Important Information Flashcards
What type of medications are particularly useful in COPD patients?
Steroids
ABG PaO2 value minimum for COPD pt
60
Why BiPAP for COPD patients
You want to prefer BiPAP if possible because you do NOT want to put them on the vent. **They are very hard to get off the vent
When dx sleep apnea, which test do you want to start out with, and which test is used to definitively dx OSA?
Start with oximetry testing, if abnormal, polysomnogram is used to confirm the diagnosis.
O2 ventilation with a TBI
Start with 100% FiO2 via non-breather aiming for SpO2 of >95%
What is Mannitol typically used for?
For TBI
Specifically via IV if the patient is posturing
When should you initiate O2 therapy
When the adult PaO2 is <60/90% sats or <50 in infants
CPAP should be initiated when severe shunting is involved, how do you know when severe shunting is occuring?
P/F ratio <200 or cannot obtain adequate O2 on 50% FiO2
**PaO2<50 on >50% FiO2
epiglottitis is caused by what type of infection? What about Croup?
epiglottitis is caused by bacterial, croup is viral
Thumb sign
indicates epiglottitis on lateral chest x ray
steeple sign
indicates croup
unilateral wheezing
FBA
pulsus paradoxus is defined by what
BP change of 10mmHg or greater during inhalation. Should increase on exhalation and decrease during inhalation
is croup subglottic or supraglottic
subglotic
A kid with copious secretions probably has what?
bronchiolitis
BNP evaluates what?
CHF. **Rule out CHF is <100
Troponin levels
0-0.2
CK is elevated when?
When there is an MI or damage to the heart muscles
% of predicted values from PFTs that are used to categorize severity
mild-70-79
moderate- 50-69
severe- <49
Normal is 80 to 120% of predicted
Memiscus sign
Indicates pleural effusion on CXR
Imaging test for cancer
PET
Imaging test for P.E.
CT
Normal CO levels
<1.5%,
Normal MetHg levels
<1.5%
Severity of sleep apnea
Measured via AHI index or RDI (respiratory disturbance index)
Mild 5-14/hour
moderate 15-30/hour
severe >30
Normal apnea-hypopnea index is 1-4
Pulse, RR, and BP for infants
90-170
RR 35-45
BP 84-52 mmHg
Ejection fraction range
65-75%
Cardiac Index value
2.5-4
CO
Normal is 4-8Lpm
CVP/PAWP values
CVP 2-6mmHg
PAWP 6-12 mmHg
How to approximate the normal level of deadspace in a person
Should assume a deadspace value equal to 1mL per pound of IBW
When should you pull back or rotate the catheter in the heart?
When a dampened waveform appears
How to calculate TLC or RV
TLC = FRC + IC
RV = FRC - ERV
Lumbar puncture is a diagnostic test for which dz process?
GB syndrome
It will show elevated protein with LOW WBC
Which studies can be done for Guillane Barre
electromyography (EMG) and nerve conduction studies (NCS)
**Dtudies will show slowing and/or blockage of the nerve conduction
A positive tensilon test tells you what?
Myasthenia Gravis
Explain what outcome of the tensilon test suggests MG
Dramatic improvement in muscle strength within 1 minute of being administered
Lidocaine concentrations and where they go
APGAR scale assesses what 5 things
Appearance (s/s hypoxemia) Pulse, Grimace, Activity, and RR
What APGAR score indicates the need for resuscitation measures?
0-3
4-6 requires supportive measures
7-10 is normal
Why do babies start grunting?
Sign of distress, they are trying to generate their own PEEP
When you are treating someone with INO therapy, what are you worried about?
Diffuse crackles on auscultation indicates what dz process?
ARDS
What are the two main tests used for sleep disorders?
Over-night oximetry or a definitive polysomnography
Which test is used to help distinguish if a person has obstructive vs central sleep apnea?
Polysymnography
**If loss of airflow of >80% while there is NO RESP EFFORT proves central apnea
What does a positive polysymnography test look like if the test is positive for OSA vs CSA
If the >80% drop in air flow occurs while there is still respiratory effort
Dornase Alfa is the drug choice for what?
Cystic Fibrosis
**Works by breaking links in the DNA of the mucous
What does TOBI treat?
Its used to treat pseudomonas aeruginosa
TOBI and Pulmozyme (dornase Alfa) are being using together on a pt. What do you think is wrong with this pt?
CF
the pulmozyme is used to treat the secretions while the TOBI is used to treat psuedo aeru. which is a common infection found in patients with Cystic Fibrosis
If CVP and PAP is high…
Lung issue
Increased VCP indicates
Cor Pulmonale
If PAWP and PAP are increased indicates
Lt sided HF
bilateral fluffy infiltrates on CXR
think CHF
Lt HF is used interchangeably with congestive HF
When the balloon is inflated in a PAC, what is being measured
it is taking a PAWP measurement, which is the preload of your left ventricle
–Your BP measures the after load of the left ventricle
The proximal port of the PAC measures what?
the CVP, which is your preload of the right ventricle
The distal port will measure PAWP when inflated, but when it is deflated, what is it measuring?
your PAP, which is your afterload of the right ventricle
PAP value
20-30mmHg/6-15mmHg
MAP value for your PAP
10-20 mmHg
What is the significance of an elevated PAWP over 18?
(elevated is defined as being >12)
An elevated PAWP indicated that there is fluid overload, but when it is >18, its fluid overload in the lungs due to LEFT HF**
Three main s/s of COPD
Dyspnea, chronic cough/sputum production, and exposure to risk factors
ICP
10-15, but requires intervention when >20
what changes in pip vs plat show a compliance/airway resistance problem?
Plateau will not change, but your PiP will increase over time if it is an AIRWAY RESISTANCE PROBLEM
Moderate COPD FEV1
50-79%
Severe COPD FEV1
30-49%
very severe COPD FEV1
<30%
What drugs to treat severe COPD
Fluticasone (inhhaled steroids) and salmeterol (LABA)
Drugs to treat moderate COPD
LABA and LAMA (tiotropium)
