Midterm Flashcards
What’s the properties of Heliox
Low density gas that doesn’t support combustion
How can heliox benefit a pt
Reduced WOB by reducing turbulent flow in severe asthmatics
What are the calculation factor for heliox
80/20=1.8
70/30=1.6
How to calculate total flow for heliox
Flow rate X heliox factor
What properties are in nitric oxide
Colorless gas, noninflammable and supports combustion
What pt can benefit from nitric oxide
Infants with hypoxic respiratory failure
What kind of gas supply systems are located at hospitals
Manifold, large stand and reserve tank, and bulk air compressors, zone valves
What is the safety system used for an E tank
PISS ( Pin index safety system)
Safety system for an H tank
ASSS ( American standard safety system)
Thorpe tube/ wall attachment safety system
DISS ( Diameter index safety system)
Why are zone valves important
Found throughout the hospitals allowing RTs to have access in case of emergency
What situation may you need to access zone valves
Turn off o2 delivery in case of fire and to turn off sections for maintenance
What are advantages and disadvantages of Thorpe tubes and bourdon gauge
Bourdon gauge: reduce pressure and flow
Thorpe tube: fixed 50 PSI, not best for different gas and pressure and is limited by gravity( must be upright)
What is more commonly used, Thorpe tube or bourdon gauge
Thorpe tube
Where is a Thorpe tube and bourdon gauge used
Thorpe tube- Bedside
Bourdon gauge- when Thorpe tube cannot be upright
What’s the factor for an H tank
3.14
Factor for E tank
.28
How to calculate the durations of o2
PSIG X Factor/ flow = divide by 6, after deci multiply by 6
What’s the PSIG on a full tank
2200 PSIg
What are hazards with o2 therapy
-Ventilatory depression in pt with elevated PaCO2 is PaO2 is greater than 60 torr
- With FiO2 greater than .5, absorption atelectasis, o2 toxicity, or depression of ciliary may occur
- be cautious when delivering supplemental o2 to pt suffering from paraquat poisoning or pt receiving bleomycin ( med for cancer)
- minimal levels of o2 during laser bronchoscopy to avoid intratracheal ignition
- fire hazards
- bacterial contamination
What are the properties of a blender
Delivers positive pressure o2
What is a blender used for
Delivers accurate o2 there or for a pt specific needs
LPM and FIO2 range for simple mask
5-10 lpm 35-50%
Post op mouth breathers
LPM and FIO2 for Nasal cannula
1-6 lpm. 22-40% rule of 4 is 24-44%
> 4 lpm = bubble humidifier
Stable pt
LPM and FIO2 for nonrebreather
10-15 lpm 60-80% theoretically up to 100%
For emergency, low pao2 and co poisoning
How does the rule of 4 work
For every lpm the Fio2 increase by 4
How does an air entrainment mask work
Delivers precise Fio2 based off the fixed jet and entrainment port size
What type of pt can benefit from AEM
COPD due to hypoxic drive bc they retain co2
What’s the alveolar air equation
Fio2 x (760-47)-(co2/.8)
Primary indications for humidity therapy
Administration of dry medical gas at flows greater than 4LPM
Upper edema, greater than 7LPM for long term, bypassed upperway, sputum specimens
At how many LPM should you add a bubble humidifier
Greater than 4
What is the pop off psi for bubble humidifier
Greater than 2 PSIG
Properties of HME
Traps body heat and expired water vapor to raise inspired gas humidity
What pt can an HME be used on and what pt should not used HME
Use: short and long term therapy, only for pt with artificial airway
Cannot use: not for swelling like croup, thick tenacious secretions, neonates and exhaled tidal volume less than 70%
And VE greater than 10 LPm
What are other names for cool mist
AEN, Bland aerosol, BANs and LVN
What is needed to give cool mist
2 tubes, drainage bag, saline bottle, interface types( aerosol mask, face tent for burns, trach mask and t tube for artificial airways
What is aerosol
Suspension of solid or liquid particles in gas.
Output= amount of drug delivered by nebulizer
Emitted= mass of drug leaving mouthpiece
What is the deposition of drug in the upper airway
5-10
Criteria for MDI
Must inhale slow and deep and hold breath, inspiratory flow of 30
How to teach MDI
Shake to mix propellant with drug, prime twice if it’s been awhile, use spacer and press inhaler into spacer, exhale then inhale into mouthpiece slow and deep and hold for 5-10 seconds. If second dose is needed wait 30-60 seconds
Criteria for DPI
Must generate inspiratory flow of 40-60 lpm and inhale fast
Teaching DPI
Exhale away, inhale rapid and deep, then rinse and spit mouth to avoid oral thrush
How to use SvN
Insert med into baffle, set flow to 8 lpm, sit in high fowlers and breathe normally with occasional deep breaths
How to use peak flow meter
Sit upright, inhale to total lung capacity and forcefully exhale into the mouthpiece as fast as possible. Record the highest out of 3 readings
Indications for incentive Spirometry
Mimics natural signing
- atelectasis, upper abdominal surgery, restrictive lung disorder
Contraindications for Incentive Spirometry
- unable to cooperate
- unable to supervise or cannot be instructed
- unable to take deep breaths
- presence of open tracheal stoma requires adaptation
How to use IS
Slow deep diaphragmic inspiration then 5-10 sec breath hold and a cough
Hit the set goal and keep yellow thing at the best or better window
What is set for IPPB
Driving pressure PIP
Causes of atelectasis
Surgery near diaphragm, obesity, hx of lung disease, poor cough
What are the types of atelectasis
1.obstructive-alveoli and trachea obstruction
2. Compression- compression of lung parenchyma by lesion
3. Hyperventilation- low tidal volume by anesthesia or drugs
4. Absorption- collapse due to loss of surfactant (ARDs, o2 toxicity)
What’s o2 toxicity and what type of atelectasis it cause
Breathing in too much o2 and cause absorption atelectasis
What’s hypoxic drive
Peripheral chemoreceptors that stimulate breathing
Indications of hyperbaric o2 therapy
Gas embolism, carbon monoxide poisoning, central retinal artery occlusion (CRAO), wounds, burns and necrotizing fasciitis
Contraindications for Hyperbaric o2 therapy
O2 toxicity, central and peripheral nervous system toxicity
Claustrophobic
What laws are used on HBO
Boyles, Henry, daltons, ficks law
Calculate air to o2 ratio
100-Fio2/ fio2- 21
Calculate total flow output on AEN
Flow x( 1+ air entrainment factor)
What’s the indication for o2 therapy
- documented or suspected hypoxemia
- severe trauma
- acute MI
- short term therapy and surgical intervention
Standard precaution
Universal- gloves
Most common bland aerosol device
Large volume aka let neb
Indications for breathing treatment
Sob, WOB, wheezing, COPD, Asthma, dyspnea
IPPB indications
Improve lung expansion, atelectasis, IS was unsuccessful, clear out secretion, short term noninvasive ventilation, aerosol therapy and severe bronchospasm.
Containdication for IPPB
-ICP >15
- hemodynamic instability
- recent face surgery
- tracheoesophageal fistula
- esophageal surgery
- hemoptysis
- nausea
Untreated tuberculosis
How to use IPpB
Assemble circuit, appropriate interface, dial settings per order, high fowlers, passive inhalation and exhalation
What does nitric oxide do
Improves blood flow to alveoli which will improve o2 transport
