Jenny Flashcards
1
Q
respiratory rate
A
12-16
2
Q
spo2
A
94-98
3
Q
temp
A
35.7-38
4
Q
HR
A
60-100
5
Q
BP
A
(S=95-140, D=60-90)
6
Q
Airways
A
- Air is black, tissue or fluid is white
Look for trachea - The trachea is normally located centrally or deviating very slightly to the right
True trachial deviation - Pushing of the trachea: large pleural effusion or tension pneumothorax.
- Pulling of the trachea: consolidation with associated lobar collapse.
Apparent tracheal deviation - Rotation of the patient can give the appearance of apparent tracheal deviation, inspect the clavicles to rule out the presence of rotation
7
Q
bones
A
- Scapula
- Clavicle
- Vertebra
- Ribs
Pathologies - Fractures #
- Dislocations
- Rib crowding
- Previous surgery
○ Plates
○ Pins
○ Cages
8
Q
Cardiac
A
- right- 1/3rd
- left- 2/3rds
sail sign cardiac - wedge of collapsed tissue behind the heart boarder
- left lower lung collapse
- appears like a boat sail
9
Q
Diaphragm
A
- right hemidiaphragm is higher than the left due to the liver
- stomach underlies left hemidiaphragm
- The diaphragm should be indistinguishable from the underlying liver
- if free gas is present (bowel perforation) air accumulates under diaphragm causing it to lift and become visibly separate from the liver
10
Q
Expansion
A
- To assess the degree of inspiration it is conventional to count ribs down to the diaphragm. The diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clavicular line. Less is a sign of incomplete inspiration.
- Less than 5 ribs indicates incomplete inspiration
- More than 7 ribs suggests lung hyper-expansion
11
Q
Fields & Fissures
A
- The left lung has two lobes and the right has three
- Fine grey lines that extend throughout the lung fields to within 2cm of the lung edge
o Equal density within the left and right lung fields
o Looking for areas that appear whiter (dense tissue or fluid) OR darker (air) than you would expect
12
Q
horizontal fissure
A
- Fluid in horiz fissure and associated pleural effusion.
- Opacity below the horiz fissure so it is clearly defined suggesting infection in middle lobe.
- Horiz fissure has moved from where you would expect it to be suggesting collapse of upper lobe.
13
Q
Gadgets
A
- Pacemaker
- ECG lead
- Tracheostomy
- Chest Drain
- Stomach tube Nasogastric
- Sternal wires - Holds sternum back together
- ETT endotracheal tube
- Rods
14
Q
Hilar or hidden areas
A
- increased density around the hilar
- bats wing pattern
- pulmonary odema/ fluid overload/ heart failiure & increased blood flow to the area
- The left hilum is often positioned slightly higher than the right, but there is a wide degree of variability between individuals.
- The hilar are usually the same size, so asymmetry should raise suspicion of pathology.
- The hilar point is also a very important landmark; anatomically it is where the descending pulmonary artery intersects the superior pulmonary vein. When this is lost, consider the possibility of a lesion here (e.g. lung tumour or enlarged lymph nodes).
15
Q
Causes of hilar enlargement or abnormal position
A
- Bilateral symmetrical enlargement is typically associated with sarcoidosis.
- Unilateral/asymmetrical enlargement may be due to underlying malignancy.
- inspect for evidence of the hilar being pushed (e.g. by an enlarging soft tissue mass)
- or pulled (e.g. lobar collapse).
16
Q
Atelectasis
A
- Collapse of the small airways – lower lobe collapse
- Alveoli collapse due to lack of deep breathing
- Mucus plug. A mucus plug is a buildup of sputum or phlegm in your airways. It commonly occurs during and after surgery because you can’t cough.
- reduced airway expansion & sputum retention is typical after abdominal surgery and use of general anesthetic
Assessment - increased respiratory rate & reduced oxygen saturations hypoxia
- hear fine crackles over the affected pulmonary tissue
Appearance - uniform white appearance
- can be localised to one lobe or whole lung
- rib crowding
- evidence of reduced expansion
- movements of structures towards the area that is more white
17
Q
Auscultation
A
- Normal turbulence of air flowing in and out of the lungs produces ‘breath sounds’.
- Louder on inspiration and faded/minimal on expiration
- Inspiratory sounds heard for longer than expiratory
- Over the trachea – bronchial
- Over the lung fields – soft and muffled (described as vesicular), becoming quieter as you move to the base of the lungs.
**Fine crackles – atelectasis
Increased vocal resonance.
**
18
Q
ACBT
A
- Breathing control 20-30 seconds
- Huffing followed by cough if needed (FET)
- Breathing control
- 3-4 deep breaths (TEE)
- Breathing control
- 3-4 deep breaths (TEE)
19
Q
breathing control
A
Tidal breathing
- Relaxation of upper chest
1. Diaphragmatic breathing
One hand on stomach and one hand on chest, breathe in through your nose.
You’ll feel your stomach expand against your hand and your chest should barely move
Breath out through your mouth and you’ll feel your stomach sink back down.
Use of proprioceptive facilitation can be helpful. (push into my hand)
20
Q
- Forced Expiratory Technique (Fet)
A
- Forcefully expelling air through an open throat and
mouth - “fogging up a mirror ‘
- Also known as a “huff’
- Helps move sputum from small to larger airways
- Don’t do too many — can cause bronchospasm
- May initiate a cough
- Can be challenging with surgical pain — + supported
21
Q
huff
A
Medium volume huff
- moves from more peripheral airways
- normal breath in and long huff out
High volume huff
- moves from more central airways
- deep breath, short sharp huff out
22
Q
- Thoracic expansion
A
- Encouraging lateral chest expansion — hands on for proprioceptive feedback
- Can add a 3’s hold and a ‘sniff’
- Increases collateral ventilation
- Monitor - patients can become lightheaded, 3-5 +/-
23
Q
3 sec hold
A
shown to decrease collapsed lung tissue and may be good for those with lung pathology as air will first fill in the unobstructed area and the hold may give time for ventilation of collateral pathways.
- Air will first fill in the unobstructed area of least resistance and have incomplete equilibrium.
- A insp hold, gives time for ventilation of collateral pathways allows and recreates equilibrium by providing additional routes for air to reach alveoli
