RRT- CLIN SIMS- LINDSEY JONES EXAM
QUESTIONS AND ANSWERS
Readiness to wean:
What are the parameters used to determine the readiness to wean? - ANSWER-VT >5
mL/kg
VC > 10 mL/gh
MIP > - 20 cm H2O
Rate 8 to 20 breaths per minute
RSBI < 106 (RR / Vt(L))
Vd/Vt ratio < 60%
% Shunt < 20%
ABGs adequate oxygenation and ventilation (or same as before ventilator)
Underlying condition needs to be resolved (if ventilatory related)
Adult Ventilator Weaning :
Weaning Failure:
A patient fails if any of what values fall below acceptable limits? - ANSWER-Pulse > 20
bpm from baseline (prior to weaning)
BP > 20 torr from baseline
PaCO2 >10 torr from baseline
RR >10 from baseline OR is > 30 breaths per minute
Also, weaning fails if there is a significant change in the patient's status generally (ie
confusion,
lethargy, unresponsiveness).
Adult Ventilator Weaning :
Successful Weaning:
While there are no explicit expectations on what methods should be used for weaning,
what are
some limitations on how far you need to go.... - ANSWER-If SIMV rate 4 is
accomplished, there is no need to decrease to 2
No need to decrease FIO2 below 0.40
No need to decrease PEEP below 5 cm H2O
Remember, cessation of mechanical ventilation does not mean extubation. One can
stay on a
ventilator on a heated aerosol and be extubated another day.
Ventilator Troubleshooting :
High pressure alarm : Patient vs Machine - ANSWER-Patient =
Patient coughing, need suctioning?
, Patient resisting inspiration , need sedation?
Pneumothorax, check for signs
ET tube cogged by sputum or herniated cuff?
Machine =
Accumulated water in the circuit?
Pinched circuit?
Recent change in alarm limits or settings?
Ventilator Troubleshooting :
Low pressure alarm : Patient vs Machine - ANSWER-Patient
Chest tube leakage
Patient inadvertently partially extubated (not always obvious)
Cuff is under-inflated or deflated
Machine
Circuit is disconnected from the patient
Circuit has come apart or has a leak
On some ventilators, flow rate may not be sufficient (pressure cycled machines)
Infant Ventilator Setup :
Ventilator Type? - ANSWER-Infant Ventilators are usually time-cycled, pressure limited.
Infant Ventilator Setup :
Mode? - ANSWER-Mode
Always pick SIMV/IMV mode first (if offered)
Infant Ventilator Setup :
Rate and I time - ANSWER-Rate
Greater than 20 breaths per minute
I-time
0.3—0.6 seconds
Infant Ventilator Setup :
Pressure ? - ANSWER-Pressure
Greater than 20 cm H2O
Infant Ventilator Setup :
FIO2? - ANSWER-FIO2
Same as previous. If there is not previous setting, then 30 to 60%
If Emergency, then 100%. Most often, you have been manually resuscitating the infant,
so you
QUESTIONS AND ANSWERS
Readiness to wean:
What are the parameters used to determine the readiness to wean? - ANSWER-VT >5
mL/kg
VC > 10 mL/gh
MIP > - 20 cm H2O
Rate 8 to 20 breaths per minute
RSBI < 106 (RR / Vt(L))
Vd/Vt ratio < 60%
% Shunt < 20%
ABGs adequate oxygenation and ventilation (or same as before ventilator)
Underlying condition needs to be resolved (if ventilatory related)
Adult Ventilator Weaning :
Weaning Failure:
A patient fails if any of what values fall below acceptable limits? - ANSWER-Pulse > 20
bpm from baseline (prior to weaning)
BP > 20 torr from baseline
PaCO2 >10 torr from baseline
RR >10 from baseline OR is > 30 breaths per minute
Also, weaning fails if there is a significant change in the patient's status generally (ie
confusion,
lethargy, unresponsiveness).
Adult Ventilator Weaning :
Successful Weaning:
While there are no explicit expectations on what methods should be used for weaning,
what are
some limitations on how far you need to go.... - ANSWER-If SIMV rate 4 is
accomplished, there is no need to decrease to 2
No need to decrease FIO2 below 0.40
No need to decrease PEEP below 5 cm H2O
Remember, cessation of mechanical ventilation does not mean extubation. One can
stay on a
ventilator on a heated aerosol and be extubated another day.
Ventilator Troubleshooting :
High pressure alarm : Patient vs Machine - ANSWER-Patient =
Patient coughing, need suctioning?
, Patient resisting inspiration , need sedation?
Pneumothorax, check for signs
ET tube cogged by sputum or herniated cuff?
Machine =
Accumulated water in the circuit?
Pinched circuit?
Recent change in alarm limits or settings?
Ventilator Troubleshooting :
Low pressure alarm : Patient vs Machine - ANSWER-Patient
Chest tube leakage
Patient inadvertently partially extubated (not always obvious)
Cuff is under-inflated or deflated
Machine
Circuit is disconnected from the patient
Circuit has come apart or has a leak
On some ventilators, flow rate may not be sufficient (pressure cycled machines)
Infant Ventilator Setup :
Ventilator Type? - ANSWER-Infant Ventilators are usually time-cycled, pressure limited.
Infant Ventilator Setup :
Mode? - ANSWER-Mode
Always pick SIMV/IMV mode first (if offered)
Infant Ventilator Setup :
Rate and I time - ANSWER-Rate
Greater than 20 breaths per minute
I-time
0.3—0.6 seconds
Infant Ventilator Setup :
Pressure ? - ANSWER-Pressure
Greater than 20 cm H2O
Infant Ventilator Setup :
FIO2? - ANSWER-FIO2
Same as previous. If there is not previous setting, then 30 to 60%
If Emergency, then 100%. Most often, you have been manually resuscitating the infant,
so you
