Important values and stuff for 1st assessment Flashcards
1
Q
Special questions to ask for respiratory presentations
A
Cough
Sputum
Dyspnea (Shortness of breath)
Wheeze
Hemoptysis (coughing up blood)
Smoking history
Home oxygen
Chest pain
Falls
Previous physio intervention
2
Q
What is dyspnea
A
shortness of breath
3
Q
What is hemoptysis
A
coughing up blood
4
Q
What are the important vital signs?
A
Respiratory rate
Heart rate
Blood pressure
Temperature
Oxygen Saturation (SpO2)
Consciousness
5
Q
What is respiratory rate and what are the normal values
A
Number of breaths a person breathes per minute
Normal: 12-20 breaths/minute
6
Q
What is tachypnoea and bradypnoea
A
Tachypnoea: rapid breathing
Bradypnoea: slow breathing
7
Q
What is heart rate and what are normal values?
A
How many times the heart beats per minute
Normal: 60-100bpm
8
Q
What is tachycardia and bradycardia?
A
Tachycardia: fast heart rate (>100 bpm)
Bradycardia: slow heart rate (<60bpm)
9
Q
What is blood pressure and what are normal values?
A
indicates the pressure of blood moving through the arteries as the heart pumps blood throughout the body
Normal: 120/80 or 130/85
10
Q
What is hypertension
A
Increase in blood pressure which may mean your heart is working hard to deliver oxygenated blood to key organs
> 140/90
11
Q
What is hypotension?
A
decrease in blood pressure which may mean the pumping pressure of the heart is not sufficient to deliver key organs with oxygenated blood
<90/60
12
Q
What is temperature and what is a normal value?
A
Temperature measures how well the body can make and remove heat
Normal: 36.5-37.2
13
Q
What is Oxygen saturation and what are normal values?
A
Provides an indication of the amount of oxygen in a patient’s blood
Normal: 95-100%
14
Q
What does ACVPU check and what are the steps
A
Checks level of consciousness
Alert
Confusion
Voice
Pain
Unresponsive
15
Q
Goals of the vital signs
A
To be within ‘the flags’
White = normal
Yellow = patient condition deteriorating
Red = emergency scenario
16
Q
4 cardiorespiratory impairments
A
Oxygen (O2) movement
Carbon Dioxide (CO2) movement
Secretion clearance
Mobility
17
Q
Treatment for O2 movement impairment
A
Positioning, breathing exercises, walking
18
Q
Treatment for CO2 movement impairment
A
relaxation, breathing techniques
19
Q
Treatment for secretion clearance impairment
A
breathing exercises (ACBT), devices, manual percussions/vibrations, walking
20
Q
Treatment for mobility impairment
A
strength exercises, functional retraining and walking
21
Q
What do antibiotics do?
A
Help to fight infections
e.g. Penicillin, ceftriaxone
22
Q
What do anti-inflammatories/steroids do?
A
reduce the inflammatory response
e.g. hydrocortisone
23
Q
What do inotropes do?
A
Increases blood pressure either by enhancing contractility of the heart or causing widespread vasoconstriction
e.g. noradrenaline, dobutamine, adrenaline
24
Q
What do anti-arrhythmics do?
A
stabilises cardiac muscle to control abnormal rhythms
e.g. amiodarone, metoprolol
25
What do bronchodilators do?
relax the smooth muscles of the airways
e.g. ventolin, salbutamol, bricanyl
26
What do anti-emetics do?
reduce nausea and vomiting
e.g. ondansetron, maxalon
27
What do anti-hypertensives do?
reduce blood pressure through vasodilation
e.g. metoprolol, catopril
28
What do anti-coagulants do?
reduces the clotting levels of blood
e.g. heparin, warfarin, aspirin
29
What do analgesics do?
impacts the reception of pain signals
e.g. fentanyl, morphine, oxycodone, endone
30
What do sedatives do?
reduces the alertness of a patient
e.g. diazepan, midazolam
31
What do mucolytics do?
breaks down proteins in sputum, which reduces the viscosity of sputum and aids in its clearance
e.g. pulmozyme
32
What do diuretics do?
causes increases in urine production to reduce total body fluid load
e.g. lasix, frusemide
33
Main markers for blood count
haemoglobin - carries O2
WBC - infection marker
haematocrit
RBC
C reactive protein - infection marker
Neutrophils
34
markers of coagulation/clotting
platelets
partial thrombin time
internalised normalised ratio (INR)
35
Normal INR
0.8-1.2
36
What are the cardiac biomarkers
Troponin
Creatine kinase
Lactate
37
What are the electrolyte panel markers
potassium
sodium
calcium
chloride
38
Kidney markers
blood urea nitrogen
serum creatine
glucose testing
39
What is compliance
the ability of the lungs to stretch
40
What is V/Q ratio
ratio of ventilation to perfusion
41
What is ventilation
flow of air into and out of the alveoli
42
What is perfusion
flow of blood to alveolar capillaries
43
What is a shunt
blood but no air (reduced ventilation)
44
What is dead space
air but no blood (reduced perfusion)
dead = no blood
45
What is pleural effusion
accumulation of fluid in the pleural space
46
What is pneumothorax
accumulation of air in the pleural space
47
What nerve innervates the diaphragm
phrenic nerve
48
What is tidal volume and normal value
normal breathing - the amount of air that moves in or out of the lungs with each respiratory cycle
500ml
49
Normal values for vital capacity
4L
50
Normal values for Functional Residual Capacity
2.5L
50
What is residual volume and Normal values for Residual volume
Amount of air in lungs after maximal expiration
1L
51
Normal values for Total lung capacity
5L
52
What is Inspiratory Residual Volume and what are the Normal values
Maximum volume that can be inhaled after a normal inhalation
2L
53
What is Expiratory Residual Volume and what are the Normal values
Maximum volume that can be exhaled after a normal exhalation
1L
54
Restrictive respiratory disease
Can't get Oxygen In
Can't get it IN
55
Obstructive respiratory disease
Can't get CO2 Out
Can't get it OUT
56
Restrictive disorders impact ... measures
inspiratory
57
Obstructive disorders impact ... measures
expiratory
58
COPD
- Obstructive/restrictive
- Symptoms
- clinical features
obstructive
Symptoms
- Dysnpnoea
- Cough
- Sputum production
Clinical features
- barrel chest
- accessory muscle use
- decreased breath sounds on auscultation
- oxygen desaturation
- hyperinflation on chest radiograph
- reduced functional exercise capacity
59
Why does CO2 rise (not getting out)
Decreased neurological control of breathing
Increased airway resistance (narrowed airway)
Decreased lung compliance
Decreased chest wall compliance
60
Main causes of decreased PaO2
alveolar ventilation
ventilation/perfusion mismatch
diffusion impairment
61
What is the DRSABCE approach for Chest X Rays
D: Details
RIPE: Rotation, Inspiration, Projection, Exposure
S: Soft tissues and bones
A: Airway - trachea, carina, bronchi, hilar structures
B: Breathing - lungs and pleura
C: Cardiac - heart size and borders
D: Diaphragm - assessment and costophrenic angles
E: Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas
62
D in DRS ABCDE
Details
Patient details
Date/time
Previous imaging
63
R in DRS ABCDE
RIPE
Rotation: clavicles equidistant
Inspiration: is patient well inflated, look at number of ribs
Projection: AP or PA (usually PA)
Exposure: brightness/darkness of chest
64
S in DRS ABCDE
Soft tissues and bones
look at bones, fat, lung marking
65
A in DRS ABCDE
Airway
- inspect trachea: located centrally
- carina: point where is divides into bronchi
- hilar structures:
66
B in DRS ABCDE
Breathing
Looking for lung markings
divide lungs into upper, middle, lower zone
Look for borders of each lung to observe pneumothorax
increased darkness = too much air == collapsed lung
67
C in DRS ABCDE
Cardiac
heart should occupy no more than 50% of thoracic width
2/3 to left and 1/3 to right
68
Second D in DRS ABCDE
Diaphragm
Costophrenic angles
Flat diaphragm
69
What does a blunt costophrenic angle indicate
lung hyperinflation as a result of diaphragmatic flattening
70
What does oxygen saturation indicate
The O2 carrying capacity of blood
71
Normal range of PaO2 (ABGs)
80-100mmHg
72
When PaO2 and Sp/SaO2 are low (Hypoxemia), what happens?
Insufficient oxygen is transported and delivered to the tissues (hypoxia)
73
High PaO2 =
good delivery of O2 to the tissues
Hb takes up O2 well
74
Value for hypoxemia
PaO2 < 80mmHg
75
What is FiO2 and what are normal values with room air
the fraction of inspired O2 when we breathe in air (concentration of room air breathed in that is oxygen)
21% (0.21)
76
What is PF ratio and what are normal values
PaO2 / FiO2
Normal: >500mmHg
Measures respiratory reserve
77
If a patient has low O2 measures, what cardiorespiratory impairment would they have?
Oxygen movement impairment
78
If pH falls out of normal range, what compensates to ensure it returns to normal
Respiratory or metabolic (kidney) system
79
What is pH and Normal pH values
Acid base balance of the body
7.35-7.45
80
pH too low =
acidosis
81
pH too high =
alkalosis
82
Normal CO2 levels
35-45mmHg
83
High PaCO2 =
acidosis (>45)
Result of hypoventilation (slow breathing) - retaining too much CO2
Carbon dioxide movement impairment
84
Low PaCO2 =
alkalosis (<35)
Result of hyperventilation (fast breathing) - getting rid of too much CO2
85
Normal Bicarbonate levels
22-26 mEq/L
86
BE normal range
-2 to +2 mEq
87
BE < -2
Base deficit
Metabolic acidosis
88
BE > +2
Base excess
Metabolic alkalosis
89
Low Bicarbonate =
Acidic
90
High Bicarbonate =
Alkalinic
91
Acidic/Alkalinic pattern
Acidic (LHLL)
pH: Low
PaCO2: High
HCO3: Low
BE: Low
Alkalinic (HLHH)
pH: high
PaCO2: low
HCO3: high
BE: high
92
Type 1 lung failure
PaO2 is low < 60
PaCO2 is normal
93
Type 2 pump failure
PaO2 is low < 60
PaCO2 is high >45
94
Forced Expiratory Ratio
FEV1/FVC
FVC: amount of air that can be forcibly expired during a maximal expiration
FEV1: amount of air expired during the first second of that maximal expiration
95
FEV1/FVC ratio measured <70%
Obstruction
Taking long time to get air out
96
FVC predicted of normal <80%
Restriction
Can't take enough air in so less blown out
97
FEV1/FVC <0.70
What does FEV1 give you
Classification of airflow limitation severity
GOLD
98
What initiates contraction of the heart?
SA (sinoatrial) Node
Purkinje fibres
99
Electrical conductivity of the heart ensure that ___ contract first, allowing blood to flow into the ___, via the opening and closing of ___
atria
ventricles
valves
100
What do working heart valves prevent
leaking and backflow of blood
101
What is myocardium
muscular layer of the heart wall
Composed of cardiac muscle
102
Whereis the myocardium thicker
Ventricles
103
What is the fluid filled sac which covers the heart
pericardial sac
104
What is found between the two thin layers of pericardium
pericardial fluid
105
What is the visceral pericardium
inner layer that covers the heart
106
What is the parietal pericardium
attaches heart to the chest wall
107
Describe flow of blood in the heart
Right atrium receives deoxygenated blood from body (Vena Cava)
Right ventricle receives deoxygenated blood from right atrium and sends it to lungs via pulmonary artery
Left atrium receives oxygenated blood from lungs via pulmonary veins
Left ventricle receives oxygenated blood via left atrium and sends it to body via atrium
108
Cardiac function measures
Heart rate
Stroke volume
Cardiac output
Mean arterial pressure
Systemic vascular resistance
109
Stroke volume and normal value
volume of blood pumped out of the left ventricle during each systolic cardiac contraction
Normal: 50-100mls
110
What is cardiac output and normal volume
amount of blood pumped by the heart each minute and is the mechanism whereby blood flows around the body, blood flow to the brain and other vital organs
Is the product of HR x SV
Normal: 5-6L/min
111
What is mean arterial pressure and normal value
average arterial pressure throughout one cardiac cycle
Normal: 80-100mmHg
112
What is systemic vascular resistance
diameter of blood vessels and viscosity of blood
113
Increased viscosity of blood =
increased resistance
114
Smaller diameter of blood vessels =
increased resistance
115
What is myocarditis and how is it commonly caused
inflamed myocardium (heart muscle) caused by vital infection or autoimmune responses
116
What is pericarditis and how does it present
inflamed pericardium (lining of the heart)
can have heart attack presentation - chest pain due to rubbing of inflamed lining
117
What marker would be elevated in coronary artery disease
Troponin
118
How is coronary artery disease caused
inadequate blood supply to the heart due to blockage in the blood vessels which supply it
- caused from clot/embolism or atherosclerosis
119
what is atherosclerosis
build up of plaque inside blood vessels which reduces blood flow to heart
120
What is angina pectoris
discomfort above waist (chest, jaw, shoulder, back and arms) experienced when the heart muscle is deprived of adequate oxygen
Aggravated by exertion or emotional stress
121
Difference between stable and unstable angina
Stable angina relieved with rest and unstable angina not relieved with rest
122
What is acute myocardial infarction
Heart attack
caused by decreased or complete cessation of blood flow to a portion of the myocardium
Present with chest pain behind sternum (retrosternal) and may describe pressure of heaviness
123
What symptom would present in heart attacks for women but not men
males dont report nausea or headache as much as women
124
Types of infarcts
anatomical location of ventricle involved
degree of thickness
- transmural (full thickness)
- subendendocardial (part of myocardial wall)
125
How can you diagnose heart disease
Cardiac stress testing
- progressively harder on treadmill and monitoring BP, ECG, etc
Coronary angiography
- insert catheter up to heart and find main blockages in blood vessels
126
What is a percutaneous coronary intervention
procedure to unclog blocked coronary arteries and restore blood flow to ischemic areas
127
types of percutaneous coronary intervention and risk of re-stenosis
balloon angioplasty
- reinflate balloon which compresses plaque to outer perimeter of artery so blood can flow
- 30% re-stenosis
Coronary angioplasty with bare metal stent
- keeps diameter of artery open
- 15% re-stenosis
Coronary angioplasty with drug eluting stent
- keeps diameter of artery open and releases drug which stops clotting
- 10% re-stenosis
128
What is coronary artery bypass graft (CABG) and which grafts are commonly used
section of a peripheral blood vessel is grafted and relocated to the heart to bypass a blocked section of the coronary artery
Grafts
- Saphenous vein graft (SVG)
- Left internal mammary artery (LIMA)
129
Typical Sternal precautions
no lifting >4kg
No weighted activities at >90 degree shoulder flexion/abduction
No scapular retraction past neutral
avoid trunk flexion and rotation with supine to sit
130
What is heart failure with preserved ejection fraction (diastolic failure)
left ventricle loses its ability to relax normally (muscle has become stiff)
Heart can't fill with blood during the resting period between each beat
131
What is heart failure and what are the two types
The decline in the hearts ability to pump as much blood as the body needs
types
- Heart failure with reduced ejection fraction (systolic failure)
- Heart failure with preserved ejection fraction (diastolic failure)
131
What is heart failure with reduced ejection fraction (systolic failure)
left ventricle loses its ability to contract normally.
Heart can't pump with enough force to push enough blood into circulation
132
Right sided heart failure
Left sided heart failure
Congestive heart failure
RSHF: back ups in the area that collects 'used blood'
LSHF: failure to properly pump blood out to the body
CHF: fluid backs up into the lungs and tissues
133
Signs and symptoms of chronic heart failure
shortness of breath
fatigue/lethargy/reduced exercise tolerance
cough/wheeze
shortness of breath worsened when lying flat
paroxysmal nocturnal dyspnoea - shortness of breath at night which wakes them up
Fluid retention
Enlarged liver
134
O2 and CO2 movement impairment reasoning
Diaphragm impaired by anaesthetic
Not taking deep enough breaths to ventilate the whole lung
valves issues or heart failure: reduced efficiency to transport oxygen around the body
blockages: not able to transport oxygen around the body
135
Secretion clearance impairment reasoning
not taking deep enough breaths
reduced strength of cough and not taking deep breaths
136
mobility impairment reasoning
pain
bed rest
impacted by sternal precautions
137
FEV1/FVC <70% =
Obstructive
138
FVC predicted <80%
Restrictive
139
how do you measure P/F ratio
Pa/O2 / FiO2
140
ARDS (Acute Respiratory Stress Disorder) Severity
Mild: 200-300 PF ratio
Moderate: 100-200 PF ratio
Severe: <100 PF ratio
141
What does a high pitched wheeze indicate?
near total obstruction
142
What does a fixed monophonic wheeze indicate?
single obstructed airway
143
What does a polyphonic wheeze (multiple) indicate?
widespread narrowing
144
What does a localised wheeze indicate?
sputum retention
145
How much sputum do healthy adults produce?
100ml
146
What does mucoid sputum indicate
opalescent or white sputum
chronic bronchitis without infection, asthma
147
What does mucopurulent sputum indicate
slightly discoloured but no frank pus
bronchiectasis, cystic fibrosis, pneumonia
148
What does purulent sputum indicate?
thick viscous: can be yellow, dark green/brown, rusty, redcurrant jelly
haemophilius, pseudomonas, pneumococcus, mycoplasma, klebsiella
149
What does frothy sputum indicate
pink or white
pulmonary oedema
150
What does haemoptysis sputum indicate
ranging from blood specks to frank blood, old blood (dark brown)
infection (TB, bronchiectasis), infarction, carcinoma, vasculitis, trauma, coagulation disorders, cardiac disease
151
what does black sputum indicate
black specks in mucoid secretions
smoke inhalation (fires, tobacco, heroin), coal dust
