Cardiopulm Tests And Tx

Question 1

MRC Sum Scale -

What it assesses. Cutoff score. Components

Answer 1

Gross muscle strength, graded 0-5 w/o + and -
12 tests: LE- ankle DF, knee ext, hip FL, UE- wrist ext, elbow FL, shoulder ABD
<48/60 = critical illness weakness

Question 2

Respiratory Reserve - when is it sufficient?

Answer 2

Respiratory reserve ratio = PO2/FiO2
>300 = sufficient for mobilization
And SpO2 >90% (PO2 >60 mmHg)

Question 3

Cardiovascular Reserve - when is it sufficient?

Answer 3

Resting HR <62% max HR, BP less than 20% recent variability and <200/<110. ECG normal. (SBP should not drop >10-20 mm Hg with exercise)

Question 4

Mean Arterial Pressure - formula, amt needed for perfusion of organs?

Answer 4

MAP = DBP + 1/3 (SBP-DBP)

> 65 mm Hg

Question 5

Active Cycle of Breathing - what are the components and why would you spend more time on a particular component?

Answer 5

1. Breathing Control - to decrease bronchospasm, 10-30s between each phase. (More w reactive airways, anxiety)
2. Thoracic Expansion - air behind secretions (more- atelectasis)
3. Forced Expiratory Technique - mobilize sputum (more- productive cough. Peripheral airways - full exhale from normal inhale. Proximal airways- faster huff from a full inhale

Question 6

GOLD - 4 Stages of COPD

Answer 6

I. FEV1 >80% predicted, smoker’s cough
II. FEV1 50-80% predicted, dyspnea on exertion, sputum cough
III. FEV1 30-50% predicted, dyspnea w mild exertion
IV. FEV1 <30% predicted, dyspnea w mild exertion + cyanosis, R heart failure

Question 7

BODE Index - What does it predict? What 4 factors does it include?

Answer 7

For COPD patients, multidimensional index for 4 year prognosis of death & hospitalization. 10 points
1. Weight (BMI) 2. Obstruction (FEV1) 3. Dyspnea (dyspnea scale) 4. Exercise capacity (6 min walk test)

Question 8

How does FEV1 impact prognosis? What are the cutoff scores?

Answer 8

FEV1 <30% predicted - 50% chance death in 2 yrs
FEV1 <55% predicted - 50% chance death in 5 yrs
Little to no obstruction - FEV1 >2.0 L in 1 s
Severe obstruction - FEV1 < 1.0 L

Question 9

4 Causes of Restrictive lung disease and an example of each

Answer 9

1. Primary lung disease - stiff parenchyma (IPF-idiopathic pulmonary fibrosis, pneumonia)
2. Pleural abnormalities (pleural effusion)
3. Thoracic abnormalities (kyphoscoliosis, decreased chest wall mobility)
4. Other: limited lung expansion 2º pregnancy, morbid obesity

Question 10

How does restrictive disease affect lung volumes & capacities?

Answer 10

Difficulty getting air IN
Decreased lung volumes: lowered vital capacity, inspiratory capacity, total lung capacity, and lower than normal residual volume

Question 11

How does obstructive disease affect lung volumes & capacities?

Answer 11

Difficulty getting air OUT
Increased: reserve volume, total lung capacity, functional reserve capacity, tidal volume slightly up
Decreased: Inspiratory and expiratory reserve volumes, inspiratory capacity, vital capacity.

Question 12

How does Arterial PO2 correspond to O2 Saturation? At what level of PO2 is oxygen therapy recommended?

Answer 12

40-50-60 PO2 / 70-80-90 % O2 sat rule

If PO2 < 60 mm Hg, hypoxemia, usually O2 therapy

Question 13

SPPB (Short Physical Performance Battery) - What are the components? What do these components predict?

Answer 13

1. Static balance: Romberg –> semi tandem –> tandem, 10s each
2. Gait speed: normal pace 10m walk from a standstill. <0.6 m/s increases risk of hospitalization, dependency in ADL’s
3. 5x Sit to Stand: if >15 s, 2x the risk of falls

Question 14

SPPB - Scoring and MCID

Answer 14

12 points total. MCID: 1 point improvement, 14% reduced risk of death and rehospitalization
Score 0-4 - 5x increased risk of death, hospitalization
Score 5-7 - 2.6x increased risk

Question 15

6 Minute Walk Test

Answer 15

Can use usual walking aids, standing breaks

Question 16

Arterial Blood Gases (ABGs) - normal values, what indicates respiratory and metabolic cause

Answer 16

PH: acidosis < 7.35 - 7.45 < alkalosis
PCO2: respiratory acidosis, hypoventilating < 45 - 35 mm Hg < resp alkalosis, hyperventilating
HCO3: metabolic acidosis < 22 - 26 mEq/L < metabolic alkalosis
PO2: 80-100 mm Hg = normal, 40-60 = moderate hypoxemia

Question 17

Fall Risk Stratification for Older Adults - What are the components? Risk scores?

Answer 17

Fall history (8 pts), Living alone (3 pt), Female (3 pt), 4 or more meds (3 pts)
Risk is: Low (0-4 pt), Moderate (5-10 pt), High (11-16 pt)

Question 18

DASI - Duke Activity Status Index - What does it measure? Cutoff for high surgical risk?

Answer 18

12 questions, activities you can do “without difficulty”
- Estimates VO2 peak up to 9.8 METs, fitness, functional capacity
<4 METs - high surgical risk

Question 19

What is the minimal aerobic capacity to remain functionally independent?

Answer 19

Males: 18 mL/kg/min (5.14 MET)
Females: 15 mL/kg/min (4.3 MET)

Question 20

6 Criteria for considering a patient “medically stable”

Answer 20

For the PAST 8 HOURS

1. No new/recurrent chest pain
2. No new signs uncompensated heart failure (dyspnea at rest, hypotension, B/L crackles >0.5 lungs)
3. No significant abnormal ECG change
4. Can speak comfortably at RR < 30
5. Cardiac index (CO/mass) > 2 L/min/m2
6. Central venous pressure < 12 mm Hg

Question 21

Acute Care Exercise Guidelines (5)

Answer 21

• Warm up and cool down at 50% stimulus intensity
• HR increase no more than 20-30 bpm above RHR
• SBP drop no more than 10-20 mm Hg
• No significant dysrhythmia/dyspnea
• RPE 11-13 (Borg) or 3-4 (modified Borg, fairly light to somewhat hard)