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Intro to Respiratory Medicine > Exam 3- 112 > Flashcards

Exam 3- 112 Flashcards

1
Q

When is a surgical airway done?

A

When normal methods (i.e. ETT) cannot be done
Due to: airway obstruction, foreign body, swelling, laryngospasm

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2
Q

What is a percutaneous trach?

How is it done?

What are 4 facts?

A

A Trach done with a needle & Catheter

  1. 12-14g needle
  2. guide wire inserted
  3. dilate stoma gradually
  4. insert trach over dialator

Facts:
1. May be done bedside
2. not done on under 12 yr old
3. sedation & local anesthesia used
4. stoma stabilized in 5 days

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3
Q

What is an open surgical trach?

What are 4 facts?

A
  1. Done in the OR
  2. Can be done under 12 yr old
  3. General anesthesia
  4. Stoma stabilized in 7-10 days
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4
Q

7 Benefits of a Trach

A
  1. Eliminates chance of vocal cord injury
  2. Greater pt comfort
  3. less sedation
  4. easier secretion removal
  5. decreased WOB
  6. Shorter weaning time
  7. easier communication
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5
Q

3 indications for a Trach

A
  1. overcome upper airway obstruction or trauma
  2. poor airway refelexes
  3. prolonged intubation
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6
Q

Trach complications Early vx. Late

A

Early:
1. Hemorrhage
2. infection in wound
3. tube occlusion
4. tube dislodging

Late:
1. tracheal stenosis
2. TE Fistula
3. Trachea innominate artery fistula
4. airway bacterial infection/ stoma infection
5. swallowing dysfunction

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7
Q

What is a Passy muir valve?

What is most important to remember?

A

t’s a speaking valve that allows air in but no air out. It’s a 1 way valve which forces exhalation air up past vocal cords to talk

Cuff must always be deflated or pt can suffocate

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8
Q

2 Types of atelectasis

A
  1. Gas absorption
  2. Compression
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9
Q

What is gas absorption atelectasis

A

When gas distal to an obstruction is absorbed causing alveoli to collapse, especially when breathing high FIO2

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10
Q

What is compression atelectasis & 2 ways to fix it

A

occurs when thoracic pressure is greater than alveoli pressure
- abdominal/chest dressings
**- reluctant to take a deep breath
-pleural effusion

  1. Remove dressing (usually unlikely)
  2. Provide pressure:
    - Negative= deep breathing
    - Positive= PEP/CPAP
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11
Q

Who is most at risk for atelectasis

A

** Post op patients
- Pts having difficulty to taking a deep breaths
- NMD
- Sedation
- ineffective cough
- disruption of surfactant
- Hx of chronic bronchitis

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12
Q

3 Indications for IS

A
  1. Presence of Atelectasis
  2. Risk Factors: Thoracic/Abdominal surgery, any surgery in COPD Pt
  3. Restrictive defect associated with quad pts or diaphragm dysfunction
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13
Q

3 Contraindications for IS

A
  1. Unable to understand instructions or perform and cooperate
  2. unable to take deep breath. Saying “it hurts” is not a reason
  3. VC <10 ml/Kg or IC <1/2 of predicted (use namogram to get predicted)
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14
Q

5 Complications of IS

2 that are not so common

A
  1. hyperventilation
  2. Resp alkalosis
  3. Dizzy/lightheaded
  4. Discomfort
  5. Fatigue
  6. Bronchospasm
  7. Barotrauma
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15
Q

5 steps for IS procedure

A
  1. mouth tight on mouthpiece
  2. nose clips
  3. slow deep breath in
  4. hold 3-5 seconds
  5. Repeat 5-10 times/hr
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16
Q

What does CPAP stand for?

How does it work?

A

Continuous positive airway pressure

Delivers flow to create pressure-transmitted to alveoli

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17
Q

3 Indications for CPAP

A
  1. To treat atelectasis (short lived benefits)
  2. Pulmonary Edema
  3. Obstructive sleep apnea
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18
Q

9 Contraindications of CPAP

A
  1. Hemodynamically unstable
  2. unable to protect airway
  3. nausea
  4. facial trauma
  5. untreated pneumothorax
  6. increased ICP
  7. active hemoptysis
  8. TE Fistula
  9. when vent help is required
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19
Q

5 Hazards of CPAP

A
  1. Barotrauma
  2. gastric distension
  3. pressure ulcers
  4. decreased venous return
  5. increased deadspace
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20
Q

What is HFNC?
What is Max delivery in L/min?
How does it work?

A

High Flow Nasal Cannula
60 L/min
Pressure applied only on exhale to create back pressure (PEP)

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21
Q

2 Benefits of HFNC
3 Contraindications
3 Hazards

A
  1. Stable FIO2
  2. CO2 washout (eliminates CO2, Decreased deadspace, decreased WOB)
  3. Hypercarbic Resp Failure
  4. Can’t protect airway
  5. Can’t tolerate
  6. HAIs
  7. Headache
  8. Dry mouth.upper airway
22
Q

What is PEP?
6 Benefits of PEP?
2 Device examples

A

Positive Expiratory Pressure

  1. Simpler than CPAP or HFNC
  2. Pt breaths against resister
  3. creates back pressure
  4. Keeps aveoli open
  5. mimics pursed lip braething
  6. Helps with secretion clearance
  7. Arobika
  8. Acappella
23
Q

5 Contraindications of PEP

4 Hazards

A
  1. Utreated Pneumothorax
  2. Elevated ICP
  3. Hemodynamically unstable
  4. can’t take a deep breath
  5. uncooperative
  6. Hyperventilation
  7. Discomfort
  8. fatigue
  9. bronchospasm
24
Q

5 steps) How to know what lung expansion therapy to use?

A
  1. Hx & Risk level
  2. Early mobilization if possible
  3. IS+DB&C
  4. PEP
  5. HFNC or CPAP if pt needs O2
25
6 Therapies for lung expansion? What is #1
1. Early mobilization 2. DB&C 3. IS 4. PEP 5. CPAP 6. HFNC
26
4 parts to an effective cough
1. irritation: something triggers sensory fibers 2. inspiration: brain responds to signal from sensory fibers 3. compression: glottis closes to create pressure 4. expulsion: glottis opens to release pressure
27
5 reasons for abnormal secretion clearance
1. non patent airway 2. abnormal mucociliary clearance 3. ineffective cough (weak muscles, surgery, NMD, spinal cord injury) 4. ETT 5. Thick secretions
28
What is the goal of bronchial hygiene (ACT=airway clearance technique)
To assist in mobilization & removing retained secretions (helps with gas exchange and alveolar expansion)
29
7 indications for ACT (Acute vs. chronic)
Acute: 1. Copious secretions 2. inability to mobilize secretions 3. ineffective cough Chronic: 4. CF 5. Ciliary dyskinetic syndrome 6. COPD w/ retained secretions 7. Bronchiectasis
30
5 Contraindications of ACT
1. Routine COPD care 2. Pneumonia w/o sputum production 3. Routine post-op care 4. uncomplicated asthma 5. prevention
31
5 ACT methods
1. mobilization & physical activity 2. coughing techniques 3. PAP adjuncts 4. High frequency oscillating devices 5. CPT
32
2 Types of coughing techniques and their examples
Directed Cough: 1. Huff cough 2. manually assisted cough Active cycle of breathing: 1. Autogenic drainage 2. MIE
33
what is diaphragmatic breathing?
1. slowly inhale through nose 2. Slowly exhale through mouth 3. repeat focusing on movement in diaphragm and chest
34
5 steps on How to do Huff Cough (FET: forced expiratory tech)
1. Deep breath 2. exhale through pursed, bending forward 3. repeat 2-3X 4. deep breath 5. open glottis and say "huff, huff, huff"
35
2 steps to do manually assisted cough? (Quad cough)
1. Pt takes deep breath 2. RT exerts pressure abruptly under diaphragm similar to hymlick
36
1 Indication for manually assisted cough? 7 Contraindications
1. NMD 1. osteoporosis 2. flail chest 3. pregnancy 4. hernia 5. abdominal aortic aneurysm (AAA) 6. Acute abdominal pathology 7. anything happening in the abdomen
37
7 steps to do active cycle of breathing? (modified huff cough)
1. diaphragmatic breathing 2. thoracic breathing 3. diaphragmatic breathing 4. thoracic breathing 5. diaphragmatic breathing 6. Huff cough 7. diaphragmatic breathing
38
3 phases for autogenic drainage Where is this typically done (location)
Diaphragmatic breathing using varying volumes in 3 phases Phase 1: unstick phase - inhale to IC, braeth at low levels Phase 2: Collection phase - breath at low-mid volumes Phase 3: cough it out - breath at higher volumes & cough * OP clinics and CF clinics
39
5 Steps to MIE? (cough assist)
1. Deliver positive pressure (40cmH2O) 1-3 sec 2. Abruptly reverse (-40 cmH2O) 2-3 sec 3. Repeat 5 breaths 4. Normal breathing 5. Repeat 5 cycles If able have Pt cough with the machine on step 2
40
3 contraindications of MIE 2 indications
1. Bullous emphysema 2. Pneumothorax 3. Pneumomediastinum 1. NMD 2. Weak cough
41
3 reasons on How PEP works?
1. Creates a back pressure 2. Keeps alveoli open 3. Helps with secretion clearance
42
2 Types of OPEP? How is it different from PEP
1. Vibrating 2. Oscillating All the benefits of PEP with added oscillations - shakes mucus free from sides of airways
43
4 OPEP devices and how to use them? How often? How/when to adjust settings?
1. Flutter Valve: blow in/balance the ball 2. Acapella: blow in, vibrates, adjust resistance as needed 3. Arobika: same as above 4. Lung Flute Done 2-4x/day Ratio is 1:3 or 1:4, if ratio does not match the expected, adjust resistance
44
What is IPV and Metaneb? How do they work? When to use them?
IPV= intrapulmonary percussive ventilation - 200-300 mini bursts of pressurized air/min Metaneb= 170-230 mini bursts/min - alternates positive pressure with oscillations Think: Percussor Can the pt DB&C? Yes-but fails... OPEP...yes and fails IPV or MetaNeb
45
Who is manually CPT used for?
Pt with CF or Bronchiectasis
46
2 Indications for CPT
1. copious secretions (>25-30 mL/day) 2. inability to mobilize secretions
47
2 Parts to CPT
1. Percussion/vibration - manually done to unstick secretions 2. Postural drainage - manually position pt - allows gravity to help - held for 3-15 min per position "put the good lung down"
48
Contraindications for CPT 2 absolutes
absolutes: 1. Head/Neck injury 2. Active bleeding - Spinal injury/surgery/epidural - Hemoptysis - Empyema - BP Fistula - Pul. Edema/Embolism - Rib Fractures - SubQ Emphysema - New pacemaker/unstable cardio - TB -Burns/wounds -SOB Trendelenburg position: - uncontrolled hypertension - distended abdomen - anything that increase ICP (eye surgery/head surgery)
49
7 steps for CPT Procedure
1. Assess Pt 2. Position Pt 3. Percuss 3-5 min 4. Pt Breaths/coughs 5. Switch positions 6. Repeat until all areas are complete 7. Assess Pt
50
2 reasons why turning a pt is important
1. To avoid pressure ulcers 2. to mobilize secretions
51
How does a High frequency chest wall (HFCWO) work When to choose it
1. Vest on Pt 2. Infaltes with air 3. air pulses quickly to produce oscillations When pt has more than 25-30 mL/day of sputum
52
How to choose with therapy to do for ACT?
1. Can/Will Pt DB&C? Yes: - DO it - OPEP -IPV/Metaneb -Do they have more than 25-30 mL/day? - CPT - HFCWO No: NMD? - Manual assist -cough assist -Suction PRN PAIN? - Splinting -Huff cough -Pain Meds

Intro to Respiratory Medicine (9 decks)

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