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Lindsey Jones > Key Concepts > Flashcards

Key Concepts Flashcards

0
Q

Moderate stridor

A

Treat with racemic

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1
Q

Mild strider

A

Treat with cool mist (hydration) or racemic

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2
Q

Severe/marked stridor

A

Intubate pt; tracheostomy; or send to surgery to establish a tracheostomy

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3
Q

Foreign body suspected

A

Perform bronchoscopy

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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

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5
Q

Pulsus paradoxus

A

Associated with significant air trapping such as in severe asthma or status asthmaticus

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6
Q

Minimum spontaneous Vt

A

5 mL/kg

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7
Q

If Vt < 5 mL/kg

A

Need some ventilator support (if on vent, pt not eligible for weaning)

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8
Q

If Vt < 3 mL/kg

A

EMERGENCY

Need full ventilatory support

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9
Q

Minimum Vital Capacity

A

10 mL/kg or will need vent assistance

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10
Q

Maximum expiratory pressure (MEP)

A

At least 40 cmH2O

Relates to ability to clear secretions

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11
Q

Tracheal deviation towards the problem

A

Pulmonary fibrosis
Atelectasis
Lobectomy

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12
Q

Tracheal deviation away from the problem

A

Tension pneumothorax
Hemothorax
Pleural effusion (very large)

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13
Q

Normal heart sounds

A

S1 or S2

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14
Q

S3 and S4 heart sounds means?

A

Abnormal and indicate cardiac dysfunction

Order echocardiogram!

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15
Q

S3 is associated with what illness?

A

CHF

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16
Q

S4 is associated with what illness?

A

Cardiomegaly

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17
Q

Normal urine output

A

40 mL/hour

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18
Q

In a pt’s history, objective info are considered…

A

Signs of illness

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19
Q

In pt’s history, subjective info indicates…

A

Symptoms (pt must be able to communicate)

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20
Q

Smoking pack years equation

A

(# of years) x (avg number of packs per day smoked)

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21
Q

Orthopnea

A

Inability to sleep flat - requires one or more pillows/sleeps in a chair

Related to CHF or fluid problems

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22
Q

If pt feels angry or combative, what’s the problem?

A

Electrolyte imbalance

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23
Q

If pt feels anxious or panic, what’s the problem?

A

Hypoxemia, pneumothorax, severe asthma

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24
Q

If pt feels euphoria, what’s the problem?

A

Ingestional error (drug overdose)

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25
Q

If pt feels depressed, what’s the problem?

A

Pt recently informed of disease

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26
Q

What is the SA node?

A

Pacemaker of the heart

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27
Q

Best ECG lead to determine left ventricle

A

Lead V5

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28
Q

Best ECG lead to determine overall electrical condition of the heart

A

Lead II

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29
Q

How fast is the heart beating in a flutter?

A

Greater than 200 bpm

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30
Q

What does fibrillation mean in ECG?

A

Very fast

Can’t count heart rate

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31
Q

Heart rate estimation from ECG tracing

A

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)

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32
Q

Memorize alternate rate estimation!!!

A

300-150-100-75-60-50

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33
Q

ECG rhythms:

Sinus rhythm

A

All bumps are there, especially “p” wave

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34
Q

ECG rhythms:

How do you treat sinus tachycardia?

A

Treat with oxygen

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35
Q

ECG rhythms:

How do you treat sinus bradycardia?

A

Stimulate heart with atropine

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36
Q

ECG rhythms:

What do you do with occasional premature ventricular contraction (PVC)?

A

Treat with oxygen

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37
Q

ECG rhythms:

What do you do with frequent premature ventricular contraction (PVC)?

A

Treat with Lidocaine

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38
Q

ECG rhythms:

Steps to treat asystole

A
  1. Confirm in two chest leads
  2. Treat with chest compressions!!!!!
  3. Epinephrine
  4. Atropine
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39
Q

Do you shock asystole?

A

NO!!

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40
Q

ECG rhythms:

How do you treat ventricular fibrillation (v-fib)?

A

Treat with defibrillation

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41
Q

ECG rhythms:

How do you treat ventricular tachycardia (v-tach)?

A

Treat with defibrillation if no pulse

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42
Q

Which ECG rhythms are deadly and constitutes an emergency?

A

V-tach and V-fib

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43
Q

Heart blocks:

1st degree

A

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

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44
Q

What drug do you use to treat bradycardia?

A

Atropine

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45
Q

Heart blocks:

2nd degree

A

“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

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46
Q

Heart blocks:

3rd degree

A

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

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47
Q

How does electricity normally flow through the heart?

A

Flows down and to the left

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48
Q

What two ways can an axis deviate from normal?

A

Hypertrophy

Infarction

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49
Q

Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.

Toward or Away?

A

Toward

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50
Q

Infarction will cause an axis to deviate ___ from the infarct tissue.

Toward or Away?

A

Away

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51
Q

State the 3 MI

A

Myocardial ischemia

Myocardial infarction

Myocardial injury

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52
Q

Myocardial ischemia

A

Causes pain

Current lack of O2 to cardiac muscle

Cause “flipped T-wave”

Can also be caused by digitalis toxicity

53
Q

Myocardial injury

A

“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
Q

Myocardial infarction

A

Dead tissue (old or fresh)

Will produce a permanent pronounced “q” wave

55
Q

Myocardial injury and infarction

A

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
Q

Heart blocks:

1st degree

A

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
Q

What drug do you use to treat bradycardia?

58
Q

Heart blocks:

2nd degree

A

“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
Q

Heart blocks:

3rd degree

A

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
Q

How does electricity normally flow through the heart?

A

Flows down and to the left

61
Q

What two ways can an axis deviate from normal?

A

Hypertrophy

Infarction

62
Q

Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.

Toward or Away?

63
Q

Infarction will cause an axis to deviate ___ from the infarct tissue.

Toward or Away?

64
Q

State the 3 MI

A

Myocardial ischemia

Myocardial infarction

Myocardial injury

65
Q

Myocardial ischemia

A

Causes pain

Current lack of O2 to cardiac muscle

Cause “flipped T-wave”

Can also be caused by digitalis toxicity

66
Q

Myocardial injury

A

“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
Q

Myocardial infarction

A

Dead tissue (old or fresh)

Will produce a permanent pronounced “q” wave

68
Q

Myocardial injury and infarction

A

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
Q

Heart blocks:

1st degree

A

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
Q

What drug do you use to treat bradycardia?

71
Q

Heart blocks:

2nd degree

A

“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
Q

Heart blocks:

3rd degree

A

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
Q

How does electricity normally flow through the heart?

A

Flows down and to the left

74
Q

What two ways can an axis deviate from normal?

A

Hypertrophy

Infarction

75
Q

Hypertrophy will cause an axis to deviate ___ the direction of the hypertrophy.

Toward or Away?

76
Q

Infarction will cause an axis to deviate ___ from the infarct tissue.

Toward or Away?

77
Q

State the 3 MI

A

Myocardial ischemia

Myocardial infarction

Myocardial injury

78
Q

Myocardial ischemia

A

Causes pain

Current lack of O2 to cardiac muscle

Cause “flipped T-wave”

Can also be caused by digitalis toxicity

79
Q

Myocardial injury

A

“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
Q

Myocardial infarction

A

Dead tissue (old or fresh)

Will produce a permanent pronounced “q” wave

81
Q

Myocardial injury and infarction

A

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
Q

PFT:

SVC should always be __ than FVC.

Higher or Lower?

83
Q

PFT:

What could be the problem if SVC is lower than FVC and what should you do about it?

A

The pt gave poor effort so repeat SVC test again.

84
Q

PFT:

What disease does SVC and FVC measure?

A

Restrictive disease

85
Q

What kind of problem does a restrictive pt have?

A

Trouble getting air in

86
Q

What problem does an obstructive pt have?

A

Trouble getting air out

87
Q

PFT:

What disease does FEV1 and FEV1/FVC % measure?

A

Obstructive disease

88
Q

PFT:

What is the purpose of doing a DLCO?

A

Diffusion study

89
Q

PFT:

Which test is a better indication of restrictive disease?

SVC or FVC?

90
Q

PFT:

Which test is better to determine obstructive disease?

FEV1 or FEV1/FVC %?

A

FEV1/FVC %

91
Q

PFT:

What is the minimum acceptable percentage of FEV1/FVC %?

What is normal FEV1/FVC %?

92
Q

PFT:

In flow volume loop, what is the problem if a tall and skinny loop is observed?

A

Restrictive disease

93
Q

PFT:

In flow volume loop, if a short and fat loop is observed, what is the problem?

A

Obstructive disease

94
Q

PFT:

If a round loop is observed in a flow volume loop, what’s the problem?

Give examples of the problem.

A

Fixed, upper airway obstruction (trouble air in and out)

Vocal cord paralysis or cancer

95
Q

PFT:

What is the purpose of Helium Dilution and Nitrogen Washout?

A

To determine FRC and try to measure RV (indirectly)

96
Q

PFT:

Which test is required to measure airway resistance (RAW)?

A

Body box/Plethysmography

97
Q

IPPV/IRV:

Why would you want a longer inspiration time?

A

It allows for greater and better distribution of gases in the lungs.

98
Q

IPPV/IRV:

What is the primary benefit of IPPV/IRV?

A

Primary benefit is improved oxygenation among poor pulmonary compliant patients.

99
Q

IPPV/IRV:

Which diseases/conditions would benefit from IPPV/IRV?

A

ARDS

Severe pulmonary fibrosis

Severe restrictive lung disease in general

100
Q

APRV:

What is APRV (airway pressure release ventilation)?

A

A mode of continuous positive airway pressure (PEEP/CPAP) that intermittently releases the pressure, allowing the pressure to fall to a predefined limit.

101
Q

APRV:

Which conditions would benefit from APRV?

A

Acute lung injury (ALI)

ARDS

Extensive atelectasis

Diffuse pneumonia

Tracheal-esophageal fistula

102
Q

PFT:

What is the normal DLCO?

A

25 mL CO/min/mmHg

103
Q

PFT:

Why is emphysema the only obstructive disease associated with poor DLCO?

A

Emphysema involves destruction of the alveoli.

104
Q

PFT:

Draw the lung volume “chart”.

A

TLC = IRV + Vt + ERV + RV

TLC = IC +FRC

TLC = VC + RV

105
Q

PFT:

What percentage is considered a significant reversibility in pre and post bronchodilator studies?

A

12% or more increase in flow is observed

FEV1 increases by more than 200 mL

106
Q

PFT:

What is the normal RAW in non-intubated patients?

A

0.6 - 2.4 cmH2O/L/sec

107
Q

PFT:

Ex Asthma patients might have a RAW of __ cmH2O/L/sec?

A

2.8 cmH2O/L/sec

108
Q

PFT:

What is the max normal RAW for vent patients?

A

5 cmH2O/L/sec

109
Q

PFT:

If DLCO is less tahn __% of predicted (< __ mL CO/min/mmHg) then patient has diffusion impairment.

A

80%

20 mL CO/min/mmHg

110
Q

PFT:

Give the percentage of each categorized interpretations.

Normal
Mild
Moderate
Severe

A 
Normal = 80% of predicted or higher
Mild = 60-79%
Moderate = 40-59%
Severe = less than 40% of predicted
111
Q

PFT:

How do you calculate the best test out of your trails?

A

Best Test = (highest FEV1) + (highest FVC)

112
Q

PFT:

What is the acceptable range for syringe calibration?

A

+/- 5% (2.85-3.15 L)

113
Q

PFT:

Name the 5 obstructive diseases.

A
  1. Asthma
  2. Bronchiectasis
  3. Bronchitis
  4. Cystic fibrosis
  5. Emphysema
114
Q

Hemo:

What are the norms for:

CVP
PAP
PCWP
CO?

A 
CVP = 4-5 torr (5 torr)
PAP = 14-15 torr
PCWP = 7-9 torr
CO = 4-7.8 L/min
115
Q

Hemo:

What are some possible lung disease problems?

A

Pulmonary embolism
Pulmonary hypertension
Air embolism
Increased pulmonary vascular resistance (PVR)

116
Q

Hemo:

What are some right heart disease problem?

A

Right heart failure

Cor pulmonale

117
Q

Hemo:

What is the mean arterial pressure (MAP) equation?

A

MAP = [(systolic) + (2 x diastolic)]/3

118
Q

Hemo:

What are some left heart disease problems?

A

Mitral valve stenosis

CHF

Left heart failure

Pulmonary edema

Negative effects of positive breathing (high pep, high PIP)

119
Q

Hemo:

What are the 3 different mechanisms of blood pressure?

A

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
Q

Hemo:

When CVP is high, what does it usually relate to and how would you treat it?

A

Usually relates to fluid overload and treat with diurese

121
Q

Hemo:

When CVP is low, what could it mean and how would you treat it?

A

Could be dehydration or vasodilation

Give fluids or vasoconstricting drugs

122
Q

Hemo:

Which unit is used for CVP?

mmHg or cmH20?

123
Q

Hemo:

What is the normal PAP systolic and diastolic pressure? What is the mean?

A

25/8 mmHg

14 mmHg (mean)

124
Q

Hemo:

Where is the best place to get a mixed-venous sample and why?

A

PAP because the blood is adequately mixed by that point.

125
Q

Hemo:

PCWP relates to which side of the heart?

126
Q

Give a general body surface area (BSA) value.

127
Q

Hemo:

How would you usually treat a cardiac output reduction?

A

Treat with cardiac inotropic and/or chronotropic medications (ex: Digitalis)

128
Q

Hemo:

What is the equation for pulse pressure?

A

Pulse Pressure = Systolic pressure - Diastolic Pressure

129
Q

Hemo:

Generically, what are Swan-Ganz called?

A

Balloon-tipped flow-directed pulmonary artery catheter (BTFDC)

Lindsey Jones (1 decks)

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