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1
Q

What are the four critical life functions?

A

Ventilation, Oxygenation, Circulation, Perfustion

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2
Q

Which of the 4 life functions is first priority?

A

Ventilation

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3
Q

What assessments would determine how well a pt is ventilating?

A

RR, Vt, Chest Movement, Breath Sounds, PaCO2 etc.

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4
Q

How would the therapist determine if there was a problem with oxygenation?

A

HR, Color, Sensorium, PaO2 etc.

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5
Q

What info would help the RT determine if a pt’s circulation is adequate?

A

Pulse/HR and strength, Cardiac Output

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6
Q

What changes would indicate that a patient may not have adequated perfusion?

A

BP, Sensorium, Temperature, Urine Output, Hemodynamics.

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7
Q

Explain the difference between signs and symptoms and list examples of each:

A

Signs - Objective information, those things that you can see or measure (color, pulse, edema, BP, etc.

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9
Q

List the 8 things that are important to examine when reviewing a patient’s chart:

A

Admission Notes

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17
Q

Define an advance directive:

A

Set of instructions documenting what treatment a patient would want if he was unable to make medical decisions.

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18
Q

List and describe the 3 types of advance directives:

A
  1. DNR - accepted in all 50 states
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21
Q

A properly written order should include what for factors?

A
  1. Type of tx
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25
Q

What is the normal value for urine output?

A

40 mL/Hr or approx 1L/day

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26
Q

What findings might indicate a patients fluid intake has exceeded his urine output?

A
  1. Weight gain
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30
Q

Changes in what reading can indicate hypovolemia?

A

Decreased CVP (CVP of < 2 mm Hg)

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31
Q

Define Semi comatose:

A

Responds only to painful stimuli.

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32
Q

Define Lethargy/Somnolence:

A

Sleep

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33
Q

Define Obtunded:

A

Drowsy state

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34
Q

When assessing a patient’s orientation to time, place and person, what are some of the factors that could affect the patient’s ability to cooperate?

A

Language difficulty

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38
Q

Define “Activities of Daily Living” ADL:

A

The basics of everyday life.

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39
Q

List the six criteria that “Activities of Daily Living” are based upon:

A

Bathing

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45
Q

Describe what a “KATz ADL” score of 1 indicates:

A

0 = Pt unable to perform or needs assistance performing activity.

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47
Q

Measuring subjective symptoms, define the following terms:

A

Orthopnea - Difficulty breathing except in an upright position (CHF, Heart problem)

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54
Q

Peripheral Edema:

A

Presence of excessive fluid in the tissue known as pitting edema - occurs primarily in arms and ankles - caused by CHF and renal failure. Rated +1 and up… the higher the number, the greater the swelling.

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55
Q

Ascites

A

Accumulation of fluid in the abdomen; generally caused by liver failure.

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56
Q

Clubbing of fingers

A

Caused by chronic hypoxia. Presence of this is suggestive of pulmonary disease.

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57
Q

Venous distension

A

Occurs with CHF; Seen in patients with obstructive lung disease. Seen during exhalation because of the obstructive component.

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58
Q

Capillary refill

A

Indication of peripheral circulation; Blanching of one hand and watching the blood return (Modified Allen’s Test)

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59
Q

Diaphoresis

A

State of profuse/heavy sweating; Heart failure; fever; infection; anxiety; nervousness; Tuberculosis (night sweats)

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60
Q

Ashen/pallor

A

Decrease in color due to anemia or acute blood loss. Can be caused by vasoconstriction too.

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61
Q

Erythema

A

Redness of the skin - May be due to capillary congestion, inflammation or infection.

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62
Q

Cyanosis

A

Blue or blue-gray(dusky) discoloration of skin and mucous membranes. Caused by hypoxia from increase amount of reduced hemoglobin (5g of reduced hemoglobin).

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63
Q

Kyphosis

A

Convex curvature of the spine (rounded leaning forward)

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64
Q

Scoliosis

A

Lateral curvature of the spine

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65
Q

Barrel chest

A

Result of air trapping in the lungs for a long period of time

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66
Q

What are the normal muscles of ventilation?

A

Diaphragm, external intercostals

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67
Q

What are the accessory muscles of ventilation?

A

Intercostal, scalene, sternocleidomastoid, pectoralis major and abdominal

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68
Q

What causes hypertrophy of the accessory muscles?

A

Occurs with COPD

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69
Q

Signs of respiratory distress in infants:

A

Flaring of nostrils and intercostal retractions.

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70
Q

What is the normal range for a patient’s heart rate?

A

60-100 BPM

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71
Q

What term would be used to describe a heart rate of 120 bpm? What would this indicate?

A

Tachycardia. Indication of hypoxemia, anxiety or stress.

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72
Q

What term would be used to describe a pulse of 47 bpm? What would this indicate?

A

Bradycardia. Indication of heart failure or shock.

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73
Q

What does pardoxical pulse/pulsus paradoxus indicate?

A

Pulse/blood pressure varies with respiration. May indicate severe air trapping.

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74
Q

What is tactile fremitus

A

Vibrations felt by hand on the chest wall

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75
Q

What is meant by crepitus and what condition is it associated with?

A

Bubbles of air under the skin that can be palpated and indicates the presence of subcutaneous emphysema.

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76
Q

Resonant

A

Normal air filled lung. Gives hollow sound.

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77
Q

Flat

A

Heard over the sternum, muscle or areas of atelectasis.

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78
Q

Dull

A

Heard over fluid-filled organs such as the heart or liver. Pleural effusion or pneumonia will give this thudding sound.

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79
Q

Tympanic

A

Heard over air-filled stomach. This is a drum like sound and when heard over the lungs indicates increased volume.

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80
Q

Hyperresonant

A

found in areas of the lung where pneumothorax or emphysema is present. This is a booming sound.

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81
Q

What is the difference between vesicular and adventitious sounds?

A

Vesicular is normal, adventitious is abnormal

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82
Q

What is egophony and what would it indicate?

A

Patient instructed to say “E” but it sounds like “A”. This would indicate consolodation in the lung like pneumonia.

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83
Q

What breath sounds would be expected in a patient with pneumonia?

A

Dull

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84
Q

Describe S1 heard sound and when it would occur in the cardiac cycle

A

Created by the normal closure of the mitral and tricuspid valves at the beginning of ventricular contraction.

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85
Q

Describe S2 heard sound and when it would occur in the cardiac cycle

A

Normal and occurs when systole ends. The ventricles relax and the pulmonic and aortic valves close.

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86
Q

Describe what the abnormal S3 sound indicates:

A

May suggest CHF; Low pitched and may be difficult to discriminate from S4

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87
Q

Describe what the abnormal S4 sound indicates:

A

Indicative of a cardiac abnormality such as myocardial infarction or cardiomegaly.

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88
Q

Describe what a murmur may indicate:

A

Caused by turbulent blood flow. May be caused by heart valve defects or congenital heart abnormalities and should be investigated.

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89
Q

Describe Bruits:

A

Sound made in an artery or vein when blood flow becomes turbulent or flows in an abnormal speed.

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90
Q

What effect could cardiac stress have on blood pressure?

A

Hyoxemia

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91
Q

What effect would hypoperfusion have aon BP?

A

Hypovolemia, CHF

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92
Q

Describe the normal appearance of the hemidiaphragm on a chest x-ray.

A

Both are rounded (dome shaped); right is slightly higher than the left; right is at the level of the 6th anterior rib.

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93
Q

Describe the normal appearance of the trachea on a chest x-ray.

A

Midline, bilateral radiolucency, with sharp costophrenic angles.

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94
Q

Describe the normal appearance of the clavicles on a normal chest x-ray.

A

Head of clavicles should be level.

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95
Q

List some possible causes for loss of airway latency:

A

Foreign body obstruction; Edema as seen with croup, epiglottitis or allergic reactions, tracheal spasms, internal or external compression, trauma leading to airleak.

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96
Q

What condition causes obliteration of the costophrenic angles?

A

Pleural effusion

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97
Q

In what pathology is the diaphragm flattened?

A

COPD

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98
Q

Describe lateral postion when used for x-ray:

A

Projection from either the right or left side.

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99
Q

Describe lateral decubitus position when used for x-ray:

A

Patient lying on the affected side. Valuable for detecting small pleural effusions.

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100
Q

Where should the tip of the endotracheal tube be positioned when viewed on a chest x-ray.

A

Below the vocal chords approx 2 cm or 1 inch above the carina. Approx the same height as the aortic notch.

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101
Q

What is the quickest way to to determine adequate ventilation following endotracheal intubation?

A

Auscultation

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102
Q

Where should the chest tube be located when positioned properly?

A

In the pleural space surrounding the lung.

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103
Q

Where should the nasogastric and feeding tube be located when positioned properly?

A

2-5 cm below the diaphragm.

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104
Q

Where should the pulmonary artery catheter be located when positioned properly?

A

In the right lower lung field.

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105
Q

Where should the pacemaker be located when positioned properly?

A

Should normally be positioned in the right ventricle (SA node…).

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106
Q

Where should the central venous catheter be located when positioned properly?

A

Right or left subclavian or jugular vein and should rest in the vena cava or right atrium of the heart.

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107
Q

What diagnostic test is appropriate for determining an upper airway obstruction in a child (croup and epiglottitis)?

A

Lateral neck x-ray.

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108
Q

Describe Croup:

A

Laryngotracheobronchitis - a viral disorder common in infants and young children. the x-ray of the neck will reveal tracheal narrowing with subglottic swelling in a classic pattern called:

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110
Q

Describe Epiglottitis:

A

A potentially life-threatening inflammation of the supraglottic airway caused by a bacterial infection. A lateral neck x-ray shows supraglottic narrowing with an enlarged and flattened epiglottis and swollen aryepiglottic folds. Seen as a thumb sign.

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111
Q

Radiolucent description and diagnosis:

A

Dark pattern (Air);

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113
Q

Radiodense/opacity

A

White pattern (Solid, Fluid);

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115
Q

Infiltrate

A

Any ill-difined radio density;

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117
Q

Consolidation

A

Solid white area;

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119
Q

Hyperlucency

A

Extra pulmonary air;

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121
Q

Vascular markings

A

Lymphatics, vessels, lung tissue;

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123
Q

Diffuse

A

Spread throughout;

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125
Q

Opaque

A

Fluid, solid;

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127
Q

Fluffy infiltrates

A

Diffuse whiteness;

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129
Q

Butterfly/Batwing pattern

A

Infiltrate in shape of butterfly/bat wing;

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131
Q

Patchy infiltrates

A

Scattered densities;

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133
Q

Patelike infiltrates

A

Thin-layered densities;

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135
Q

Ground glass appearance

A

Reticulogranular;

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137
Q

Honeycomb pattern

A

Reticulondodular;

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139
Q

Diffuse bilateral radiopacity

A

ARDS

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140
Q

Air Bronchogram

A

Pneumonia

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141
Q

Peripheral wedge-shaped infiltrate

A

Pulmonary embolus

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142
Q

Concave superior interface/border

A

Pleural effusion

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143
Q

Basilar infiltrates with meniscus

A

Pleural effusion

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144
Q

Describe a CT scan:

A

An x-ray through a specific plane of the body part to be examined. Images appear as narrow slices of the organ or body part.

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145
Q

What pathologies would a CT be indicated?

A

Bronchiectasis

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146
Q

What special type of CT scan is indicated to diagnose a pulmonary embolus?

A

Ct scan with conrtrast dye.

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147
Q

What is the advantage of using MRI over a conventional x-ray?

A

No x-rays are used.

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148
Q

What type of ventilators are used with MRI and why?

A

Fluidic (non-electric, gas powered)

149
Q

Describe how ventilation/perfusion scan test is performed:

A

Ventilation -

153
Q

What is indicated by normal ventilation and abnormal perfusion?

A

Pulmonary emboli.

154
Q

What are indications for a barium swallow test?

A

Suspected esophageal malignancy.

159
Q

What is the main indication for bronchography?

A

Bronchiectasis

160
Q

List two hazards of a bronchography:

A

Allergic reaction and impairment of ventilation

161
Q

A PET (positron emission topography) scan would be useful to help diagnose what conditions?

A

Cancer, brain disorders and heart disease.

162
Q

An EEG is indicated to assess activit of the?

A

Brain

163
Q

Pulmonary (arteriogram) Angiogram test is indicated to diagnose what pathology?

A

Pulmonary embolism.

164
Q

Briefly describe what echocardiograpy would be indicated and what can be measured with two different types of procedures:

A

Indications are valvular disease or dysfunciton; mycocardial disease, abnormalities of cardiac blood flow; Cardiac abnormalites in infant (ASD, VSD, PDA); Abnormal hear sounds.

166
Q

What is the normal rance for ICP?

A

5-110 mmHg

167
Q

Treatment is recommended when ICP increases above what level?

A

> 20 mmHg

168
Q

Define cerebral perfusion pressure

A

The pressure gradient that determines cerebral perfusion

169
Q

What is the formula to calculate CPP?

A

MAP - ICP

170
Q

What is the normal value for CPP?

A

70-90 mmHg

172
Q

CVP - Normal values; related to…

A

2-6 mmHg; Right heart fx

173
Q

PAP - Normal values; related to…

A

25/8 Mean 14 Range 9-18 mmHg; Lungs

174
Q

PCWP - Normal values; related to…

A

4-12 mmHg; Left heart fx

175
Q

CO - Normal values

A

4-8 L/min

176
Q

Usual cause high CVP

A

Fluid overload, diurese

177
Q

When CVP low

A

Usually dehydration or vasodilation, give fluids or vasoconstrictors

178
Q

Possible pathology increased CVP

A

Right heart failure, cor pulmonale, tricuspid valve stenosis

179
Q

(xray)Central venous catheter placement

A

Tip should rest in right atrium or vena cava

180
Q

(xray) Pulmonary artery catheter placement

A

Tip should be over the right lower lung field

181
Q

Most common complication of PA catheter insertion

A

Arrythmias

182
Q

How you will know you are in the pulmonary artery

A

Dicrotic notch

183
Q

How to fix pressure dampening (dicrotic notch absent)

A

a. Check for air bubbles

188
Q

Hb range

A

12-16 gm/dL

189
Q

Vd/Vt - Formula; range

A

PaCO2-(PeCO2)/PaCO2; 20-40%, up to 60% if ventilated

190
Q

High Vd/Vt usually relates to

A

Pulmonary embolus

191
Q

Alveolar air equation (PAO2)

A

((Pb-PH2O)FIO2) - PaCO2/0.8

192
Q

A-a Gradient - Formula; values

A

A-aDO2 = PAO2 - PaO2; Normal 25-65. 65-299 = V/Q mismatch, >300 = shunt

193
Q

It is best to obtain the A-a gradient when

A

The patient is on 100% FIO2

194
Q

Arterial Oxygen Content - Formula; values

A

CaO2 = (Hbx1.34xSaO2) + (PaO2x0.003);

196
Q

Venous Oxygen Content - Formula; values

A

CvO2 = (Hbx1.34xSv02) + (PvO2x0.003);

198
Q

Arterial-Venous Oxygen Content Difference - Values

A

C(a-v)O2; Normal 4-5 vol%; difference INCREASES when Qt is DECREASING

199
Q

Best measurement of oxygen being delivered to the tissues

A

CaO2

200
Q

The CvO2 should be drawn from

A

Pulmonary artery

201
Q

P/F ratio - values

A

Normal >380 (PaO2 of 80/21%), <200 ARDS

202
Q

Fick Equation

A

Qt = VO2/C(a-v)02x10

203
Q

If a BP cuff and an arterial line display different values. Trust the

A

BP cuff

204
Q

Neonate, acceptable PaO2

A

50-80 mmHg, all other values same

205
Q

(xray) Obliterated costophrenic angles; concave superior surface; meniscus

A

Pleural effusion

206
Q

(xray) Flattened diaphragm

A

Air trapping

207
Q

(xray) Radiolucent

A

Normal

208
Q

(xray) Fluffy infiltrates, butterfly/batwing pattern

A

Pulmonary edema

209
Q

(xray) Air bronchogram

A

Pneumonia

210
Q

(xray) Ground glass, honeycomb, reticulogranular

A

ARDS/IRDS

211
Q

(xray) Thumb sign

A

Acute epiglottitis

212
Q

(xray) Steeple sign

A

Croup

213
Q

(xray) Airway placement

A

2-5 cm above carina; level w/ 4th rib/T-4, aortic knob

214
Q

(xray) Chest tube placement

A

Should be in the neural space

215
Q

Primary Dx tool for bronchiectasis

A

Bronchogram

216
Q

Used to determine risk for aspiration

A

Barium swallow

217
Q

Low K+ can cause

A

Metabolic alkalosis

218
Q

Hypokalemia - cause; ECG

A

Excessive fluid loss (vomiting, dehydration); Flattened T-wave

219
Q

Cl- follows

A

Na+

220
Q

Eosinophils associated w/

A

Asthma, allergic reactions

221
Q

Monocytes associated w/

A

TB

222
Q

PT - use; values

A

Monitors Warfarin (Coumadin) Therapys, 12-15 sec

223
Q

APTT - use; values

A

Monitors Heparin therapy; 24-32 sec

224
Q

Acid Fast stain

A

Tuberculosis

225
Q

Culture

A

Identifies organism

226
Q

Sensitivity

A

Identifies which antibiotics kills organism

227
Q

TcPO2/TcPCO2 electrodes should be moved

A

Q4H

228
Q

TcPO2/TcPCO2 calibration

A

Room air and zeroing solution

229
Q

Best indicator of perfusion

A

Urine output

230
Q

Dry non-productive cough

A

Think cancer

231
Q

Digital clubbing

A

Chronic hypoxemia (think COPD)

232
Q

Neck vein distension

A

Associate with CHF and COPD

233
Q

Night sweats

A

TB

234
Q

Cold and clammy skin

A

Think myocardial infarction

235
Q

Unilateral wheeze

A

Foreign body; broncoscopy

236
Q

Rhonchi

A

Suction

237
Q

Mild stridor

A

Cool mist, racemic epi

238
Q

Moderate stridor

A

Racemic epi

239
Q

Severe stridor

A

Intubate

240
Q

Pulsus paradoxus

A

BP rises and falls during inspiratory and expiratory efforts. Severe air trapping. Status asthmaticus

241
Q

Test when S3/S4 heart sounds are heard

A

Echocardiogram

242
Q

S3/S4 associations

A

S3 CHF, S4 cardiomegally

243
Q

(ECG) Best lead to assess left ventricle

A

Lead V5

244
Q

(ECG) Best lead to determine overall electrical condition

A

Lead II

245
Q

Tx sinus tach

A

Oxygen

246
Q

Tx sinus brady

A

Oxygen and atropine

247
Q

Tx PVCs

A

Oxygen if occasional, lidocaine if frequent

248
Q

Tx asystole

A

Confirm in two chest leads, CPR, epi, atropine

249
Q

Tx V-tach

A

Pulse - Lidocaine and cardioversion

251
Q

Tx V-fib

A

Defibrillate

252
Q

Tx 1st degree heart block

A

Atropine

253
Q

Tx 2nd degree heart block

A

Atropine, pacing

254
Q

Tx 3rd degree heart block

A

Pacemaker

255
Q

Reasons for cardiac electrical current deviation

A

Hypertrophy, infarction

256
Q

(ECG) Ischemia

A

Current lack of oxygen; Inverted T-wave (may also be caused by digitalis toxicity)

257
Q

(ECG) Injury

A

Cardiac tissue in a state of dying; S-T elevation

258
Q

(ECG) Infarction

A

Dead cardiac tissue; significant Q-wave

259
Q

The SVC should always be

A

Greater than the FVC. If FVC is greater, PT effort is poor (i.e. wanting disability)

260
Q

FVC loop - Round

A

Large fixed airway obstruction (such as vocal cord paralysis or cancer)

261
Q

FRC measurement

A

Nitrogen washout or plethsymograph

262
Q

Only obstructive Dz associated w/ poor DLco

A

Emphysema

263
Q

Pre-Post BD reversibility considered significant if

A

There is a 12%/200mL or greater increase in flows

264
Q

Selection of best test

A

Best FEV1 + FVC

265
Q

Calibration syringe - Results close together but far from correct

A

Inaccurate but precise

266
Q

ICP

A

5-10 mmHg; Tx suggested >20 mmHg; keep PT sedated

267
Q

PaCO2 range for PT w/ increased ICPs

A

25-30

268
Q

Drugs to Tx increased ICPs

A

Diamox, Osmitrol

269
Q

APGAR 7-10

A

Provide routine care

270
Q

APGAR 4-6

A

Support w/ O2, warmth, stimulation

271
Q

APGAR 0-3

A

Code

272
Q

Gestational age ranges

A

42 Postterm

273
Q

Venturi mask, bed covers may

A

Accidentally occlude entrainment port and increase FIO2

274
Q

Problem suspected w/ pulse-dose O2 delivery system

A

Switch to continuous mode

275
Q

Oxygen concentrator (molecular sieve) can produce up to

A

6 lpm

276
Q

CPAP problem w/ infants

A

If infant is crying, pressure is lost

277
Q

100% body humidity

A

44 mg/L

278
Q

Ultrasonic neb frequency

A

Can not be changed

279
Q

Back pressure does this to FIO2

A

Increases

280
Q

Common home vents

A

PLV 100, LP 6, LP 10, PB Companion, Intermed Bear

281
Q

Oral ET tube should be

A

20-24 lips

282
Q

Nasal ET tube should be

A

25-29 at nares

283
Q

PetCO2 during code

A

Will first read low, then rise w/ adequate ventilation

284
Q

Best equipment to continually measure flow

A

Fleisch pneumotachometer

285
Q

Helium dilution uses this type of analyzer

A

Wheatstone bridge

286
Q

Nitrogen washout equipment that measures nitrogen

A

Geissler tube ionizer

287
Q

Polarographic analyzer reads low FIO2

A

Change batteries

288
Q

Polarographic analyzer will not read

A

If batteries are good, replace electrolyte solution

289
Q

Galvanic fuel cell troubleshoot

A

Change cell (don’t change solution or battery, the cell IS the battery)

290
Q

BVM collapses easily

A

Change bag, otherwise replace air-inlet valve

291
Q

BVM difficult

A

Ensure patient valve is not stuck open, does PT have low lung compliance?

292
Q

Facilitate suction of left main stem bronchus

A

Coude tip catheter

293
Q

Suction catheter diameter should not exceed

A

1/2 diameter of ETT

294
Q

Difficult suction troubleshoot

A

Suction pressure range -> Increase cath size -> Increase suction time

295
Q

Change Cidex

A

Every 14 days

296
Q

Cidex is tuberculocidal in

A

20 minutes

297
Q

Post-Op IS goal

A

1/2 amount achieved pre-op

298
Q

Initiation of MV - Rate; Vt

A

Rate 8-12, Vt 8-12 mL/kg

299
Q

Dynamic compliance

A

Exhaled Vt/PIP-PEEP

300
Q

Static compliance

A

Exhaled Vt/Pplat-PEEP; 25-100 mL/cmH20 acceptable

301
Q

If PaO2 is low

A

Raise FIO2 5-10% until 60%, then add/raise PEEP by 5

302
Q

If PaO2 is high

A

Lower FIO2 until <60%, then lower PEEP in increments of 5

303
Q

Most important alarm in paralyzed PT

A

Low PEEP. If low PEEP alarm not available, then low volume or disconnect

304
Q

Best position for gas distribution during MV

A

Semi-Fowler’s

305
Q

If patient is in distress from suctioning

A

Decrease suction time

306
Q

Avoid PEP therapy during

A

Epistaxis, middle ear infections, sinus problems

307
Q

Low exhaled Vt w/ chest tube

A

Adjust Vt to maintain ABG values

308
Q

Excessive bubbling in suction control bottle

A

Too much suction pressure

309
Q

Excessive bubbling in water seal chamber

A

Clamp tube proximal PT, if bubbling stops, problem is inside the PT

310
Q

If glass bottle breaks

A

Submerge chest tube into water from any container

311
Q

Heliox 80/20 correction factor

A

1.8

312
Q

Heliox 70/30 correction factor

A

1.6

313
Q

Cardioversion must be done on

A

The R-wave of ECG. Ensure synchronization is on

314
Q

Bleeding during bronchoscopy

A

Instill epi, then apply pressure with bronchoscope

315
Q

AHI > 30

A

Severe sleep apnea. Next step is titration study

316
Q

Transport vent volumes fall

A

Check tank

CRT (4 decks)

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