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RCP > Midterm 202/203 > Flashcards

Midterm 202/203 Flashcards

1
Q

Open-ended questions

A

= asks the patient to provide narrative information

THOUGHT PROVOKING

Begin the interview, introduce new questions, and gather further information whenever the patient introduces a new topic

Unbiased

Examiner stops and listens to patients concerns (long answers)

“Tell me about it” “Anything else?” type of questions examiners ask (build and enhance rapport)

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2
Q

Closed or Direct questions

A
  • asks the patient for specific information

GIVE LIMITED INSIGHT

Short one-word or two-word answers, yes or no, or forced choice

Closed question is used to fill in the details the patient may have left out

Closed questions are used to obtain specific facts (cold facts)

Speed up interview process, useful in emergency situations (limit rapport and leave interaction neutral)

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3
Q

Level 1 of communication

A

= peak communication-highest level, reserved for couples, immediate family, close friends

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4
Q

Level 2 of communication

A

= feelings and emotions-used within atmosphere of trust and mutual respect for close family and friends

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5
Q

Level 3 of communication

A

= personal judgment or ideas- beginning of self-disclosure with some risk for coworkers and close friends

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6
Q

Level 4 of communication

A

= reporting factors- some sharing, neutral topics with nothing personal

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7
Q

Level 5 of communication

A

= cliche conversation- no genuine sharing, shallow with standard answers

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8
Q

3 V’s of communication:

A

Visual- How you look, including your body language, facial expressions, posture, and clothing

Vocal- How you sound, including your tone, volume, pace, pitch, and accent

Verbal- What you say, including your vocabulary, grammar, word choice, and delivery

93% nonverbal

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9
Q

Social space

A

4 to 12 feet for casual and professional relationships

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10
Q

Personal space

A

1.5 to 4 feet for family and friends

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11
Q

Intimate space

A

close physical contact and 1.5 feet (18 inches) for romantic partners

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12
Q

A major burn

A

covering > 25% or more of total body surface area (TBSA)

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13
Q

Large burn

A

patients typically have a deep, painful wound and are risk for sepsis
- And progressive multiorgan dysfunction

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14
Q

First degree burn

A

→ red, dry, painful wounds that often are deeper than they appear;
sloughing occur the next day
- Painful

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15
Q

Second degree burn

A

→ red, wet, very painful wounds. Their depth, ability to heal and
propensity to form hypertrophic scars vary immensely
- Painful

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16
Q

Third degree burn

A

→ leathery, dry, insensate, waxy wounds that do not heal
- Not painful

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17
Q

Fourth degree burn

A

wounds that involve underlying subcutaneous tissue, tendon, or bone

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18
Q

Static compliance

A

= reflects the elastic properties of the lung and chest wall (resistance)
- 70-100mL/cm H2O
- Decreases in ARDS, Pneumonia, Pulmonary edema, Atelectasis, Pneumothorax, and Pleural effusion
APPAPP

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19
Q

Static compliance equation

A

Volume፥plateau pressure-PEEP

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20
Q

Dynamic compliance

A

= reflects the airway resistance and elastic properties of the lung and chest wall
- 50-100 mL/cm H2O
- Decreases in pulmonary edema, pulmonary hypertension, and fibrosis
PPF

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21
Q

Dynamic compliance equation

A

Volume፥PIP-PEEP

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22
Q

Compliance

A

= combined chest wall and lung compliance must be high enough that work ofspontaneous breathing is not excessive

  • Should be at least 50mL/cm H2O
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23
Q

ECMO

A

= a method of gas exchange in which a large-bore cannula drains blood from the patient, the blood is pumped through an oxygenator, and the oxygenated/ventilated blood is returned to the patient

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24
Q

Goal of VV ECMO

A

allow the patient’s injured lung to rest and be exposed to lower lung volumes, peak end-expiratory pressures, and lower FiO2 support

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25
Q

Criteria for ECMO

A

For patients with extreme hypoxemic respiratory failure/ARDS with compromised gas exchange

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26
Q

Right patient for ECMO

A
  • 50%-80% mortality rate
  • PaO2/FIO2 less than 150 on FIO2 greater than 0.9
  • Murray score of 2-3
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27
Q

Access points of ECMO

A
  1. Right internal jugular vein
  2. Femoral vessels
  3. Subclavian vessels
  4. Axillary vessels
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28
Q

Venovenous (VV)

A

= Provides support for ONLY Respiratory Failure

  • Supports oxygenation and CO2 removal and requires an adequate cardiac function
  • Acts as a third lung
  • TYPICALLY PREFERRED
  • Right atrium to right atrium
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29
Q

Venoarterial (VA)

A

= Provides support for BOTH Cardiac & Respiratory support

  • Provides oxygenation, CO2 removal and also adequate perfusion
  • Typically used for kids and NICU
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30
Q

Monitoring ECMO

A
  1. Visual
  2. Aline for frequent ABG’s to ensure adequate gas exchange
  3. Measure pressures/resistance to flow
  4. Cannula placement
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31
Q

Acetylcholine

A

Parasympathetic of nervous system

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32
Q

Azotemia

A

characterized by abnormal levels of nitrogen-containing compounds, such as urea or creatinine

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33
Q

Uremia

A

elevated urea nitrogen levels

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34
Q

Systemic effects of uremia

A

Cardiopulmonary= hypertension, pericarditis with fever, chest pain, pulmonary edema, and Kussmaul respirations

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35
Q

ICP range

A

10-15mmHG

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36
Q

ICP greater than 20 for more than 5-10 minutes

A

abnormally high

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37
Q

ICP greater than 25mmHG for prolonged time

A

poor patient outcome

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38
Q

Causes of decreased ICP

A
  • Head elevation
  • Decrease in CSF volume
  • Severe arterial hypotension
  • hyperventilation/hypocapnia
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39
Q

Causes of increased ICP

A
  • Increased volume of brain (edema or tumor) or blood (hemorrhage/hematoma)
  • Restrictive venous outflow (CVP)
  • Right heart failure/cor pulmonale
  • High intrathoracic pressure (PEEP/recruitment maneuvers)
  • Severe arterial hypertension
  • hypoventilation/hypercapnia
  • Hypoxia
  • Intubation
  • suctioning/cough
  • High PEEP
  • High MAP
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40
Q

PSV

A

= variation of the spontaneous mode of ventilation that augments (change/support) a patient’s spontaneous effort with positive pressure

  • patient spontaneously breathing
  • Low spontaneous tidal volume
  • High spontaneous frequency
  • Increased WOB
  • facilitate weaning in a difficult-to-wean patient
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41
Q

CMV

A

= ventilator delivers the preset tidal volume at a set time interval (time-triggered frequency) (controls patients tidal volume, respiratory, minute ventilation)

  • if patient ¨fights¨ the ventilator in the initial stages of mechanical ventilatory support
  • tetanus or other seizure activity
  • complete rest for the patient for 24 hour period
  • patient with a crush chest injury
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42
Q

SIMV/VC

A

= patient spontaneously breathes while giving mandatory breathes when needed (rate set)

  • ventilatory support
  • patient provides part of minute ventilation
  • Mainly for patients out of surgery
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43
Q

SIMV/PC

A

= patient spontaneously breathing while time triggered by present frequency (rate set)

  • severe ARDS (need high PIP)
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44
Q

AC/VC

A

= mandatory mechanical breaths may be patient-triggered by the patient’s spontaneous inspiratory efforts (assist) or time-triggered by a present frequency (control)

  • provide full ventilatory support
  • stable respiratory drive
  • Set tidal volume in volume control
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45
Q

AC/PC

A

= mandatory pressure-controlled breathes are time-triggered by a preset frequency (pressure plateau created)

  • severe ARDS (need high PIP)
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46
Q

PRVC

A

= provides volume-controlled breaths with the lowest pressure possible by altering the flow and inspiratory time

  • achieve volume support while keeping the PIP at a lowest level possible
  • Lowers flow to decrease resistant and decrease pressure
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47
Q

MMV

A

= causes an increase of mandatory frequency when the patients spontaneously breathing level becomes inadequate (safe minute ventilation)

  • Additional function of SIMV mode
  • prevent hypercapnia
  • preventing hypoventilation
  • preventing respiratory acidosis
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48
Q

PAV

A

= provides pressure support based on changes with the patient’s breathing effort over time

  • No target flow, volume, or pressure during mechanical ventilation
  • Can over inflated lungs
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49
Q

VV+

A

combines two different dual mode volume-targeted breath types

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50
Q

APRV

A

= inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing

  • Delivered Vt determined by pressure gradient between Phigh (PINSP) and Plow (PEEP)
  • No respiratory rate since patient is breathing on their own
  • For severe ARDS (decreased lung compliance)
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51
Q

HFOV

A

= minimize development of lung injury while providing mechanical ventilation

  • Delivers extremely small volumes at high frequency
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52
Q

PEEP

A

= increase the end-expiratory or baseline airway pressure that reinflates collapsed alveoli and supports and maintains alveolar inflation during exhalation

  • NOT A STAND ALONE MODE
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53
Q

Indications for PEEP

A
  • Intrapulmonary shunting
  • Refractory hypoxemia → not responding to method
  • Decreased FRC
  • Decreased lung compliance
  • Auto-PEEP (patient not getting rid of gas in system) not responding to adjustments of vent systems
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54
Q

Complications of PEEP

A
  • Decreased venous return → decreased CO and hypotension
  • Barotrauma → PEEP greater than 10cmH2O lead to alveoli rupture
  • Increase ICP
  • High PEEP effects- INCREASED PAP, INCREASE CVP, DECREASE PCWP
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55
Q

Otis equation

A

ASV use the otis equation to calculate the optimal (best) frequency that corresponds with lowest WOB

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56
Q

BIPAP

A

applies independent positive pressure pressures (PAP) to both inspiration and expiration

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57
Q

Indications for BIPAP

A
  1. Help prevent Intubation for end-stage COPD patients
  2. Supporting patients with chronic ventilatory failure
  3. Patients with Restrictive diseases, Neuromuscular diseases, and NOCturnal Hypoventilation
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58
Q

Guidelines for BIPAP

A
  1. Respiratory acidosis
  2. Tachypnea
  3. Respiratory distress with dyspnea
  4. Use of accessory muscles
  5. Abdominal paradox
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59
Q

Inspiratory Positive Airway Pressure (IPAP)

A

= Applied only in Inspiration

  • think Ventilation (VT) (Improves Ventilation & Hypoxemia)
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60
Q

Expiratory Positive Airway Pressure (EPAP)

A

= Continuously applied during Inspiration and Exhalation
- think Oxygenation (SpO2) (Improves FRC & Shunting)

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61
Q

Goal for BIPAP

A
  1. Decrease intubation rate
  2. Decrease pneumonia rate
  3. Increase survival rate
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62
Q

ABG

A

provides information on patients ventilation (PaCO2), oxygenation (PaO2), and acid-base (pH) status

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63
Q

Asthma

A

= A chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity, characterized by exacerbations of wheezing and coughing

Anatomic Alterations of the Lungs
- Smooth muscle constriction of bronchial airways (bronchospasm)
- Excessive production of thick, whitish bronchial secretions
- Mucous plugging
- Hyperinflation of alveoli (air trapping)
- Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)

Patient Assessment-History and Physical exam
- SOB-pursed-lip breathing, chest tightness
- Appearance of the chest –increased A-P diameter during an attack
- Respiratory Pattern- Accessory muscle usage, retractions (more so in kids)

Diagnostic Chest Percussion – hyperresonant/tympanic note

BS - Diffuse wheezing, bilateral wheezing, diminished breath sounds, prolonged expiration

Physical Appearance – diaphoresis
Vitals – tachycardia, tachypnea
- Decreased blood pressure during inspiration
- Increased blood pressure during expiration

Chest X-ray –During an attack increased A-P diameter, translucent lung fields, depressed or flattened diaphragm

ABG – Initially acute respiratory alkalosis with hypoxemia then acute respiratory acidosis

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64
Q

Asthma PFT

A

PFT –Spirometry shows reduced flowrates during an attack

  • Post-bronchodilator: if asthma return to normal
  • Significant response if FEV1 increases at least 12% and 200ml (Peak Flow Meter)
  • Bronchial Provocation test –FEV1 decreases significantly when methacholine is given
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65
Q

COPD

A
  • Inhalers with bronchodilators or steroids to help people with lung disease like COPD.
  • high heart rate
  • high BP
  • high RR
  • leaning forward position to breathe
  • pursed lips
  • decreased tactile fremitus
  • bilateral diminished with scattered expiratory wheezing, basilar rhonchi
  • possible edema
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66
Q

Mallampati classification method used

A

Class 1= conscious sedation, soft palate, fauces, uvula, anterior and posterior tonsillar pillars

Class 2= conscious sedation, soft palate, fauces, and uvula

Class 3= seek anesthesia consultation, soft palate, and base of uvula

Class 4= seek anesthesia consultation, soft palate only

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67
Q

Et tube

A

size 7.5 to 8 typical male size and 7.0 to 7.5 for adult females

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68
Q

Propofol

A

= aka Diprivan used for sedation
- Intravenous use
- GABA-activated chloride ion channel

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69
Q

Etomidate (Amidate)

A

= sedation and induction

= decreases cerebral metabolic rate, cerebral blood flow, and intracranial pressure

  • Etomidate binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore is open
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70
Q

Endotracheal Tube

A

artificial airway that is passed through the mouth or nose and advanced into the trachea

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71
Q

OPA

A

designed to relieve obstruction in the unconscious patient caused by the tongue and other soft tissue

Adult female- 80mm/3
Adult male- 90mm/4
Large adult- 100mm/5

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72
Q

NPA

A

relieve obstructions in the conscious or semiconscious patient caused by the tongue esophageal obturator airway. Can be used to facilitate ventilation or removal of secretions

Adult female- 6 (24-Fr)
Adult male- 6 (28-Fr)
Large adult- 8-9 (32-36 Fr)

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73
Q

VAP

A

= infection of the lung parenchyma that is related to any or multiple events that the patient undergoes during mechanical ventilation that happens after 48 hours

  • proper handwashing techniques
  • closed suction systems
  • continuous feed humidification systems
  • change of ventilator circuit only when visibly soiled
  • elevated head of 30-45 degrees
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74
Q

Ventilation

A

= the movement of gas in and out of the lungs → moves oxygen to enter the body and carbon dioxide to be removed

  • Focuses on the PaCo2
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75
Q

Oxygenation

A

= amount of oxygen available for metabolic functions; affected by ventilation, diffusion, and perfusion

  • Focuses on the PaO2
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76
Q

IBW

A

F → 45 + 2.3 x (inches over 5’)

M→ 50 + 2.3 x (inches over 5’)

THEN → answer x 8 = tidal volume

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77
Q

Oxyhemoglobin dissociation curve shifts RIGHT → P50 INCREASES

A
  • low pH (more acidotic)= curves right
  • increase in body temp = curves right
  • PCO2 increase = curves right
  • 2,3 BPG increase = curves right
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78
Q

Oxyhemoglobin dissociation curve shifts LEFT → P50 DECREASES

A
  • high pH = curves left
  • decrease in body temp = curves left
  • PCO2 decrease = shift left
  • Fetal hemoglobin = shifts left
  • Carbon monoxide hemoglobin = shifts left
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79
Q

Dead space

A

= volume of gas moves in and out of the lungs without taking part in gas exchange

  • ARDS
  • 150mL for anatomic dead space (conducting airways)
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80
Q

CO poisoning

A

= occurs when carbon monoxide builds up in the blood

  • Carboxyhemoglobin reduces the hemoglobin O2 saturation
  • CO causes a leftward shift in the oxyhemoglobin curve
  • Measure with Co-oximetry
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81
Q

Treat CO poisoning

A

→ ADMINTRATE 100% OXYGEN

  • Considered hyperbaric oxygen therapy (HBOT)
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82
Q

Bronchoprovocation test

A

Methacholine Challenge

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83
Q

Chronic Hypercarbia

A

CO2 Retainer

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84
Q

Controlled O2 concentration

A

Specific FiO2

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85
Q

Expiratory Balloon Valve

A

One-way valve

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86
Q

HFNC

A

VapoTherm or Optiflow (Fisher & Paykel) (NOT HFNC up to 15L)

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87
Q

Liberation Parameters

A

Weaning

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88
Q

NIPPV

A

NPPV = NIV = BiPAP

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89
Q

Contact transmission

A

the spread of microorganisms by direct or indirect contact with the patient or the patient’s environment, including contaminated equipment

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90
Q

Droplet transmission

A

the spread of microorganisms in the air via large droplets (larger than 5 um)

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91
Q

Airborne transmission

A

the spread of microorganisms in the air via small droplet nuclei (5um or smaller)

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92
Q

H cylinders

A

= home use primarily as backup system in cae the concentrator fails or these is a power outage

  • can be used for infants who require very little flow, or if flows higher than concentrator capabilities are required
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93
Q

High-pressure gas cylinder

A

used in hospital setting in areas that lack piped wall gas and during patient ambulation or transport

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94
Q

Duration of flow equation

A

Duration of flow= [gauge pressure (psi) x cylinder factor] ፥ flow (L/min) → ፥60

PSI= 2200

E tank → 0.28

H tank → 3.14

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95
Q

LOX (liquid-oxygen system)

A

efficient way to store supplemental oxygen

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96
Q

Stationary home storage cylinder (“base” unit)

A

holds between 45 and 100 pounds of LOX

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97
Q

Duration of flow (LOX)

A

LOX weight in pounds to volume of gaseous O2 in liters

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98
Q

1 L of liquid O2

A

vaporizes into 860L of gaseous O2

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99
Q

1 lb of LOX

A

equals approximately 344 L of gaseous O2

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100
Q

LOX calculation

A

→ total available gaseous O2 ፥ prescribed flow (L/min)

  • portable LOX systems are used in conjunction with a stationary base unit
  • typical portable unit holds about 1L of LOX and weighs less than 6 pounds
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101
Q

Cylinders

A
  • cylinders can last longer with O2-conserving device
  • O2-conserving devices minimize O2 waste that occurs during exhalation with standard nasal cannula
  • can reduce 50-75%, doubling or tripling duration of flow from bulk sources
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102
Q

Simple reservoir cannula

A

= store O2 in a small reservoir during exhalation and release it during inhalation

  • bulky appearance not well tolerated by patients
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103
Q

Pulse-dose/demand flow systems

A

= these systems trigger a valve that delivers O2 only during inspiration

  • flow must be individually adjusted to achieve desired SpO2
  • if fails →patient must switch to continuous O2 source at 2-3 times the conserving device flow
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104
Q

BIPAP requirements

A

the patient has control over his or her upper airway function, can manage secretions, and is cooperative and motivated

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105
Q

BIPAP indications

A
  • to avoid intubation of patients in hypercapnic respiratory failure (COPD)
  • to avoid reintubation of patients after extubation
  • to treat patients with acute cardiogenic pulmonary edema
  • to treat patients with sleep apnea (CSA)
  • to support patients with chronic hypoventilation syndromes
  • to alleviate breathlessness and fatigue in terminally ill patients
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106
Q

BiPAP hazards/complication

A
  • Local skin damage from the mask
  • Mild stomach bloating
  • Dry mouth
  • Leaking from the mask, causing less pressure to be delivered
  • Eye irritation
  • Trouble clearing phlegm
  • Sinus pain or sinus congestion
  • Anxiety or claustrophobia preventing you from keeping mask on and cooperating with ventilator
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107
Q

BIPAP settings

A

Tv → aiming for 6-8 mL/kg

Pressure limit → IPAP= 10-15

Rate → backup rate at least 8

Trigger/sensitivity → 1-2cm H2O below baseline or 1-3L/min below baseline flow

Flow, I:E ratio → in 20-30% range

FiO2 → 40%

Flow waveform → no spiking

PEEP → EPAP= 5

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108
Q

BIPAP adjust pH/PaCO2

A

To INCREASE pH or DECREASE PaCO2 → INCREASE IPAP or INCREASE PEEP

TO DECREASE pH or INCREASE PaCO2 → DECREASE IPAP or DECREASE PEEP

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109
Q

Condensation

A
  • condensation can trigger breaths without pt effort; proper tubing replacement can help avoid occlusion of side stream sampling systems
  • with heated humidifiers or any nebulizer
  • use large-bore corrugated tubing with water trap/drain to avoid blockage by condensation
  • HME or heated wires can eliminate condensation → a little is acceptable
  • prevent accidental drainage into pt airway
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110
Q

Oxygen concentrator

A

electrically powered device that physically separates the O2 in RA from nitrogen (N2)

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111
Q

Oxygen concentrators use

A

sodium-aluminum silicate pellets to absorb nitrogen, CO2, and water vapor and produce about 90-95% O2 at flows up to 10L/min

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112
Q

Nasal cannula

A

1-6L for adults with 22-45% FIO2

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113
Q

FIO2 equation

A

LPM x 4 + 20

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114
Q

Hyperventilation cause

A
  • Blood clot (CVT or pulmonary embolism)
  • Heart failure
  • Pulmonary edema
  • Infection → pneumonia
  • scarring of lungs → pulmonary fibrosis
  • Asthma
  • COPD
  • Drug overdose
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115
Q

Briggs adaptor

A

aka T-piece;patient is only breathing on oxygen
- an instrument used in weaning of a patient from ventilator during spontaneous breath trials

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116
Q

Levy-Jennings graph

A

=most common plotting format used for statical Q/C
plots individual values for control media over multiple measurements and compares these values with mean and standard deviation (+-2) of data

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117
Q

MDI steps

A
  • shake canister
  • wait less than 1 minute between puffs
  • have patient hold breath for 10 seconds to allow MAXIMUM DRUG DEPOSITION
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118
Q

Dry powder inhaler steps

A
  • correct patients technique
  • higher inspiratory flows are needed (greater than 60L/min)
  • breath hold not required
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119
Q

Dry powder inhaler

A

Spirvana

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120
Q

Large-volume air entrainment nebulizer (LVN)

A

= provide humidification (and O2) for a bypassed upper airway and reduce inflammation for patients with upper airway edema

  • large volumes with high output of aerosol
  • interface include t-piece
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121
Q

Small-volume nebulizer (SVN)

A

= delivers aerosolized medications

  • input gas flow 6-8L/min for optimal particle size
122
Q

Ultrasonic nebulizer

A

= small is to deliver inhaled medications while large is to help thin secretions or for sputum induction

  • high volume and high density
123
Q

Vibrating-mesh nebulizer

A

= deliver inhaled medications

  • agitation created by vibrations creates aerosol droplets
  • preferred with mechanically ventilated patients
124
Q

TB

A

= A contagious chronic bacterial infection that primarily affects the lungs

  • fever
  • night sweats
  • cough
  • weight loss

TB pathogen, Mycobacterium tuberculosis—a rod-shaped bacterium with a waxy capsule

Anatomic:
- Alveolar consolidation
- Alveolar-capillary destruction
- Caseous tubercles or granulomas
- Cavity formation
- Fibrosis and secondary calcification of the lung parenchyma
- Distortion and dilation of the bronchi
- Increased bronchial airway secretions

Diagnosis:
- Mantoux tuberculin skin test
- Acid-fast bacilli (AFB) sputum cultures
- The QuantiFERON-TB Gold (QFT-G) test
- The rapid Xpert MTB/RI assay

CXR →may show infiltrates or cavities, interstitial markings bilaterally, increased opacities, calcifications, fibrosis

125
Q

TB treatment

A
  • Pharmacologic agents
  • Consists of 2 to 4 drugs for 6 to 9 months
  • Isoniazid (INH) and rifampin (Rifadin) are first-line agents prescribed for the entire 9 months
  • Isoniazid is considered to be the most effective first-line antituberculosis agent
  • Rifampin is bactericidal and is most commonly used with isoniazid
  • When the TB is resistant to one or more of these agents, at least three or more antibiotics must be added to the treatment regimen and the duration should be extended
  • Oxygen therapy protocol
  • Airway clearance therapy protocol
  • Mechanical ventilation protocol
  • Infectious control measures protocols
126
Q

Inspiratory flow

A

Tidal Volume (L) / Inspiratory Time (s) x 60

127
Q

Venturi mask (AE mask)

A

→ 4-12L/min →24-50% for unstable COPD

  • provide stable FIO2 to provide total flow of at least 40 L/min
128
Q

Cool aerosol (AE nebulizer)

A

→ 10-15L/min → 28-100%

  • for patients with artificial airways requiring low to moderate FIO2
  • post-extubation or post upper airway surgery
129
Q

Point-of-care analyzer

A

= involves the collection, measurement, and reporting of selected lab tests at or near the site of the patient care

  • ABG
130
Q

Low exhaled volume

A

= should be set at 100mL lower than expired mechanical tidal volume

  • alarm triggered if patient does not exhale an adequate tidal volume
131
Q

Low inspiratory pressure

A

= should be set at 10-15cmH2O below the observed PIP

  • alarm triggered if PIP is less than alarm setting
132
Q

High inspiratory pressure

A

= should be set 10-15cmH2O above observed PIP

  • alarm triggered when PIP is equal or higher than the high pressure limit
133
Q

Apnea

A

= should be set 15-20 seconds time delay

  • triggered in circuit disconnection, ET suctioning
134
Q

High frequency

A

= should be set at 10/min over the observed frequency

  • triggering is a sign of respiratory distress
135
Q

High/low FIO2

A

should be set 5-10% over and under analyzed FIO2

136
Q

Quality control on pulse ox/oxygen analyzer

A
  • check probe position
  • warm probe site
  • fingernail polish

Check heart rate manually to see if sensor is working

137
Q

FVC maneuver

A

= to obtain VC and other volumes as well as flows to help determine the presence and the severity. of obstructive and restrictive disease processes

  • 2 largest FVC and FEV1 measurements must be within 200mL or % of each other
138
Q

Back extrapolated Volume

A

patient hesitated → greater than 5% FVC or 150mL

139
Q

MMV

A

= calculates how much gas patient can move in a minute

  • patient deeps breaths and rapid for 12-15 seconds
140
Q

Single breath DLCO

A

= to measure amount of CO that crosses the alveolar-capillary membrane in units of mL per minute per unit of pressure

  • 25-30%
  • helps quantify the diffusing capacity of lungs
  • single inhalation of gas that includes small amount of CO and He with 10 second breath hold
141
Q

Troubleshooting spirometry

A
  1. inject 3L of room air into the spirometry
  2. occlude the breathing circuit at the patient interface
  3. use manufacturer recommended method to pressurize the system to 3cmH2O
  4. observe for any change in volume over 1 minute
  5. ATS volume accuracy standard for diagnostic spirometers is +3 or +50mL
142
Q

Incentive spirometry

A

= simple disposable indicator devices to help patients perform slow, deep breaths accompanied by a breath-hold (sustained maximal inspiration)

  • patient must be able to cooperate and general a INSPIRATORY capacity that is at least ⅓ of predicted values
143
Q

Troubleshooting IS

A

→ patient cant cooperate or generate IC greater than 33% predicted

  • not inhaling fast
  • not blowing into device
144
Q

Catheter size

A

ETT or trach ID size x 2 → choose next smallest catheter size

145
Q

Adults suction wall regulator

A

= -100 to -150mmHg

  • negative pressure
146
Q

Pleural drainage system

A

remove air or fluid from the pleural space via tube properly positioned inside the chest cavity

147
Q

One way seal

A

prevent air from returning to the pleural space

148
Q

Suction control

A

for adjusting the negative pressure applied to the chest tube

149
Q

Collection chamber

A

for gathering fluid aspirated through the chest tube

150
Q

1 chamber

A

= initially contains 100mL sterile water

  • long tube submerged in exactly 2cm of water (water seal)
151
Q

2 chamber

A

chamber 1 collects all pleural fluids. chamber 2 remains constant and the work of spontaneous breathing is unaffected

152
Q

3 chamber

A

chamber 1 collection chamber of pleural fluid. chamber 2 water seal chamber with 2cm of water and acts as water seal. chamber 3 suction chamber regulates amount of suction in the three-chamber system

153
Q

Troubleshooting chest tube

A

pinch the chest tube near its insertion point into the patient

154
Q

NRB

A

= for emergencies, short term therapy requiring high FIO2, or for heliox therapy

  • minimum 10L/min to prevent bag collapse
  • 60-80% FIO 2
155
Q

Heliox

A

= helium with oxygen that can help decrease the work of breathing, especially in patients with large airway obstruction or severe asthma

  • 1.8 for 80/20%***
  • 1.6 for 70/30%
  • 1.4 for 60/40%
156
Q

SST

A

short self test

157
Q

Dual-limb “wye circuit”

A

= used on intensive care ventilation

  1. inspiratory limb that delivers fresh gas from ventilator to patient
  2. a standard 15-mm patient connector/swivel adapter
  3. expiratory limb that directs expired gas to the ventilator expiratory valve or PEEP/CPAP valve
158
Q

Single-limb circuit with exhalation valve

A

used in home care of transport ventilators

159
Q

Single-limb circuit without exhalation valve

A

noninvasive ventilators

160
Q

PEP device

A

= used to aid secretion clearance, help prevent or treat atelectasis, and reduce air trapping in asthma and COPD

  • generate 6-25cmH2O pressure during exhalation
  • allow unrestricted inspiration
161
Q

Flutter valve/Acapella (PEP)

A

patient exhales against a threshold resistor with an expiratory valve oscillating at 10-30Hz

162
Q

Transcutaneous monitoring

A

= monitors employ a sensor with miniaturized PO2 and PCO2 electrodes like those in lab ABG analyzers along with heating element

  • heating elemental “arterialized” the blood by dilating the underlying capillary bed and increased its blood flow
  • oxygen and CO2 diffuse from capillaries through the skin and into the sensor’s contact gel, where their pressure are measured by electrode
163
Q

Reduce VAP

A
  • elevate head of bed 30-45%
  • implementing sedation vacations and SBTs
  • providing peptic ulcer disease prophylaxis
  • providing oral care with chlorhexidine
  • using subglottic ETTs that remove secretion above ETT cuff
  • in-line or closed-suction catheter to avoid breaking the circuit
164
Q

3 stages for ABG

A
  1. measure CO2%
  2. confirm three levels of measurement
  3. adding a high-precision gas with 10% CO2 (PCO2=76mmHG)
    - tap the syringe to fix air bubbles
165
Q

Bourdon Guage regulator

A

a medical device that measures gas pressure and gas flow rate for respiratory equipment

166
Q

Bourdon guage calibrate

A

A dead weight tester can be used to calibrate a Bourdon tube pressure gauge by adding weights to a platform that puts a known force on a piston

167
Q

Thrope flowmeter

A

a medical instrument that measures the flow rate of gases, such as oxygen

168
Q

Calibrate thrope flowmeter

A
  • Turn the selector ring until the arrow is above the green “continuous flow”
  • Turn the white flow control knob until the red ball is at the same height as the indication line on the Thorpe tube
  • Turn the selector ring to the right until the arrow is above the desired therapy level
169
Q

ECG

A

used to assess rhythm disturbances, determine the heart’s electrical axis, and identify the site and extent of myocardial damage

170
Q

ECG troubleshooting

A
  • verify ECG snaps and connectors are clean and corrosion free
  • verify lead electrodes are connected properly to patient
  • electrode gel is not dry
  • check ECG main cable
  • confirm patient is motionless
  • verify device’s setting
171
Q

Abnormal P wave

A

left or right atrial hypertrophy (enlarged muscle)

172
Q

Absent P wave

A

AFIB

173
Q

Prolonged QT

A

greater than 0.45 seconds, MI

174
Q

Shortened QT

A

less than 0.30 seconds, electrolyte imbalance, digoxin

175
Q

Shortened R-R

A

less than 0.60 seconds, tachycardia

176
Q

Prolonged R-R

A

greater than 1.00 second, bradycardia

177
Q

Depressed ST

A

non-ST elevation, MI/infarction (NSTEMI)

178
Q

Elevated ST

A

ST elevation, MI/infarction (STEMI)

179
Q

Tall T wave

A

hyperkalemia

180
Q

Small, flat T wave

A

MI, hyperventilation, pulmonary embolism

181
Q

Non-disposable equipment

A
  • vinegar
  • soap and water
182
Q

Sterilization

A

the destruction of all forms of microbial life, including bacteria, viruses, spores, and fungi

183
Q

Glutaraldehyde (cidex)

A

liquid chemical solution can be achieved in 20 minutes at room temperature, but true sterilization requires full 10 hours

184
Q

Hemothorax CXR

A
  • blunting of costophrenic angle
  • partial to complete opacification of affected half of thorax
185
Q

Pneumothorax CXR

A

regions of darkness around the lungs

186
Q

Pleurisy CXR

A

cannot be shown in CXR directly if they do not have fluid in them

187
Q

Infiltrates CXR

A
  • substances denser than air, pus, edema, blood, surfactant, protein, or cells
  • loungers in the lung parenchyma
  • small patchy opacities scattered in the lungs
188
Q

Pleural effusion CXR

A
  • dependent opacities with lateral upward sloping
  • looks more like fluid in lungs rather than blurry opacities such as hemothorax
189
Q

Crepitus

A

bubbles on the skin that produce a crackling sensation seen in subcutaneous emphysema
- conjunction with pneumothorax

190
Q

FEV1 post-bronchodilator

A

< (less than) 80% predicted and FEV1/FVC ratio < 70%

191
Q

FEV formula

A

Normal FEV1% (FEV1/FVC x 100)
- 70% or more for most patients

192
Q

Percent change formula

A

% change= post – pre ፥ pre x 100

193
Q

Hazards for pre/post FEV1

A
  • dizzy
  • lightheaded
  • tired
  • cough
194
Q

CXR

A

Able to assess and confirm patient’s overall cardiopulmonary status

EET-> 5-10 above carina

195
Q

Radiopacities

A

areas of increased whiteness → high-density objects (bone)

196
Q

Radiolucency

A

areas of darkness → low-density mattern (air)

197
Q

Radiolucency

A

areas of darkness → low-density mattern (air)

198
Q

Orthopnea

A

patient’s sensation of uncomfortable breathing when lying down → find relief when sitting or standing up

199
Q

Diagnostic test for orthopnea

A

Modified borg scale → 0 representing non sensation of SOB/10 representing maximum sensation of SOB

Graded cardiopulmonary exercise test → 6 minute walk test (6MWT) → 0=none, 4=severe

200
Q

Abnormal WOB

A
  • tachypnea
  • thoracic-abdominal dyssynchrony or paradox (see-saw motion)

-x use of accessory muscles

201
Q

Shunt equation

A

a mathematical formula used to determine the percentage of blood that bypasses the normal gas exchange process in the lungs

202
Q

Shunt equation formula

A

Shunt equation→ Qs= CcO2 - CaO2
———————–
Qr= CcO2 - CvO2

1.PAO2= (PB- PH2O) FIO2 - PaCO2 (1.25)

2.CcO2= (Hb x 1.34) + (PAO2 x 0.003)

3.CaO2= (Hb x 1.34 x SaO2) + (PaO2 x 0.003)

4.CVO2= (Hb x 1.34 x SVO2) + (PVO2 x 0.003)

203
Q

Static lung volumes (TLC, FRC)

A

→ RV= FRC – ERV, TLC= FRC + IC

  • helium dilution and nitrogen washout methods both measure actual FRC
  • Body plethysmography measures total Thoracic Gas Volume (TGV)
204
Q

TGV that that exceeds FRC

A

“trapped” gas that is not in communication with the airways

205
Q

Diffusing capacity (DLco)

A

= assessed by measuring the transfer of carbon monoxide (CO) from the lungs into the pulmonary capillaries

  • single-breath test is the most common procedure
206
Q

Peak expiratory flow rate (PEFR)

A
  • monitor airway tone of patients with asthma over time
  • assess changes in airway tone in response to bronchodilator therapy (FEV spirometry)
  • a post-bronchodilator improvement of 12% or more is considered significant
207
Q

Screening/bedside spirometry

A
  • screen for lung dysfunction suggested by history and physical indicators or other abnormal diagnostic tests
  • asses changes in lung function in response to treatment
  • assess the risk for surgical procedures known to affect lung function
  • monitor disease progression
208
Q

Pre/post bronchodilator spirometry (bedside or lab)

A
  • confirm the need for bronchodilator therapy
  • individualize the patient’s medication dose
  • determine patient status during acute and long-term drug therapy
  • determine if a change in dose, frequency, or medication is needed
209
Q

Laboratory spirometry (FVC volumes and flows)

A
  • quantify the severity and prognosis associated with lung disease
  • follow up on bedside spirometry results are not definitive (restrictive)
  • assess the potential pulmonary effects of environmental or occupational exposures
  • assess the degree of pulmonary impairment for rehabilitation or disability claims
210
Q

Carbon monoxide diffusing capacity (DLCO)

A
  • follow course of interstitial lung diseases (pulmonary fibrosis and pneumoconiosis)
  • follow course of emphysema and cystic fibrosis
  • differentiate among chronic bronchitis, emphysema, and asthma in obstructive patients
  • quantify degree of pulmonary impairment disability
  • evaluate cardiovascular disorders
211
Q

Bronchial provocation (methacholine challenge test)

A
  • assess the presence/severity of airway hyperreactivity
  • evaluate occupational asthma
  • determine relative risk of developing asthma
  • assess response to therapeutic interventions
212
Q

APGAR

A

used to assess neonates at 1 and 5 minutes after birth

A= appearance (color)

P= pulse (heart rate)

G= grimace (reflex irritability)

A= activity (muscle tone)

R= respirations (respiratory effort) →m 0= absent, 1= slow, irregular, gasping, 2= crying, vigorous breathing

213
Q

Apgar scoring

A

Normal APGAR score= 7-10

Intensive support for APGAR= 4-6

APGAR score 0-3 → resuscitation

214
Q

acute respiratory acidosis

A

Low pH, Elevated PaCO2, Normal HCO3

215
Q

acute metabolic acidosis

A

Low pH, Low HCO3, Normal PaCO2

216
Q

acute respiratory alkalosis

A

High pH, low PaCo2, normal HCO3

217
Q

acute metabolic alkalosis

A

High pH, normal PaCO2, high HCO3

218
Q

Chronic respiratory acidosis

A

Slightly low pH, Elevated PaCO2, Slightly elevated HCO3

219
Q

chronic metabolic acidosis

A

Slightly low pH, Low HCO3, Slightly low PaCO2

220
Q

Chronic respiratory alkalosis

A

slightly high pH, low PaCO2, normal or slightly low HCO3

221
Q

Chornic metabolic alkalosis

A

slightly elevated pH, slightly elevated PaCO2, high HCO3

222
Q

Common causes of disorientation

A
  1. neurological injury
  2. Sedation and analgesics (opioid)
  3. Severe hypoxemia or hypercapnia
223
Q

Glasgow coma scale

A

Mild impairment= 13-15

Moderate impairment= 9-12

Severe impairment (coma)= 8 and less → INTUBATE

224
Q

PEA

A

Pulseless electrical activity= nons-shockable situations

  • asystole
  • CPR only
  • switch resecurer position every 2 minutes
225
Q

Capnometry

A

measures carbon dioxide concentration in expired gases

226
Q

Capnography

A

= measurement and graphical display of CO2 levels, usually the end-tidal PCO2 or PETCO2

  • in healthy adults → PETCO provides estimate of arterial PCO2 2-5 torr less than ABG or 30-45 torr
  • INCREASE in PaCO2– PetCO2= increase in physiological dead space
227
Q

Sudden change in rise of PETCO2

A
  • sudden increase in cardiac output (ROSC)
  • sudden release of a tourniquet
  • injection of sodium bicarbonate
  • tracheal intubation
228
Q

Gradual change in rise of PETCO2

A
  • hypoventilation
  • increased metabolism/CO2 production (fever)
  • rapid rise in temperature (malignant hyperthermia)
229
Q

Sudden change in fall of PETCO2

A
  • sudden hyperventilation
  • sudden drop in cardiac output/cardiac arrest
  • massive pulmonary/air embolism
  • circuit leak/disconnection
  • esophageal intubation
  • ETT/trach tube obstruction or dislodgement
230
Q

Gradual change in fall in PETCO2

A
  • hyperventilation
  • decreased metabolism/CO2 production
  • decreased pulmonary perfusion
  • decrease in body temperature
231
Q

Central cyanosis

A

= indicates low SaO2 associated with poor oxygenation of blood by the lungs

  • blueish tint of the mucous membranes of the lips and mouth
  • Normal Hb content → SaO2 drops below 80% (PaO2 45-50 torr)
232
Q

Peripheral cyanosis (ACROCYANOSIS)

A

= poor blood flow

  • appear in only extremities
  • can occur in normal SaO2 saturation
233
Q

Circulatory faliure

A

central and peripheral cyanosis present with cool extremities

234
Q

Static lung compliance pressure time curve graph

A

= (C = ΔV / ΔP)

  • determine plateau pressure forming an inspiratory pause maneuver (while employing a square inspiratory flow pattern) during volume-targeted ventilation
  • should be kept below 30cmH2O
235
Q

Static compliance

A

no air movement in the lungs → 60-100cc

236
Q

Dynamic compliance

A

measure of the total impedance to inflation during ventilation-control ventilation → air movement in the lungs → 35-45cc

237
Q

Pulmonary compliance measurement

A
  1. the pressure needed to overcome the elastic recoil of the lungs and thorax (Vt/Crs) on mechanical ventilation
  2. the pressure due to airway resistance (Raw x V1) on mechanical ventilation
  • to assess how easily the lungs can expand and contract
238
Q

Bacterial pneumonia

A
  • restrictive
  • results of inflammatory process that primary affects gas exchange areas of the lungs
  • alveolar consolidation
  • inflammation of the alveoli
  • atelectasis (aspiration pneumonia)
  • abnormal sputum examination
  • C-reactive protein elevated (<100mg/L)
239
Q

Emphysema

A
  • pink puffers
  • decreased DLco
  • permanent enlargement of the air spaces distal to the terminal bronchioles, destruction of their walls and without fibrosis
  • air trapping and hyperinflation
  • excessive bronchial secretions
  • bronchospasms
  • distal airway and alveolar weakening
  • high white blood cell count
240
Q

Pleural effusion

A

accumulation of fluid in pleural space

  • infected
  • lung compression
  • atelectasis
  • compression of great veins and decreased cardiac venous return
241
Q

Pulmonary fibrosis

A
  • hand disease that occurs when lung tissue becomes damaged and scarred
  • thickened, stiff tissue makes it difficult for lungs to work properly
  • presence of high titers of antinuclear or rheumatoid factor
242
Q

Forced vital capacities

A

Total amount of air that the lungs can accommodate

  • capacities are 2 or more
243
Q

Maximum inspiratory pressure (MIF/NIF)

A

= maximum pressure generated against airway occlusion at or near residual volume (RV) after successive inspiratory efforts for 15-25 sec

NIF normal value= -80 to -120cm H2O

NIF critical value= 0 to –20 or -25

244
Q

L/S ratio

A

= a test that measures the ratio of lecithin to sphingomyelin in amniotic fluid to assess the maturity of a fetus’s lungs

Normal: A ratio of 2.0 to 2.5 indicates normal fetal lung development

Immature: A ratio of 1.5 or less indicates immature fetal lung development

Transitional: A ratio of 1.51 to 1.80 indicates transitional fetal lung development

Mature: A ratio of over 1.80 indicates mature fetal lung development

245
Q

Mature surfactant

A

= present around week 35

  • Reduces muscular effort
  • Works in tandem with the change in size of the alveoli
  • Can be measured in amniotic fluid
  • Determined by lecithin-to-sphingomyelin ratio (L/S ratio)
246
Q

Croup

A

= viral infection of the upper airway that occurs most commonly in children 6 months to 3 years old

  • caused by parainfluenza virus, adenovirus, respiratory syncytial virus (RSV), or influence A or B
  • inflammation and swelling or subglottic tissue (larynx, trachea, and large bronchi)
  • barking cough
  • cold-like symptoms that become severe
  • tachypnea
  • lethargy
  • hypotonia
  • cyanosis
247
Q

XRAY croup

A
  • “Steeple sign” Married and tapering airway below larynx due to subglottic edema → tracheal dilation possibly present if the film was taken during expiration
  • may appear normal (little or no evidence of supraglottic involvement)
248
Q

Epiglottis

A

= bacterial infection of the upper airway that occurs mostly in children 2-8 years old

  • WAS caused by haemophilus influenzae
  • NOW caused by staphylococcus aureus and group A streptococcus-associated epiglottis
  • inflammation and swelling of epiglottis aryepiglottic folds, and arytenoids → can lead to airway obstruction and death in HOURS
  • high fever up to 104 degrees celsius
  • irritability, anxiety
  • BS decrease
  • orthopnea or forward leaning preference
  • drooling
249
Q

XRAY epiglottis

A
  • lateral side
  • little to no evidence of subglottis involvement
  • “thumb sign” due to prominent shadow caused by a swollen epiglottis
250
Q

Restrictive PFT

A

= low volumes (unable for lungs to hold air)

  • FVC, IRV, ERV, RV, TLV
  • neuromuscular disorders, obesity, pulmonary fibrosis
251
Q

Restrictive RV, FRC, TLC

A

increased

252
Q

Restrictive FRC

A

less than 80% is restrictive

253
Q

Restrictive FEV1

A

decreased or normal

254
Q

Restrictive FEV1% (greater than 70%)

A

increased or normal

255
Q

Obstructive PFT

A

= low flows (blocking air getting in)

  • FEV1, FEV1% (FEV1/FVC), PEFR, FEF 25-75%
  • asthma, COPD
256
Q

Obstructive RV, FRC, TLC

A

decreased

257
Q

Obstructive FVC

A

Decreased or normal (80%)

258
Q

Obstructive FEV1

A

decreased (less than 8%)

259
Q

Obstructive FEV1% (normal greater than 70%)

A

decreased

260
Q

Mixed (restrictive and obstruction)

A

decreased volume and flows
- FVC, FEV1, FEV1% DECREASED
- cystic fibrosis

261
Q

Hypoxia in infants

A

central cyanosis (lips and mouth are blue) on room air

  • preductal SpO2 that does not quickly normalize
  • lack of fetal movement
  • low heart rate
  • no crying
  • PaO2 needs to maintain at 55-80 torr with SpO2 of 88-95%
262
Q

Chronic/acute PE

A

occurs where fluid builds up in the pleural space

263
Q

Chronic PE

A

→ dry cough, difficulty breathing, fever, chest pain

Chronic pleural effusion treatment:
- antibiotics
- thoracentesis
- steroids anti inflammatory drugs
- bronchodilators

Pleurodesis= procedure offered if thoracentesis didn’t work

264
Q

Acute PE

A

→ fever, chest pain, chills, cough, hiccups, rapid breathing

Acute pleural effusion treatment:
- antibiotics
- diuretics
- steroid anti-inflammatory
- bronchodilator

265
Q

How to normalize a high PaCO2 on a vent or BIPAP.

A

= minute ventilation required needs to be increased → increase ventilatory frequency

  1. Decrease or remove dead space
  2. Increase Tidal Volume
  3. Increase Respiratory Rate
266
Q

How to normalize a high PaO2 on a vent or BIPAP.

A
  1. FIRST- decrease FIO2 to less than .60
  2. THEN - decrease PEEP
267
Q

How to normalize a low PaCO2 on a vent or BIPAP.

A
  1. Increase Dead Space
  2. Decrease the Respiratory Rate
  3. Decrease the Tidal Volume
268
Q

How to normalize a low PaO2 on a vent or BIPAP.

A
  1. FIRST - increase Fio2 by 5-10% (up to 60%)
  2. THEN - Increase PEEP levels by 5cmH20 until:
  • acceptable oxygenation is achieved
  • unacceptable side-effects occur (decrease in compliance, decrease in cardiac function, barotrauma)
269
Q

Tube sizing & cuff pressures

A
  • A improper small size tube can cause leaks with an excessive cuff pressure that can obstruct blood flow (ischemia) → tissue ulceration and necrosis → tracheomalacia
  • A improper big size and low cuff pressure can cause mucosal damage and leakage-type aspiration can occur → VAP
270
Q

Mean arterial BP-MAP

A

70-105mmHG

271
Q

CVP

A

2-6mmHG

272
Q

PAWP

A

6-12mmHG

273
Q

CO

A

4.0-8.0 L/min

274
Q

Cromolyn sodium

A

a mast cell stabilizer that prevents the release of inflammatory mediators, such as histamine and leukotrienes, which cause allergic symptoms and bronchoconstriction

  • managment of asthma
275
Q

SV

A

60-130 mL/beat

276
Q

Nitrogen washout

A

measure FRC, so the ERV from an SVC maneuver is used to calculate RV and TLV

277
Q

Bench hemoximeter

A

a compact device that is placed on a laboratory bench to measure oxygen saturation and hemoglobin concentration

278
Q

FVC equipment

A

Clip: A soft clip is placed on your nose to ensure you breathe through your mouth, not your nose

Mouthpiece: A disposable mouthpiece is attached to the spirometer

Chair: You sit upright in a chair during the test

279
Q

Refractory

A

Treatment not working; no response to it

280
Q

Air leak syndrome

A

Pneumothorax

281
Q

Cannula chatted (chugging)

A

Low intravascular volume then flow decrease then vessels

282
Q

Recruitment

A

Telling alveoli go inflate/helping them inflate

283
Q

Standard precaution

A

“Universal precaution”
- basic level of infection control precaution
example: glove

284
Q

Applying PPE

A
  1. Hair/foot coverings
  2. Gown
  3. Mask
  4. Goggles or face shield
  5. Gloves
285
Q

removing PPE

A
  1. Hair/foot covering
  2. Goggles or face shield
  3. Mask
  4. Gloves
  5. Gown
286
Q

Bordetella pertussis

A

Whooping cough

287
Q

Oxygen analyzer

A

Used Clark electrode aka polarographic type or galvanic fuel cell to measure PO2
- failure to reach 100% or 21% may indicate damaged probe or defective analyzer

288
Q

Percent predicted value

A

%predicted = actual / predicted x 100

289
Q

3-0 liter syringe percent error

A

[(3.00 — Liters) / 3.00] x 100

290
Q

Flow calibration

A

+ - 5

291
Q

Efforts on PFT are reproducible if…

A

2 largest volumes for both FVC and the FEV1 are within 0.150L/150mL of each other

292
Q

POCT preanalyzer errors

A
  1. Calibration error message
  2. Flagged results
293
Q

Alternative for ETT intubation for emergency for ventilator/airway support

A

LMA (cuff pressure max 60cmH2O)

294
Q

What can expiratory obstruction lead to

A
  • CO2 build up
  • rebreathing
  • asphyxia
  • barotrauma
295
Q

In a vent, how can we rule out their circuit obstruction

A

high pressures and low Vt

296
Q

Most common problems causing loss of ventilator volume and pressure

A

large leak

297
Q

Henderson-hasselbalch equation

A

describes the relationship between blood pH, ([HCO3-]), and the partial pressure of carbon dioxide (PCO2), showing how the respiratory system influences blood pH by regulating the level of CO2 through breathing

298
Q

Increase IPAP

A

Have to increase EPAP

299
Q

Increase EPAP

A

Don’t have to increase IPAP

300
Q

Single breath N2 elimination

A

An estimate of anatomical dead space

301
Q

Lung volumes and capacities

A

Normal= 80-120

Mild= 65-80

Moderate= 50-65

Severe= less than 50

302
Q

Airway resistance

A

Body plethysmography

= evaluate airway responsiveness to provocation
- identify obstructive lung diseases

RCP (8 decks)

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