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Clin Med: Pulmonary > ABG, Oximetry, Spirometry Testing > Flashcards

ABG, Oximetry, Spirometry Testing Flashcards

1
Q

What info do you get from ABG?

A

Acid base status

Oxygenation (dissolved O2, saturation of Hb)

CO2 elimination –> ventilation

Levels of carboxyhemoglobin/methemoglobin

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2
Q

What are the indications for ABG testing?

A

Asses ventilatory status (aka CO2 elimination)

oxygenation

acid-base status

Assess response to intervention

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3
Q

What are the contraindications for ABG testing?

A

Bleeding diathesis

AV fistula

Severe peripheral vascular dz

No arterial pulse

Infection over site

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4
Q

What is better about pulse ox compared to ABG?

A

Non-invasive

Continuous data

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5
Q

What are drawbacks about pulse ox compared to ABG?

A

No VENTILATION (pCO2)!!

No acid-base status

Unreliable when pO2 < 70-80%

Can get errors

No methemoglobin/carboxyhemoglobin

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6
Q

Which artery is best for ABG and why?

A

Radial (can use femoral, dorsal is pedis, brachial in emergency)

Superficial

Has collaterals

Easily compressible

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7
Q

What are the normal ABG values (pH, PaO2, PaCO2, HCO3)?

A

pH = 7.35 - 7.45

PaO2 = 80 - 100

PaCO2 = 35 -45 mmHg

HCO3 = 22 - 26 mEq/L

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8
Q

What are acidotic ABG values (pH, PaO2, PaCO2, HCO3)?

A

pH = < 7.35

PaO2 = N/A

PaCO2 = > 45 mmHg

HCO3 = < 22 mEq/L

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9
Q

What are alkalotic ABG values (pH, PaO2, PaCO2, HCO3)?

A

pH = > 7.45

PaO2 = N/A

PaCO2 = < 35 mmHg

HCO3 = > 26 mEq/L

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10
Q

When interpreting ABG, when would you decide someone has respiratory acidosis?

A

Low pH

High pCO2

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11
Q

When interpreting ABG, when would you decide someone has metabolic acidosis?

A

Low pH

Low HCO3

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12
Q

When interpreting ABG, when would you decide someone has respiratory alkalosis?

A

High pH

Low pCO2

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13
Q

When interpreting ABG, when would you decide someone has metabolic alkalosis?

A

High pH

High HCO3

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14
Q

What happens in respiratory alkalosis?

A

For every 10 decrease in pCO2 –> HCO3 decreases by 2/increase in pH of 0.08

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15
Q

What are the central causes of respiratory alkalosis?

A

Respiratory center issues

Ischemia

CNS tumor

Hyperventilation

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16
Q

What are the lung issues that cause respiratory alkalosis?

A

Pneumonia

Asthma

PE

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17
Q

What are the chest cavity issues that can caues respiratory acidosis?

A

Flail Chest

Pneumothorax

Effusion

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18
Q

What are the central causes of respiratory acidosis?

A

Sedation

CVA

Narcotics

Neuromuscular issues

19
Q

What are some lung issues that can cause respiratory acidosis?

A

Pneumonia

Asthma

FB

COPD

20
Q

What is spirometry used for?

A

Diagnosing Asthma/COPD

21
Q

What are the most important indications to use spirometry?

A

Persistant cough

Chronic sputum production

Breathlessness on exertion

Reduction in activity

22
Q

What are some other indications for spirometry testing?

A

Recurrent/chronic respiratory symptoms

Occupational exposure to respiratory irritants

Family Hx of respiratory dz/symptoms –> alpha1-antitrypsin; early onset emphysema

REQUIRED quality measure for accurate COPD diagnosis

Selective screening in high risk populations (fam. medicine)

23
Q

What types of diseases can spirometry differentiate?

A

Restrictive vs Obstructive

24
Q

Is Spirometry recommended for screening of COPD pts?

A

NOT routine screening tool

Only recommended in PRESENCE of respiratory symptoms

25
Q

Why is QUALITY spirometry important?

A

Prevent overdiagnosis of COPD

26
Q

According to the NAEPP (National Asthma Education & Prevention Program) when should you use spirometry?

A

For initial diagnosis (can’t diagnosis w/o spirometry testing!)

After treatment is initiated/symptoms and peak flow have stabilized

During periods of loss of asthma control

Assessing response change to pharmacotherapy

Every 1 - 2 years to assess maintenance of airway function

Check PEF meter accuracy

27
Q

What is the FEV1 or FEV1/FVC of a asthmatic 5 - 11 yo that is considered well controlled?

A

FEV1 = > 80% predicted

FEV1/FVC = > 80%

28
Q

What is the FEV1 or FEV1/FVC of an asthmatic 5 - 11 yo that is considered not well controlled?

A

FEV1 = 60 - 80% predicted

FEV1/FVC = 75 - 80%

29
Q

What is the FEV1 or FEV1/FVC of an asthmatic 5 - 11 yo that is considered very poorly controlled?

A

FEV1 = < 60% predicted

FEV1/FVC = < 75%

30
Q

What do you have to do before you do spirometry?

A

Coach patient (so get max effort –> accuracy)

31
Q

What is the most important varible for spirometry?

A

Pace of expired air –> should be released w/ explosive force)

32
Q

What is the minimum exhalation interval?

A

6 seconds w/ 2 second plateau

33
Q

How should the patients be positioned during spirometry?

A

Sitting or Standing

34
Q

What are the contraindications for spirometry (edit this, there’s a lot)?

A

> 6 wks since last exacerbation

MI < 3 -6 months ago

Unstable agina in last 24 hrs

Haemoptysis of unknown origin

Recent Eye, abdominal Surgery (< 3 - 6 months ago)

CVA < 3 -6 months ago

Pt w/ TB

PE < 3 -6 months ago

Ear infection

Sponatneous pneumothorax

Aortic Aneurysm

35
Q

What are some of the common reasons for unacceptable/unreliable readings?

A

Inadequate or incomplete inhalation

Lack of blast effor during exhalation –> false (+) COPD

Additional breath during maneuver

Lips not tight around mouthpiece

Slow start to forced exhalation

Exhalation stops before complete expiration

Exhalation through nose

Coughing

Tight/Restrictive clothing

36
Q

What should you avoid during spirometry?

A

Unsatisfactory start (excessive hesitation/false start)

Air leak

Coughing during first second

Early termination of forced expiration

Glottis closure

Obstructed mouthpiece (Tongue/false teeth/Chewing gum)

37
Q

What is FEV1?

A

Forced expired volume in 1 second

38
Q

What is FVC and what can be substituted for this value?

A

Forced Vital Capacity

FEV6 can substitute it

39
Q

What is PEFR?

A

Peak expiratory flow rate

(not reproducible, but useful in tracking progress)

40
Q

What is FEF 25 - 75%?

A

Forced expiratory flow between 25 - 75% of the vital capacity

(Usually not clinically useful)

41
Q

What are some factors that would affect normal spirometry values?

A

Height –> Tall = larger lungs

Age –> Function declines w/ age

Sex –> females have smaller volumes

Race –> Blacks/Asians had smaller lung volumes

Posture –> reduced in supine position

42
Q

Why is it important to enter accurate values for pt’s bio-demographic variables?

A

Prevent misdiagnosis

43
Q
A

Clin Med: Pulmonary (3 decks)

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