ME Forms & #s Flashcards
~ Length of bronchioles in the lungs?
~# & Length of alveoli in the lungs?
= = ~15,000 miles.
= ~300 mil; cover an area of half a tennis court.
What is considered the highest allowable PEEP setting without medical consultation?
10cm H2O
What initiates respiratory drive:
Pedis end-tidal & Dead Space:
= Increase of Arterial CO2
= 3-5mL/kg & 5-7mL/kg
What ECG pattern is associated with a patient having a pulmonary embolism:
S1Q3T3
Wellen’s wave type A:
Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower
Highly specific for for a critical blockage of the LAD
Wellen’s wave type B:
DEEP inverted T waves V2 or V3,
VT vs SVT w/ aberrancy) 3rd Criteria:
Josephson’s Sign:
Nadir:
= Josephson’s Sign
= Notching near the nadir of the S-wave
= deepest/most distal point of depression
VT vs SVT w/ aberrancy) 2nd Criteria
Fusion P waves is from what:
= Fusion P waves present?
= SA trying to take over ventricles
VT vs SVT w/ aberrancy) 1st Criteria/ (ERAD):
= up aVR, V6 down (99.9% evident) w/ all 3) all 3= VT
CNS blood supply) 1 Brain receives ~ of body’s blood flow/min:
2 Circle of Willis:
3 comprised of:
1= ~15- 20%
2= system “circle of feeders” coming off 4 arteries that provide supplements (blood oxy glucose) to brain
3= Carotid system (anterior) & Vertebrobasilar system (posterior)
Time interval markings on ECG paper are placed at:
3-second intervals.
Tidal Volume:
= Amount of air moved in & out of lungs in
1 breath (~500 mL’s in a healthy adult)
The most important factor that determines the ventilation rate of a patient is the amount of:
Arterial pCO2
The majority of carbon dioxide that is made by our cells during metabolism is transported in the blood and to the alveoli:
as bicarbonate ions
The majority of carbon dioxide that is made by our cells during metabolism is transported in the blood and to the alveoli:
as bicarbonate ions
The forced expiratory volume (FEV)
Most commonly, FEV1 measures
Peak flow measures:
Both these measurements are commonly used for:
= vol/ of air exhaled over measured period of time
= air vol/ expelled in 1st sec of a forced expiration
= max/ rate of airflow during a forced expiration( Ls of air expiration per min)
= assessing PTs w/ lung diseases (COPD, asthma)
What would cause a right-shift of the Oxygen Dissociation Curve?
decrease in the pH of the blood, increase in body temperature, increase in the amount of CO
The amount of air that remains in your lungs after each breath is termed the:
Residual volume
ST elevation leads criteria:
V2 & V3 females criteria:
V2 & V3 Males <40 criteria:
V2 & V3 Males>40 criteria:
STEMI criteria:
= > 1mm in all leads except V2 & V3
= 1.5 mm or more
= 2.5 mm or more
= 2 mm or more
= leads’ criteria in 2 or more contiguous leads
Spodick’s Sign:
Downsloping of P wave
Spinal Nerve Plexuses) def/:
Locations:
Key myotomes for neurologic evaluation:
Dermatomes
= sensory components of spinal nerves innervate specific & discrete surface areas called dermatomes
= distributed from the occiput of the head to the heel of the foot and buttocks.
= arm extension (C-5), elbow extension (C-7), small finger abduction (T-1), knee extension (L-3), & ankle (plantar) flexion (S-1).
Spinal Cord) length & width:
SC conducts impulses:
= Approximately 18 inches long & ½ inch wide
= Conducts impulses to & from PNS & for some reflexes
Spinal Cord)Pairs of nerve fibers exiting SC:
Nerve fibers terminate @:
If cauda equina compressed too long:
= 31 pairs of N. fibers out SC
= L1or L2 / Cauda Equina “Horse Tail”
= can loose bladder cord/control, lower extrm sense
Sgarbossa smith modified criteria 3:
Discordant ST elevation > .20 QRS amp in leads w/ negative QRS
ST/QRS #= 0.12
Sgarbossa criteria 3:
Discordant ST elevation > 5 mm in leads w/ a negative QRS.
Sgarbossa criteria 1:
Concordant ST elevation ≥ 1 mm in leads w/ a positive QRS.
Sgarbossa criteria 2:
Concordant ST depression ≥ 1 mm in V1-V3.
S3 is heard when
S4 is heard when
S3 after S2
S4 before S1
S3 is heard when
S4 is heard when
S3 after S2
S4 before S1
S1Q3T3 Pattern & Use
Lead 1 prominent S wave, Lead 3: Path Q & flipped T & 95% accurate 25% sensitivity w/ PEs
S1Q3T3 Pattern & Use
Lead 1 prominent S wave, Lead 3: Path Q & flipped T & 95% accurate 25% sensitivity w/ PEs
S1 Sounds auscultated @:
S2 Sounds (aortic) auscultated @:
S2 Sounds (Pulmonic) auscultated @:
= 5th ICS at Left Sternal border
= 2nd ICS at Right Sternal border
= 2nd ICS at Left Sternal border
Rs 6sec strip method:
big box method:
Small box method:
Triplicate method:
= # of Rs x 10
= 1R to R BB#s then 300/BB#
= 1R-R SB#s then 1500/ SB#
= descend W/ SB 300, 150, 100, 75, 50, 43, 38
Residual Volume (RV)=
amount of air remaining in the lungs at the end of maximal expiration (~1200mLs)
Waste products of respiration?
What catalyzes CO2 + H2O → Carbonic Acid?
= Heat, water, CO2.
= Carbonic anhydrase.
Q: Formula for Minute Volume?
RR × Tidal Volume.
Formula for Minute Volume?
RR × Tidal Volume.
Formula for Alveolar Minute Volume?
= (Tidal Volume - Dead Space) × RR.
Formula for Alveolar Minute Volume?
= (Tidal Volume - Dead Space) × RR.
Pulse pressure:
Pulse pressure signifies:
Pulse pressure <25 mmHg may be seen w/
= dif/ between DBP & SBP pressures (PP= SBP-DBP)
= amount of force the heart generates with each contraction
= PTs w/ sings of shock
CPP)
CPP form/:
If MAP falls below 50 mmHg:
= Cerebral Perfusion Pressure provides cerebral blood flow
= MAP - ICP
= normal ICP reduces CPP to critical levels.
Percentage of Blood Flow & Glucose Used by Brain
Brain receives 20% of total blood flow & uses 25% of glucose despite being only 2% of body weight
PaCO2=
Partial pressure of CO2 in the arterial blood
Oxygen saturation is the:
Oxygen saturation formula:
= ratio of the blood’s actual oxygen content to its total oxygen-carrying capacity
= O2 content /O2 capacity×100(%)
normal bicarbonate ion to carbonic acid ratio
20:1
normal bicarbonate ion to carbonic acid ratio
20:1
Norm/ ventricle ejects ~2/3s blood it contains @ after systole, known as
Ejection Fraction
Monro-Kellie Doctrine:
in short:
= The pressure-vol/ relationship between ICP, Vol/ of CSF, blood, brain tissue, & CPP
= In the fixed space of the cranial cavity, when one increases, the others must decrease
Mirror Criteria
V1&2 leads (v2 most sensitive w/ R): ST depression w/ big R wave (accompany 15-20% inferior or lateral STEMI)
MetHemoglobin Lvls- 1-3%:
3-15%:
15-20%:
25-50%:
50-70%:
>70%:
= Normal
= discoloration, grayish-blue
= Cyanotic, asymptomatic
= CNS H/A, N/V, Confusion, Chest pain
= AMS, delirium
= Fatal
Lower Airway Anatomy) Cricoid ring
Narrowest point in Aduldts vs Pedis
How many alveoli do you have in your lungs?
bronchioles streched out would be how far:
Cilia fn & triggers what if obstructed:
= only 360 degree cartilage
= Cricoid ring in PEDIs vs adults glottis
= 300 mil
= 15K miles of bronchioles
= Cilia moves up if stuck triggers cough reflex
Left Ventricular Hypertrophy (LVH)
How to Recognize LVH:
= Enlargement & thickening of the L-ventricle
= Take the tallest R wave in V5 or V6 + the S wave in V1 = > 35mm –R in aVL > 11mm
Leads aVR, aVL, aVF are what type of leads
as Augmented leads.
Side of heart has most myocardium:
Epicardium makes what & how:
Pericardium holds what, w/ what color & Fn.:
= L side of heart (muscle)
= folds over self to make pericardium
= holds 25-50mLs straw color fluid to reduce friction, 150mL = heart can squeeze,
Ion that depolarizes Contractile cell :
Ion that repolarizes Contractile cell :
Ion that depolarizes Autorhythmic cell :
Ion that repolarizes Autorhythmic cell :
Ion that depolarizes Neuron cell :
Ion that repolarizes Neuron cell :
= Sodium
= Potassium
= Calcium
= Potassium
= Sodium
= Potassium
Inspiratory reserve volume (IRV)=
maximum amount of air that can be inhaled after a normal inspiration (~3000mLs)
Inspiratory reserve volume (IRV)=
maximum amount of air that can be inhaled after a normal inspiration (~3000mLs)
Pleural space has a pressure between:
W/ expiration the chest wall & diaphragm:
= 4 & 8 mmHg <than atmospheric pressure.
= recoil to normal resting state, thus increases inside the chest to ~1-2 mmHg >atmospheric P
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
If Oxygen Dissociation Curve would stay shifted too far to the right, what would this cause?
cause the hemoglobin to decrease it’s affinity towards oxygen
What would cause a left-shift of the Oxygen Dissociation Curve?
increase in the pH of the blood, decrease in the amount of CO2 & Body Temp
Hypothermia affect on heart:
= Osborn waves (J waves), <90 core usually, So irritable will/can throw to AFIB
How much air is filtered, warmed, & humidified daily?
= ~10,000 gallons.
How much air is filtered, warmed, & humidified daily?
= ~10,000 gallons.
How does CO2 get transported throughout our body?
Mostly bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
How does CO2 get transported throughout our body:
Bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
Henry’s Law:
The amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
Diving down puts more pressure on nitrogen to dissolve & into bloodstream
Usually compresses brain
Descent injurie w/ diving w/ ear infection or dental work
Henry’s Law:
The amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
Diving down puts more pressure on nitrogen to dissolve & into bloodstream
Usually compresses brain
Descent injurie w/ diving w/ ear infection or dental work
Functional residual capacity (FRC)=
volume of gas that remains in the lungs at the end of normal expiration
Formulas) Min Vol
Alveolar min vol =
= RR x tidal vol
= (tidal vol - dead space) x RR
Cardiac Output formula:
HR:
SV:
Formula for BP:
Calculate a PT’s MAP:
= CO=HR×SV
= Heart Rate (beats per minute)
= Stroke Volume (amount of blood pumped per beat)
= BP= SVR x (SV x HR)
= DBP+ ⅓(SBP-DBP)
Expiratory reserve volume (ERV)=
maximum amount of air that can be exhaled after a normal expiration. (~1200mLs)
Expiratory reserve volume (ERV)=
maximum amount of air that can be exhaled after a normal expiration. (~1200mLs)
Ejection Fraction (EF):
<45% usually indicates:
<30%:
= Ratio of blood pumped from the ventricle to the amount remaining @ the end of diastole/ %of blood pumped out from ventricle (60-70%)
=<45% usually indicates in or going to CHF
=<30% in CHF & chronic cardiac crip on oxy
ECG Lead views) Lead aVR views what
LMCA - 3 vessel disease
ECG Lead views) Lead V5 V6 views what
Lateral
ECG Lead views) Lead V3 V4 views what
Anterior
ECG Lead views) Lead V1 V2 views what
Septal
ECG Lead views) Lead I, aVL, V4, V5 views what
Left Lateral
ECG Lead views) Lead V4R views what
Right
ECG Lead views) Lead V8 V9 views what
Posterior
ECG Camera views) Right view by which lead
Lead V4R
ECG Camera views) Posterior view by which leads
Lead V9 V8
ECG Camera views) LMCA - 3 vessel disease view by which lead
Lead aVR
ECG Camera views) Left Lateral view by which lead
Lead I, aVL, V6, V5
ECG Camera views) Septal view by which leads
Lead V1 V2
Dead Space Volume:
= Area where there are no alveoli or gas exchange occurs in this area (~150mL)
Dead Space Volume:
= Area where there are no alveoli or gas exchange occurs in this area (~150mL)
Contractile cell RP:
Contractile cell AP:
Autorhythmic cell RP:
Autorhythmic cell AP:
Neuron cell RP:
Neuron cell AP:
= -90mV
= -85mV
= -60mV
= -40mV
= -70mV
= -55mV
Carbon Monoxide (CO) Poisoning Lvls)
Severity w/ S/S) 1. Aysymptomatic:
2. H/A, N/V, dizziness, blurred vision:
3. Confusion, syncope, chest pain, dyspnea, Tcardia/pnea, weakness:
4. Dysrhythmias, hypoBP, cardiac ischemia, palpitations, resp/ arrest, pulmonary edema, seizures, coma,
cardiac arrest
5. Dead, Cherry Pink skin
1= <15
2= Mild 20%
3= Moderate 21–40%
4= Severe 41–59%
5= Fatal/Lethal >60%
Carbon Monoxide (CO) Poisoning Lvls)
Severity w/ S/S) 1. Aysymptomatic:
2. H/A, N/V, dizziness, blurred vision:
3. Confusion, syncope, chest pain, dyspnea, Tcardia/pnea, weakness:
4. Dysrhythmias, hypoBP, cardiac ischemia, palpitations, resp/ arrest, pulmonary edema, seizures, coma,
cardiac arrest
5. Dead, Cherry Pink skin
1= <15
2= Mild 20%
3= Moderate 21–40%
4= Severe 41–59%
5= Fatal/Lethal >60%
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
Carbonic acid:
H2CO3
Carbonic Acid-Bicarbonate Buffer system formula:
CO2 + H20 <> H2CO3 <> H + HCO3
Final concentrations of oxygen & carbon dioxide in blood leaving pulmonary capillaries?
= Oxygen: 104 mmHg, Carbon dioxide: 40 mmHg
Final concentrations of oxygen & carbon dioxide in blood leaving pulmonary capillaries?
= Oxygen: 104 mmHg, Carbon dioxide: 40 mmHg
Capography wave forms
Brain vascular supply) Astrocytes:
Myoglobin:
Brain receives of body’s total blood:
Wight & BGL Consumption:
Vascular supply system :
= open door for glucose
= supports & stores oxygen “muscle O2 storage”
= Brain receives ~20% body’s total blood flow/min
= 2% body weight & Consumes 25% body’s glucose
(Neurons need continuous supply of O2 & gL)
Brain Injury) 1 S/S:
2 Treatment of Brain Herniation:
3 Vent/ing Brain Herniation:
4 Do not let PT become:
5 Note with ETCO2 & ICP:
1= AMS, Alterations in personality, Amnesia, Cushing’s triad
2= Maintain ETCO2 between 30-40, Vent/ at upper end of norm/, Admin IV fluids for SBP 90-100,
3= Adults: No more 20 per/min, Children: No more 30per/min Infants: No more 35 per/min
4= hypoxic or hypovolemic
5= Norm ETCO2 35-45 but controlled hypervent/ 30-40
(if overoxygenate can actually decrease amount going to brain)
BP form/s:
BP is related to:
= (SV x HR) x SVR or CO x SVR
= CO & peripheral resistance
BP form/s:
BP is related to:
= (SV x HR) x SVR or CO x SVR
= CO & peripheral resistance
Boyle’s Law:
The volume of gas is inversely proportional to the pressure of it The more pressure, the less volume.
The less pressure, the more volume.
At sea level 1 atmosphere of pressure on your body
Every 33 feet under water adds another atmosphere
14.7PSI
Down 33ft 1000 vol, 66ft 500
Ascent pops lung
Boyle’s Law:
The volume of gas is inversely proportional to the pressure of it The more pressure, the less volume.
The less pressure, the more volume.
At sea level 1 atmosphere of pressure on your body
Every 33 feet under water adds another atmosphere
14.7PSI
Down 33ft 1000 vol, 66ft 500
Ascent pops lung
Body makes how much CSF in 24Hrs
What structure is maker:
~500-600mL
Brain perfusion] Cerebral Perfusion Pressure (CPP) form:
MAP’s relation w/ perfusion:
Head injury PTs will have increase BP b/c:
= MAP – ICP (Norm/ ICP between 5-15 mmHg average 10mL)
= MAP needs to stay > ICP to maintain brain perfusion
= increase MAP helps to keep the MAP>ICP. (bodys attempt to compensate)
Brain perfusion] Cerebral Perfusion Pressure (CPP) form:
MAP’s relation w/ perfusion:
Head injury PTs will have increase BP b/c:
= MAP – ICP (Norm/ ICP between 5-15 mmHg average 10mL)
= MAP needs to stay > ICP to maintain brain perfusion
= increase MAP helps to keep the MAP>ICP. (bodys attempt to compensate)
Bicarbonate ion:
HCO3
Benign Early Repolarization (BER) ECG changes:
Widespread concave ST elevation limited to precordial leads (usually V2-V5)
Absence of PR depression
Prominent T waves
Characteristic “fish-hook” appearance (often best in lead V4)
Oxygen arterial partial pressure (PaO2) form:
Carbon Dioxide arterial partial pressure (PaCO2) form:
= 100Torr ( average = 80 - 100)
= 40torr (average = 35-45)
Axis pys L
Axis Path L
Axis Path L cause:
Anterior Hemiblock
Axis QRSs) normal axis leads & Degrees
= all Up) 0° to +90°
Axis QRSs) Pyscio Left leads & Degrees
= U, U, D) 0° to -30°
Axis QRSs) Patho Left leads & Degrees
= U,D,D) -30° to -90°
Axis QRSs) RIght axis leads & Degrees
= D, U/D, U) +90° to +180°
Axis QRSs) Extreme right leads & Degrees
=All down )+180° to -90°
Axis QRSs) all Up
Normal
Axis QRSs) U, U, D
physcio L
Axis QRSs) U, D, D
Patho Left
Axis QRSs) D, U/D, U
RIght
Axis QRSs) D, D, D
Extreme Right
Axis normal
Axis quick ID
Lead 1,2,&3
At what blood glucose level does the kidneys start passing glucose into urine?
180 mg/dL
Antipyretic needed when temp >
only if fever is >101F)
ECG Camera views) Anterior
Lead V3 V4
An unconscious patient was pulled out of his enclosed garage after he attempted to kill himself with carbon monoxide. Your partner has attached the CO-Oximeter and it shows a reading a 50% carboxyhemoglobin. You quickly identify this as:
Severe CO poisoning
Normal T Wave in any chest lead should have max amplitude:
= 10 mm
Normal T Wave in any limb lead should have a max amplitude:
= 5 mm
Normal T Wave in any chest lead should have max amplitude:
= 10 mm
Normal T Wave in any limb lead should have a max amplitude:
= 5 mm
Alveolar Volume formula:
Tidal Volume – Dead Space 500-150
Afterload:
= resistance against which the heart must pump against afterload become increased w/ increased ventricular workload
what is the cut off for using adult vs pediatric colormetric ETCO2 device
= PT’s weight is: 15 kg or below
Ability to speak:
Sternal retraction seen w/:
= 1-2 word dyspnea, broken syllable dyspnea
= kids (grunting last sound “BVM”)
ABG normal range:
Alkalosis:
Acidosis:
= 22-26
= >26
= <22
Sig/ head injury PT should receive/maintain oxy/ if < than:
If spinal injury is suspected, head & neck should be pos/ed:
Hypos for brief time can worsen outcome of head injuries:
= 96%
= gently moved into a Neutral position
= hypotension & hypoxia
A patient is breathing normal tidal volume with a rate of 14 breaths per minute. What is their estimated alveolar minute volume?
4900mL/min (500-150) x 14)
How much air is filtered, warmed & humidified each day?
10k gallons of air
T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
Refractory periods) Absolute:
Relative:
= end of P to apex of T wave- cells absolute Beginning of repolarization
= “some really could happen” lot of cells repolar but not all so can throw out of rhythm Commodo cordis
P wave) morphology:
represents:
Limb Lead amplitude
Precordial “chest” Leads amplitude:
= + deflection in leads 1,2,&3 >Biphasic in V1
= Atrial depolarization
= <2.5
= <1.5
Capnography) Height:
Length:
W/ Applying remember:
= total CO2
= time/rate
= Keep connected off of PT for 10 secs to calibrate baseline ETCO2
Capnography) Height:
Length:
W/ Applying remember:
= total CO2
= time/rate
= Keep connected off of PT for 10 secs to calibrate baseline ETCO2
Poiseuille’s law:
Example:
= vessel w/ relative radius of 1 would transport 1mL per min at BP difference of 100mmHg. Keep pressure constant
= Less blood = vaso-press
Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:
= neutral/ground
= Negative
= Positive
Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:
= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)
