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Neonatal Pediatric Specialty (NPS) > Diagnostic Testing - Core Concepts > Flashcards

Diagnostic Testing - Core Concepts Flashcards

1
Q

What is the quick alveolar air equation?

A

(FiO2 x 7) - (PaCO2 + 10)

In a pinch, FiO2 x 7 should be close enough

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2
Q

How do you calculate the A-a gradient?

A

PAO2 - PaO2

Find PAO2 with the alveolar air equation, then subtract your arterial (ABG) PaO2.

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3
Q

What is normal a/A ratio?

a
___
A

A ratio lower than ___ indicates surfactant therapy.

A

0.8 - 0.9

Lower than 0.2 is an indication for surfactant usage. A higher number indicates improvement.

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4
Q

A normal shunt is ___%, and increases by ___% for every increase of ___ in the A-a gradient.

A

Normal is 5%. Shunt increases by 5% for every increase of 100 in the A-a gradient.

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5
Q

An A-a gradient of 200 would correlate with a shunt of what %?

A

15%. Start with the normal of 5%, and add 5% for every 100 torr of A-a gradient.

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6
Q

An oxygenation index (OI) of > ___ indicates the need for nitric oxide (iNO)

An oxygenation index (OI) of > ___ indicates the need for ECMO, and is indicative of an 80% mortality rate.

A

> 25 indicates nitric oxide therapy.

> 40 indicates ECMO therapy.

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7
Q

What is a normal PF ratio?

A

380 or greater.

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8
Q

PF ratio of:
201-300 indicates ___ ARDS
< 200 indicates ___ ARDS
< 100 ___ ARDS

A

Mild
Moderate
Severe

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9
Q

What is a normal SaO2/FiO2 ratio? is it less invasive that a P/F ratio?

A

400

Yes

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10
Q

What is a normal Vd/Vt ratio? (deadspace to tidal volume ratio)

A

20% - 40% (up to 60% in mech vent patients)

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11
Q

What is the deadspace to tidal volume equation? (Vd/Vt)

A

PaCO2- PetCO2
_____________ x 100
PetCO2

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12
Q

The most common pathology related to a high deadspace to tidal volume ratio is?

A

Pulmonary embolism (PE)

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13
Q

A 3L calibrating syringe has an acceptable accuracy range of what %, and what volume?

A

3.5%, which is about 100 ml. If the syringe is considered accurate, it’s volume will be between 2.9L - 3.1L

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14
Q

The vital capacity measures volume and identifies (restrictive/obstructive) disorders?

A

Vital capacity identifies restrictive disorders.

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15
Q

The FEV1 measures flow and identifies (obstructive/restrictive) disorders?

A

FEV1 identifies obstructive disorders.

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16
Q

is 80-100% of predicted a normal result on a PFT?

A

Yes.

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17
Q

Are CF, bronchitis, asthma, and bronchiectasis obstructive or restrictive?

A

Obstructive. EVERYTHING else is restrictive.

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18
Q

MIP (maximum inspiratory pressure) of less than ___ indicates inspiratory muscle weakness

A

<20

19
Q

MEP (maximum expiratory pressure) of less than ___ indicates poor ability to clear secretions.

A

<40

20
Q

Normal SpO2 for newborns?

Normal SpO2 for children?

A

Newborns: 90-95
Children: 93-97

21
Q

What is the ideal temperature range for transcutaneous monitoring?

A

41C - 44C

22
Q

A transcutaneous monitoring electrode should be moved to a new site in how many hours?

If erythema (redness/blistering) occurs, what should you do?

A

Move electrode every 4-12 hours.

Move the electrode, and change sites more frequently.

23
Q

In what order do you assess blood gas values on the exam?

A

VOCP!!!

CO2 first
PaO2, FiO2
pH

24
Q

Assess the following blood gas results in order of the NBRC guidelines:

pH
PaCO2
PaO2/FiO2

A

VOCP!!!

PaCO2 first (assess ventilation)
PaO2/FiO2 (assess oxygenation)
pH (if both are acceptable)

25
Q

Is the patient ventilating, according to the NBRC guidelines?

If PaCO2 is normal?
if PaCO2 is increased?
if PaCO2 is decreased?

A

If PaCO2 is normal? Yes the pt is ventilating.
if PaCO2 is increased? No. Change settings.
if PaCO2 is decreased? Yes the pt is ventilating.

26
Q

What are the 3 possible causes of poor oxygenation?

A

Poor ventilation
V/Q mismatch (ventilation/perfusion defects)
Shunting (alveolar collapse, PPHN, heart defects)

27
Q

What is the adequate PaO2 range for the following patients?

Newborn:
Infant:
Child:

A

Newborn: 50-70
Infant: 85-100
Child: 80-100

28
Q

On the exam, what is the first drug to always give if there is a problem?

A

Oxygen

29
Q

Metabolic alkalosis is almost always a result of low ___,

and is best treated by giving ___.

A

Potassium. (Hypokalemia)

Treat by giving KCl (potassium chloride).

30
Q

How many seconds of apnea is considered abnormal for

an infant?
a child?

A

> 20 seconds for infants

>10 seconds for a child

31
Q

An AHI (apnea-hypopnea index) of what range is considered moderate?

A

16-30

32
Q

Before discharging a baby with an apnea monitor, the parents should know ___.

A

CPR.

33
Q

The low heart rate alarm on an apnea monitor should be set between ___.

A

60-80

34
Q

Pulmonary Artery Pressure (PAP) is ___

Mean PAP is ___

A

Pulmonary Artery Pressure (PAP) is 25/8

Mean PAP is 14

35
Q

If the exam says “wedge” pressure is rising, the problem is in the ___ heart.

A

Left

36
Q

If the PAP is rising, the problem is in the ___.

Similarly, if there is a problem with the ___, think PAP.

A

Lungs

Lungs

37
Q

If the exam says “left” anything is rising (mitral/bicuspid/left atrial/etc), think ___.

A

Wedge

38
Q

Mean systemic arterial pressure is ___

A

In the 90’s

39
Q

Normal CVP (central venous pressure) is ___

A

2-6 mmHg or 4-12 cmH2O

40
Q

If you are worried about fluids, you should look at this pressure…

A

CVP. (very sensitive to fluid changes)

41
Q

If the CVP is rising one of 2 problems exist…

  1. All values rise, which indicates ___
  2. Only CVP rises, which indicates ___
A 
Fluid overload (all values rise)
Right heart failure (only CVP rises)
42
Q

Normal CO (cardiac output) is ___.

A

4-8 L/min

43
Q

Venous saturation and ___ are directly proportional. If one increases/decreases, the other will follow.

A

Cardiac output.

Neonatal Pediatric Specialty (NPS) (7 decks)

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