Kettering NPS Test: The Rematch Flashcards
What is the normal red blood cell count?
What is the normal hemoglobin count?
What is the normal hematocrit count?
4.1-5.7
15 +/-3
47 +/-10
What is the normal white blood cell count?
6,800 - 14,300 mm3
Can be as high as 30,000 in first few days of life
If pre-ductal PaO2 is more than 15 torr greater than post ductal PaO2, this indicates the presence of a (Right to left or left to right) shunt.
Right to left
An oxygen challenge (hyperoxia) test differentiates between ___ or ___ / ___.
Paranchymal lung disease or PPHN / congenital heart defect.
What are the indications for chest transillumination?
Asymetrical chest movement with resp distress
Decreased lung sounds
Decreased heart sounds
Trachea or mediastinum shifting away.
Optimum placement of an uncuffed ET tube is with the tip between __ and __.
Cuffed ET tubes: __ above carina.
T2 and T4. 2 cm (1 inch) above carina.
When the feeding tube is coiled up in the mediastinum, suspect ___.
Esophageal Atresia.
OI (Oxygen Index) greater than ___ is associated with high mortality rate, consider ECMO.
40
A P/F ratio is __ divided by __.
Less than 300: ___
Less than 200: ___
PaO2/FiO2
ALI
ARDS
Capillary blood samples are used to measure __ and __, but not __.
Measures pH and PCO2
Not PO2.
Normal ABG's for a newborn: pH: \_\_ PCO2: \_\_ PO2: \_\_ HCO3: \_\_ BE: \_\_
ph: 7.25-7.35 PCO2: 40-50 PO2: 50-70 HCO3: 17-23 BE: -10 - +2
Chest movement is seen for (central or obstructive) apnea. Chest movement is NOT seen for (central or obstructive) apnea.
+ chest movement in obstructive apnea.
- chest movement in central apnea.
What does AHI stand for? What does it mean?
A moderate AHI is __ to __.
Apnea-Hypopnea Index. It is an index of severity that combines apneas with hypopneas.
Moderate AHI: 6-10
An increased CaO2-CvO2 indicates (increased or decreased) Qt or (increased or decreased) O2 extraction.
A decreased CaO2-CvO2 indicates (increased or decreased) Qt or (increased or decreased) O2 extraction.
Increased values = decreased Qt or increased O2 extraction.
Decreased values = increased Qt or decreased O2 extraction.
What is normal cardiac index?
2.5-5
CvO2 values will (increase or decrease) when cardiac output decreases.
Decrease
On an ET tube, if high cuff pressures are needed to seal the airway, you should change to a (smaller or larger) tube.
Change to a larger tube.
On an ET tube if ventilating pressures are greater than 30 without an air leak, change to a (smaller or larger) tube.
Change to a smaller tube.
What is the suction pressure for neonates?
What is the suction pressure for children?
60-80 for neonates
80-100 for children
A patient with unilateral pneumonia may have a V/Q mismatch when lying on the ___ side because blood flow is affected by gravity.
Affected
What airway clearance device should you use on a cystic fibrosis patient? (Besides the oscillating vest)
PEP device.
Use this airway clearance device for patients with neurologic problems or muscular weakness.
Cough Assist Device (In-Exsufflator)
Use this airway clearance device for patients with cerebral atrophy and poor cognitive skills who cannot use PEP or flutter valve.
Intrapulmonary Percussive Ventilation (IPV)
How much humidity?
30-34
What does a whistling sound in the bubble humidifier mean?
Obstruction in the tubing or cannula
When you place a Passy-Muir device on a patient, make sure the cuff is ___. Consider changing to a ____ tube.
Deflated.
Fenestrated
The skin around a transcutaneous electrode should be heated to ___.
43-44 degrees centigrade.
How is calibration for a transcutaneous monitor done?
Done on room air and with a zeroing solution.
After giving surfactant, you need to reduce ___ and ___. Also, reduce the ___ and ___ if indicated.
PIP and PEEP.
Pressure limit and rate.
While giving NO therapy, monitor ___ levels by ___.
Methemoglobin levels, co-oximetry
What drug is given to treat methmoglobinemia?
Methylene Blue. (Given IV)
The INOvent delivery system blends ___ into inspired air to maintain ___ and ___.
Nitric Oxide (NO) FiO2 and NO
How often do you calibrate the INOvent? (Low range and high range calibrations)
Low range: every 24 hours
High range: once per month
When using the INOvent with a HFOV, install a ___ between the ___ and the ___.
One-way valve injector module and humidifier
Hypoxia indications for ECMO:
___ hours of hypoxia
Oxygenation index ___.
With FiO2 100%, PaO2 of ___ on ventilation with PIP ___ or Paw ___.
4 hours
Greater than 40
50 or less, PIP 35, or Paw 20 or higher
Acidosis indications for ECMO:
pH less than ___ despite treatment with ___ and ___.
Also, ___.
7.20 despite bicarb and hyperventilation.
Also, rising lactic acid levels.
Name four pathologies that may indicate ECMO treatment is necessary.
Barotrauma
CDH
Cardiac Dysfunction
Severe PPHN
A water seal suction drainage system (chest tube) has three compartments. The first one is known as the ___ compartment. The second one is the ___. The third one is the ___.
- Collection compartment.
- Water seal compartment.
- Suction control compartment.
Which chest tube compartment bubbles continuously?
Suction control compartment
Which chest tube compartment bubbles intermittently?
Water seal bottle
If continuous bubbling is noted in the ___ compartment of a chest drainage system, this indicates ___ and it must be reported immediately.
Water seal
Air leak in system or patient.
You’re doing a bronchoscopy for therapeutic reasons. Use a (rigid or flexible) bronchoscope.
Rigid
You’re doing a bronchoscopy for diagnostic reasons. Use a (rigid or flexible) bronchoscope.
Flexible
What is the initial HFJV rate?
7 Hz with background IMV of 2
To increase ventilation on HFJV, what should you do? (Two things)
Increase drive pressure to increase Tv
or
Increase I time to increase Tv
To increase Pmean on the HFJV, what should you do?
Increase PEEP
or
Increase drive pressure to increase Tv
What is the initial Tv for HFJV?
90% of CV peak pressure.
If the PIP is going up, look at the ___. If it is still the same then the ___ is increasing. If not, then ___ is decreasing.
Pplat.
Raw
Compliance
How do you calculate RAW?
PIP - Pplat
How do you calculate Corrected Tidal Volume?
Set Tv - Compressible Volume
How do you calculate compressible volume?
(PIP - PEEP) x tubing compliance factor
If a patient is 26 weeks gestation, keep ___ below 26.
PIP
For full-term, healthy lungs, keep PIP below ___.
For sick lungs, premature, or RDS, PIP should be ___.
Low 20’s.
High 20’s. Use gestational age.
At high altitudes, you should ___ the oxygen analyzer.
Recalibrate
How often should you calibrate a capnograph?
Every 8 hours.
Low PetCO2 readings following intubation indicate the tube is in the ___.
Espohagus.
The accuracy of SpO2 readings are affected by light transmission and ___.
Perfusion
To calculate the amount of gas flow while giving heliox, multiply the observed O2 flow by the heliox factor.
What is the Heliox factor for 80% He & 20% O2?
What is the Heliox factor for 70% He & 30% O2?
What is the Heliox factor for 60%He & 40%O2?
- 8
- 6
- 4
On the HFJV, what does it mean if the servo pressure is going down?
Either less compliance or more resistance.
On the HFJV, what does it mean if the servo pressure is going up?
Either more compliance or less resistance.
What is the calculation for Oxygen Index?
FiO2 x Mean Airway Press / PaO2
