Key Concepts Flashcards
0
Q
Moderate stridor
A
Treat with racemic
1
Q
Mild strider
A
Treat with cool mist (hydration) or racemic
2
Q
Severe/marked stridor
A
Intubate pt; tracheostomy; or send to surgery to establish a tracheostomy
3
Q
Foreign body suspected
A
Perform bronchoscopy
4
Q
Friction rub (pleural friction rub/grating sound)
A
Treat with steroids for inflammation and antibiotics for infection
Seen in TB, pulmonary infarction, and pleurisy
5
Q
Pulsus paradoxus
A
Associated with significant air trapping such as in severe asthma or status asthmaticus
6
Q
Minimum spontaneous Vt
A
5 mL/kg
7
Q
If Vt < 5 mL/kg
A
Need some ventilator support (if on vent, pt not eligible for weaning)
8
Q
If Vt < 3 mL/kg
A
EMERGENCY
Need full ventilatory support
9
Q
Minimum Vital Capacity
A
10 mL/kg or will need vent assistance
10
Q
Maximum expiratory pressure (MEP)
A
At least 40 cmH2O
Relates to ability to clear secretions
11
Q
Tracheal deviation towards the problem
A
Pulmonary fibrosis
Atelectasis
Lobectomy
12
Q
Tracheal deviation away from the problem
A
Tension pneumothorax
Hemothorax
Pleural effusion (very large)
13
Q
Normal heart sounds
A
S1 or S2
14
Q
S3 and S4 heart sounds means?
A
Abnormal and indicate cardiac dysfunction
Order echocardiogram!
15
Q
S3 is associated with what illness?
A
CHF
16
Q
S4 is associated with what illness?
A
Cardiomegaly
17
Q
Normal urine output
A
40 mL/hour
18
Q
In a pt’s history, objective info are considered…
A
Signs of illness
19
Q
In pt’s history, subjective info indicates…
A
Symptoms (pt must be able to communicate)
20
Q
Smoking pack years equation
A
(# of years) x (avg number of packs per day smoked)
21
Q
Orthopnea
A
Inability to sleep flat - requires one or more pillows/sleeps in a chair
Related to CHF or fluid problems
22
Q
If pt feels angry or combative, what’s the problem?
A
Electrolyte imbalance
23
Q
If pt feels anxious or panic, what’s the problem?
A
Hypoxemia, pneumothorax, severe asthma
24
If pt feels euphoria, what's the problem?
Ingestional error (drug overdose)
25
If pt feels depressed, what's the problem?
Pt recently informed of disease
26
What is the SA node?
Pacemaker of the heart
27
Best ECG lead to determine left ventricle
Lead V5
28
Best ECG lead to determine overall electrical condition of the heart
Lead II
29
How fast is the heart beating in a flutter?
Greater than 200 bpm
30
What does fibrillation mean in ECG?
Very fast
Can't count heart rate
31
Heart rate estimation from ECG tracing
Pick consistent wave form
Count how many large boxes from one wave to the next wave (ex: first R wave to the next R wave)
Equation: 300/(#of large boxes)
32
Memorize alternate rate estimation!!!
300-150-100-75-60-50
33
ECG rhythms:
Sinus rhythm
All bumps are there, especially "p" wave
34
ECG rhythms:
How do you treat sinus tachycardia?
Treat with oxygen
35
ECG rhythms:
How do you treat sinus bradycardia?
Stimulate heart with atropine
36
ECG rhythms:
What do you do with occasional premature ventricular contraction (PVC)?
Treat with oxygen
37
ECG rhythms:
What do you do with frequent premature ventricular contraction (PVC)?
Treat with Lidocaine
38
ECG rhythms:
Steps to treat asystole
1. Confirm in two chest leads
2. Treat with chest compressions!!!!!
3. Epinephrine
4. Atropine
39
Do you shock asystole?
NO!!
40
ECG rhythms:
How do you treat ventricular fibrillation (v-fib)?
Treat with defibrillation
41
ECG rhythms:
How do you treat ventricular tachycardia (v-tach)?
Treat with defibrillation if no pulse
42
Which ECG rhythms are deadly and constitutes an emergency?
V-tach and V-fib
43
Heart blocks:
1st degree
Distance btwn beginning of "p" wave to beginning of "QRS" complex (p to r interval) is > 20 sec (five small boxes/one large box)
May treat with atropine - not extremely dangerous
Monitor pt
44
What drug do you use to treat bradycardia?
Atropine
45
Heart blocks:
2nd degree
"P" wave present, but occasionally miss corresponding QRS complex (missing heart beat)
May treat with atropine or pacing
Hook up to pacemaker but don't turn on
46
Heart blocks:
3rd degree
No obvious coordination btwn "p" wave and QRS interval. Unpredictable from one moment to the next and can't exactly identify waves
Deadly!
Turn on pacemaker
47
How does electricity normally flow through the heart?
Flows down and to the left
48
What two ways can an axis deviate from normal?
Hypertrophy
Infarction
49
Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.
Toward or Away?
Toward
50
Infarction will cause an axis to deviate ___ from the infarct tissue.
Toward or Away?
Away
51
State the 3 MI
Myocardial ischemia
Myocardial infarction
Myocardial injury
52
Myocardial ischemia
Causes pain
Current lack of O2 to cardiac muscle
Cause "flipped T-wave"
Can also be caused by digitalis toxicity
53
Myocardial injury
"Bruising" of heart
Cardiac tissue in current state of dying.
If this happens, "s-t" segment will be elevated from the baseline (looks like sideways fireman hat on ECG).
54
Myocardial infarction
Dead tissue (old or fresh)
Will produce a permanent pronounced "q" wave
55
Myocardial injury and infarction
Can see both at the same time
Pt is having/has had a heart attack and there is tissue death and tissue is currently dying
Cardiac muscle not receiving enough oxygen
"Widow maker"
56
Heart blocks:
1st degree
Distance btwn beginning of "p" wave to beginning of "QRS" complex (p to r interval) is > 20 sec (five small boxes/one large box)
May treat with atropine - not extremely dangerous
Monitor pt
57
What drug do you use to treat bradycardia?
Atropine
58
Heart blocks:
2nd degree
"P" wave present, but occasionally miss corresponding QRS complex (missing heart beat)
May treat with atropine or pacing
Hook up to pacemaker but don't turn on
59
Heart blocks:
3rd degree
No obvious coordination btwn "p" wave and QRS interval. Unpredictable from one moment to the next and can't exactly identify waves
Deadly!
Turn on pacemaker
60
How does electricity normally flow through the heart?
Flows down and to the left
61
What two ways can an axis deviate from normal?
Hypertrophy
Infarction
62
Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.
Toward or Away?
Toward
63
Infarction will cause an axis to deviate ___ from the infarct tissue.
Toward or Away?
Away
64
State the 3 MI
Myocardial ischemia
Myocardial infarction
Myocardial injury
65
Myocardial ischemia
Causes pain
Current lack of O2 to cardiac muscle
Cause "flipped T-wave"
Can also be caused by digitalis toxicity
66
Myocardial injury
"Bruising" of heart
Cardiac tissue in current state of dying.
If this happens, "s-t" segment will be elevated from the baseline (looks like sideways fireman hat on ECG).
67
Myocardial infarction
Dead tissue (old or fresh)
Will produce a permanent pronounced "q" wave
68
Myocardial injury and infarction
Can see both at the same time
Pt is having/has had a heart attack and there is tissue death and tissue is currently dying
Cardiac muscle not receiving enough oxygen
"Widow maker"
69
Heart blocks:
1st degree
Distance btwn beginning of "p" wave to beginning of "QRS" complex (p to r interval) is > 20 sec (five small boxes/one large box)
May treat with atropine - not extremely dangerous
Monitor pt
70
What drug do you use to treat bradycardia?
Atropine
71
Heart blocks:
2nd degree
"P" wave present, but occasionally miss corresponding QRS complex (missing heart beat)
May treat with atropine or pacing
Hook up to pacemaker but don't turn on
72
Heart blocks:
3rd degree
No obvious coordination btwn "p" wave and QRS interval. Unpredictable from one moment to the next and can't exactly identify waves
Deadly!
Turn on pacemaker
73
How does electricity normally flow through the heart?
Flows down and to the left
74
What two ways can an axis deviate from normal?
Hypertrophy
Infarction
75
Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.
Toward or Away?
Toward
76
Infarction will cause an axis to deviate ___ from the infarct tissue.
Toward or Away?
Away
77
State the 3 MI
Myocardial ischemia
Myocardial infarction
Myocardial injury
78
Myocardial ischemia
Causes pain
Current lack of O2 to cardiac muscle
Cause "flipped T-wave"
Can also be caused by digitalis toxicity
79
Myocardial injury
"Bruising" of heart
Cardiac tissue in current state of dying.
If this happens, "s-t" segment will be elevated from the baseline (looks like sideways fireman hat on ECG).
80
Myocardial infarction
Dead tissue (old or fresh)
Will produce a permanent pronounced "q" wave
81
Myocardial injury and infarction
Can see both at the same time
Pt is having/has had a heart attack and there is tissue death and tissue is currently dying
Cardiac muscle not receiving enough oxygen
"Widow maker"
82
PFT:
SVC should always be __ than FVC.
Higher or Lower?
Higher
83
PFT:
What could be the problem if SVC is lower than FVC and what should you do about it?
The pt gave poor effort so repeat SVC test again.
84
PFT:
What disease does SVC and FVC measure?
Restrictive disease
85
What kind of problem does a restrictive pt have?
Trouble getting air in
86
What problem does an obstructive pt have?
Trouble getting air out
87
PFT:
What disease does FEV1 and FEV1/FVC % measure?
Obstructive disease
88
PFT:
What is the purpose of doing a DLCO?
Diffusion study
89
PFT:
Which test is a better indication of restrictive disease?
SVC or FVC?
SVC
90
PFT:
Which test is better to determine obstructive disease?
FEV1 or FEV1/FVC %?
FEV1/FVC %
91
PFT:
What is the minimum acceptable percentage of FEV1/FVC %?
What is normal FEV1/FVC %?
75%
85%
92
PFT:
In flow volume loop, what is the problem if a tall and skinny loop is observed?
Restrictive disease
93
PFT:
In flow volume loop, if a short and fat loop is observed, what is the problem?
Obstructive disease
94
PFT:
If a round loop is observed in a flow volume loop, what's the problem?
Give examples of the problem.
Fixed, upper airway obstruction (trouble air in and out)
Vocal cord paralysis or cancer
95
PFT:
What is the purpose of Helium Dilution and Nitrogen Washout?
To determine FRC and try to measure RV (indirectly)
96
PFT:
Which test is required to measure airway resistance (RAW)?
Body box/Plethysmography
97
IPPV/IRV:
Why would you want a longer inspiration time?
It allows for greater and better distribution of gases in the lungs.
98
IPPV/IRV:
What is the primary benefit of IPPV/IRV?
Primary benefit is improved oxygenation among poor pulmonary compliant patients.
99
IPPV/IRV:
Which diseases/conditions would benefit from IPPV/IRV?
ARDS
Severe pulmonary fibrosis
Severe restrictive lung disease in general
100
APRV:
What is APRV (airway pressure release ventilation)?
A mode of continuous positive airway pressure (PEEP/CPAP) that intermittently releases the pressure, allowing the pressure to fall to a predefined limit.
101
APRV:
Which conditions would benefit from APRV?
Acute lung injury (ALI)
ARDS
Extensive atelectasis
Diffuse pneumonia
Tracheal-esophageal fistula
102
PFT:
What is the normal DLCO?
25 mL CO/min/mmHg
103
PFT:
Why is emphysema the only obstructive disease associated with poor DLCO?
Emphysema involves destruction of the alveoli.
104
PFT:
Draw the lung volume "chart".
TLC = IRV + Vt + ERV + RV
TLC = IC +FRC
TLC = VC + RV
105
PFT:
What percentage is considered a significant reversibility in pre and post bronchodilator studies?
12% or more increase in flow is observed
FEV1 increases by more than 200 mL
106
PFT:
What is the normal RAW in non-intubated patients?
0.6 - 2.4 cmH2O/L/sec
107
PFT:
Ex Asthma patients might have a RAW of __ cmH2O/L/sec?
2.8 cmH2O/L/sec
108
PFT:
What is the max normal RAW for vent patients?
5 cmH2O/L/sec
109
PFT:
If DLCO is less tahn __% of predicted (< __ mL CO/min/mmHg) then patient has diffusion impairment.
80%
20 mL CO/min/mmHg
110
PFT:
Give the percentage of each categorized interpretations.
Normal
Mild
Moderate
Severe
```
Normal = 80% of predicted or higher
Mild = 60-79%
Moderate = 40-59%
Severe = less than 40% of predicted
```
111
PFT:
How do you calculate the best test out of your trails?
Best Test = (highest FEV1) + (highest FVC)
112
PFT:
What is the acceptable range for syringe calibration?
+/- 5% (2.85-3.15 L)
113
PFT:
Name the 5 obstructive diseases.
1. Asthma
2. Bronchiectasis
3. Bronchitis
4. Cystic fibrosis
5. Emphysema
114
Hemo:
What are the norms for:
CVP
PAP
PCWP
CO?
```
CVP = 4-5 torr (5 torr)
PAP = 14-15 torr
PCWP = 7-9 torr
CO = 4-7.8 L/min
```
115
Hemo:
What are some possible lung disease problems?
Pulmonary embolism
Pulmonary hypertension
Air embolism
Increased pulmonary vascular resistance (PVR)
116
Hemo:
What are some right heart disease problem?
Right heart failure
| Cor pulmonale
117
Hemo:
What is the mean arterial pressure (MAP) equation?
MAP = [(systolic) + (2 x diastolic)]/3
118
Hemo:
What are some left heart disease problems?
Mitral valve stenosis
CHF
Left heart failure
Pulmonary edema
Negative effects of positive breathing (high pep, high PIP)
119
Hemo:
What are the 3 different mechanisms of blood pressure?
Vessels - contract or dilate to control pressure
Blood volume - high volume, high pressure and vice versa
Heart - increased contractility (strength of contraction) combines with rate will increase blood pressure
120
Hemo:
When CVP is high, what does it usually relate to and how would you treat it?
Usually relates to fluid overload and treat with diurese
121
Hemo:
When CVP is low, what could it mean and how would you treat it?
Could be dehydration or vasodilation
Give fluids or vasoconstricting drugs
122
Hemo:
Which unit is used for CVP?
mmHg or cmH20?
mmHg
123
Hemo:
What is the normal PAP systolic and diastolic pressure? What is the mean?
25/8 mmHg
14 mmHg (mean)
124
Hemo:
Where is the best place to get a mixed-venous sample and why?
PAP because the blood is adequately mixed by that point.
125
Hemo:
PCWP relates to which side of the heart?
Left
126
Give a general body surface area (BSA) value.
2.0 m^2
127
Hemo:
How would you usually treat a cardiac output reduction?
Treat with cardiac inotropic and/or chronotropic medications (ex: Digitalis)
128
Hemo:
What is the equation for pulse pressure?
Pulse Pressure = Systolic pressure - Diastolic Pressure
129
Hemo:
Generically, what are Swan-Ganz called?
Balloon-tipped flow-directed pulmonary artery catheter (BTFDC)
