he cannot breathe. No peak pressures are seen on the manometer. You should immediately ___

Answer 34

check for vent disconnect

Question 35

A patient is on mechanical ventilation. The tidal volume is set at 1000 mLs. Delivered tidal volume is only 200 mLs. The most likely cause of this volume difference is ___

Answer 35

a large leak in the humidifier

Question 36

A patient being ventilated with a Bennett 7200 begins to sound the high pressure alarm consistently. Possible causes include ___

Answer 36

- tracheal suctioning is required - bronchospasm - the patient is agitated and uncomfortable