gary test 1 Flashcards
1
Q
maximum inspiratory pressure normal/critical value
A
- 100 - -30
- 20 - 0 (critical)
2
Q
maximum expiratory pressure normal/critical value
A
100
less than 40
3
Q
vc - normal/critical
A
65-75
less than 10-15
4
Q
vt normal/critical
A
5-8
less than 5
5
Q
fev1 normal/critical
A
50-60
less than 10
6
Q
pefr normal/critical
A
150-600
75-100
7
Q
when do you stop MIP test
A
distress, dysrhythmia, hemodynamic instability
8
Q
what is mip
A
lowest pressure generated during a forceful inspiratory effort against an occluded airway
9
Q
when is mip values most accurate
A
when it is measured from residual volume
10
Q
what are the 3 electrodes
A
positive, negative, ground
11
Q
what is the name of the recording equipment for ecgs
A
oscilloscope
12
Q
what produces an electrical current of the heart muscles
A
contraction of heart muscles
13
Q
how does the current travel through the heart
A
in a wave from base to apex
14
Q
what is the natural direction of the wave of the current called
A
a vector
15
Q
where does the vector travel to and from
A
atria to ventricle
16
Q
what is the key electrode
A
positive electrode
17
Q
if the current is heading towards the positive electrode what type of deflection is seen on the oscilloscope
A
upward deflection
18
Q
if the current is heading away from the positive electrode what type of deflection is seen on the oscilloscope
A
downward deflection
19
Q
what are leads
A
electrodes arranged in patterns
20
Q
why are there more than one pattern
A
bc different patterns give different views of the hearts activities
21
Q
what do different views add to diagnostically
A
the accuracy of diagnosing the heart disease
22
Q
what are the 3 lead categories
A
limb leads, augmented leads, precordial leads
23
Q
where do the limb leads go
A
lead 1 - right arm negative, left arm positive
lead 2 - right arm negative, left leg positive
lead 3 - left arm negative, left leg positive
24
Q
what do all the limb leads to
A
einthoven triangle
25
how are augmented leads created
by making a single limb positive and all other limbs negative
26
why are augmented leads augmented
bc the weak electrical signal must be amplified
27
what do the augmented leads represent
vectors / views of the heart
28
where are AVR leads located
right arm positive
| left arm/left leg negative
29
where are AVL leads located
right arm/left leg negative
| left arm postiive
30
where are AVF leads located
right/left arm negative
| left leg postive
31
how many views do precordial or chest leads have
6 extra views of the hearts electrical activity
32
do chest leads improve diagnostic accuracy
yes
33
what type of disease does it help pinpoint
myocardial infarction
34
what type of view of the heart do limb leads offer
vertical view
35
what type of view of the heart do chest leads offer
horizontal view
36
where do V1 leads go
4th intercostal space, on the right side of sternum
37
where do V2 leads go
4th intercostal space, left side of sternum
38
where is V4 lead go
5th intercostal space in midclavicular line
39
where does V3 lead go
in between v2/v4
40
where does v6 lead go
5th intercostal space in the midaxillary line
41
where does v5 lead go
in between v4/v6
42
how do you avoid artifacts
careful patient preparation
43
what if there is a 60hz electrical artifact
change electrical outlets
44
what causes artifacts
friction of electrode wires with sheets and bed rails, loose connections, muscle movement
45
what color is a ground lead
green
46
what color is a negative lead
white
47
what color is a positive lead
red or black
48
what do electrical cells in the heart do
initiate and conduct impulses
49
what do mechanical cells in the heart do
contract in response to electrical stimulation and provide pumping action
50
what is the electrical impulse from
result of the cells chemically changing
51
where does the chemical change of cells come from
sodium potassium pump at cellular level
52
what makes the heart automatic
cellular ability to repeat impulse without an external signal
53
what is the conducting system
conducting/electrical cells that are arranged in a specific path that control the flow of electrical implulses from the atria to the ventricles in a coordinated fashion
54
what does the picture look like of resting or polarized state
the negative cells are in the cardiac cell with lots of dots in the middle, and positive cells are outside of wall
55
what does depolarization picture look like
positive cells are inside of wall, no dots, negative cells are outside of wall
56
what is the dominant controller or pacemaker of the conduction system
sa node
57
what does the pacemaker do
rhythmically repeats electrical impulses that travel down the conducting system
58
what is the polarization state
ready state - sodium is outside cell potassium is inside cell
59
what is the discharge state
depolarization state - sodium and potassium are uniting and switching spots
60
what is Repolarization state
recovery state - potassium is outside of cell, and sodium is inside of cell
61
what is the inherent rate of the sa node
60-100
62
what is the inherent rate of the av junction
40-60
63
what is the inherent rate of purkinje fibers
20-40
64
what happens if the dominant pacemaker fails
the next one in line will take over av junction then purkinje fibers, and they will pace the heart at their inherent rate
65
are all heart cells subject to the irritability mechanism
yes
66
what is the irritability mechanism
clump of heart cells that can take over and become the pacemaker
67
what does the parasympathetic system take influence over and decrease
decreases irritability, decreases heart rate, decreases force of contraction
68
which system is the heart influenced by
autonomic nervous system
69
what must happen before contraction of the heart
electrical stimulation
70
can electrical activity occur w/o mechanical contraction
yes
71
how do you study mechanical contraction
pulse, blood pressure, cardiac output
72
how do you study electrical activity
ECG
73
what does the sympathetic system do to the heart
directly influences every heart cell, the av node, sa node, and it increases irritability, increases rate, and increases force of contraction
74
what does NIV encompasses both?
ventilation and cpap
75
what is the pneumobelt
pts in wheelchairs like it and it pushes up and down on abdomen forcing exhalation and inhalation is passive
76
what are the goal of ppv
```
avoid intubation
improve mortality
decreases VAP
relieve symptoms
enhance gas exchange
improves patient/ventilator synchroniztion
patient comfort
decrease length of stay on vent/hospitilaztion
```
77
what is the primary indication for niv
hypercapnic respiratory failure due to cold
| its the first line therapy for acute exacerbation
78
asthma and niv
some evidence of positive results use remains controversial
79
acute cardiogenic pulmonary edema and niv
cPap == first line of defense
80
if NIV is not working w/in 1-2 hours what should u do
intubate
81
in community acquired pneumonia how does niv help
only helps copd patients who get it
82
should u use NIV for weaning
only for cold/chf patients, all other patients who used NIV instead of reintubation got worse
83
when can u use NIV for DNI patients
only if it makes them more comfortable or managing reversible disorder
84
how does NIV help for nocturnal hypoventilaion
resting muscles, lowering co2, and improved compliance, frc, and deadspace
85
is niv indicated for patients with restrictive thoracic diseases like kypho or polio
yes
86
when is NIV used for copd patients at home
severe patients with at least one of the following: co2 greater than 55, or co2 less than 55 with nocturnal desating, and 2 hospital admissions for vent failure
87
what is the first line of therapy for nocturnal hypoventilation
nasal cpap
88
what types of diseases are associated with nocturnal hypoventilation
sleep apnea and lung parenchymal diseases
89
when is nppv recommend for nocturnal hypoventilation
when cpap doesn't work
90
when does exclusion of NPPV occur
when ventilatory assistance has been established
91
when is selection of NPPV happen
when signs and symptoms of resp, distress occur
92
what are most common types of patient interfaces
nasal mask, full face mask, mouth piece
93
what are the least common types of patient interfaces
total face mask, nasal pillows, helmet
94
what is the interface of choice for patients in acute resp failure
full face mask
95
are they designed to work with leaks
yes small leaks that they compensate for
96
what are typical modes of NPPV
cpap, psv, p-a/c
97
what do they do less of than icu vents
generate lower rates, pressures, and flows
98
what happens with critical care vents used as a bipap
they can't compensate for leaks, so u should use a full face mask to minimize leaks
99
what aren't vc modes recommended
lead to leaks and hypoventilation
100
what are major complications of NPPV
aspiration, hypotenstion, pneumothorax
101
causes of nppv failure
```
mask related problems
flow related problems
large air leaks
patient/vent asynchrony
lack of improvement of ABGS
```
102
what is success of NPPV closely linked with
RT to take time to give proper mask fitting, application, adjustment of settings, and patient education
