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001 Respiratory Therapy > PA Tests > Flashcards

PA Tests Flashcards

1
Q

The Palliative Ventilator Weaning Pathway is a multidisciplinary approach to discontinuing care on a patient. The pathway involves

a. Using sedative so that a patient with a drive to breath appears to be comfortable
b. Paralyzing the patient to decrease WOB
c. Hyper-oxygenating the patient
d. Using inhaled corticosteroids to improve WOB

A

a. Using sedative so that a patient with a drive to breath appears to be comfortable

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2
Q

During an assessment for Neurological Determination of Death, the physician tests the oculocephalic reflex. The head is vigorously turned to the left. What of the following would be considered a normal response

a. Eyes do not move
b. Eyes move to the right
c. Eyes move to the left
d. Both eyes blink

A

b. Eyes move to the right

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3
Q

Which of the following statements identifies a component of the Palliative Ventilator Weaning Pathway during End of Life Care

a. A verbal order from the nurse in charge of the patient is adequate to commence the procedure
b. Intubated patient with a spontaneous drive to breath are placed in the Airway Management Pathway before the ventilator weaning procedure is commenced
c. Additional sedation can be used if the patient Tobin Score remains >105 during titration of ventilator support
d. The ETT is usually left in situ during discontinuation of care

A

c. Additional sedation can be used if the patient Tobin Score remains >105 during titration of ventilator support

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4
Q

Uncuffed ETT Tube Size in Peds

A

Formula for uncuffed tube: 1 x ETT= (age/4) + 4

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5
Q

Cuffed ETT Tube Size in Peds

A

Formula for Cuffed tube: 1 x ETT= (age/4) + 3.5

Remember that you can used cuffed tubes in any child with the exception of neonates

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6
Q

NG/OG/Foley Size in Peds

A

2 x ETT

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7
Q

Depth of ETT Insertion in Peds

A

3 x ETT

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8
Q

Chest Tube Size in Peds

A

Chest Tube Size= 4 x ETT

*This is for the biggest chest tube size

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9
Q

In pediatric patient, which of the following signs of work of breathing involves the sternocleidomastoids

a. Head bobbing
b. Suprasternal retractions
c. Grunting
d. Nasal Flaring

A

a. Head bobbing

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10
Q

Which of the following is an ancillary test that is used in Neurological Determination of Death

a. Perfusion Scan
b. Caloric Test
c. Apnea Test
d. Pharyngeal Reflex

A

a. Perfusion Scan

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11
Q

A patient with a suspected anoxic brain injury due to prolonged CPR is taken for a CT head immediately after ROSC (Return of Spontaneous Circulation). Which of the following is the CT most likely to show

a. Abnormalities that confirm loss of brain stem function
b. Normal Scan
c. Midline shift
d. Intracranial Hemorrhage

A

b. Normal Scan

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12
Q

Whole brain death indicates

a. Higher brain death
b. The patient will not have spinal reflexes
c. Higher and lower brain death
d. The patient has a small chance of recovery

A

c. Higher and lower brain death

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13
Q

When comparing the airways of a paediatric patient to an adult patient, which of the following is TRUE

a. Apneas <20 seconds in pediatric patients are normal. Apnea is not normal in the adult population
b. The pediatric patient has increased resistance compared to an adult
c. The angle of Louis is located in the same anatomical position in both pediatric and adult patient
d. The pediatric has increased compliance compared to an adult

A

b . The pediatric patient has increased resistance compared to an adult

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14
Q

In preparation for the Apnea test the patient has a baseline ABG of pH 7.37, PaCO2 42, PsO2 90, HCO3 25, SaO2 97. The patient is prepared for Apnea Test according to the procedure 5 minutes after the Apnea Test commences another ABG is drawn. The results are pH 7.35, PaCO2 58, PsO2 55, HCO3 27, SaO2 88. The patient has not made any spontaneous efforts. What does this ABG indicate

a. Apnea test is negative
b. Apnea test should be discontinued
c. Apnea test is positive and the patient cannot be an organ donor
d. The patient was not preoxygenated adequately

A

b. Apnea test should be discontinued

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15
Q

. As an RRT on the Outreach Team, which of the following would you NOT do without a Physician’s order

a. Meet a patient’s increasing oxygen requirements by starting optiflow
b. Intubate a patient
c. Start chest compressions on pulseless patient
d. Puncture an obtunded patient for an ABG

A

b. Intubate a patient

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16
Q

An RRT working on the wards is called to assess a patient. Upon arrival the patient is only rousing with painful stimuli. The patient was speaking coherently with the bedside RN 30 minutes prior to your assessment. You called the switchboard and activate a Code 66. What would you expect?

a. The Outreach team to response within 15 min
b. The Outreach Physician to respond
c. The Outreach team to immediately response
d. The patient MRHP (most responsible health practitioner) to immediately response

A

a. The Outreach team to response within 15 min

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17
Q

Which of the following is a sign Respiratory Failure in a 4 year old patient

a. Hyperpnea
b. Cyanosis
c. Restlessness
d. Nasal Flaring

A

b. Cyanosis

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18
Q

You are paged to a ward. Upon arrival you are directed to a room. You enter and find two ward staff standing by a bed. As you enter the room your initial impression of the patient is that they are apneic and unresponsive. The patient has a HR of 50. As you are making these observations, the staff advise you that the patient has a Goal of Care R1. You ask the staff to:

a. Page for an additional respiratory therapist to help with your assessment of the patient
b. Activate a call for assistance (code blue)
c. Get an AED
d. Do nothing as an R1 is not category that includes CPR in the goals

A

b. Activate a call for assistance (code blue)

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19
Q

The Outreach Team is called to assess a patient. They categorize the call as level one. What does this mean?

a. A code blue should be activated
b. This category indicates the call is non-acute
c. The Intensivist must be notified
d. Only the MRHP (most responsible health practitioner) needs to be called

A

c. The Intensivist must be notified

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20
Q

The primary cause of most cardiac arrest in pediatrics is

a. Cardiovascular
b. Respiratory
c. Due to Trauma
d. Due to disturbances in neutral thermal environment

A

b. Respiratory

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21
Q

Which of the following parameters would prompt you to activate a Code 66

a. A desaturation resulting in SpO2 decreasing to 78% that recovers when placed on 4 lpm nasal cannula
b. The patient has suddenly gone into VTach with a pulse
c. The patient has to be shaken to be roused after given their sleeping pill
d. RR is 25

A

b. The patient has suddenly gone into VTach with a pulse

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22
Q

Which of the following characteristics would be most worrisome when assessing a three year old pediatric patient

a. Poor mentation
b. Crying loudly in response to pain
c. Intercostal retractions
d. A child displaying the characteristics of regressing in mental age

A

a. Poor mentation

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23
Q

Which of the following is NOT a reason to discontinue a bedside apnea test

a. Spontaneous respiratory effort is observed
b. The CO2 exceeds 60 mmHg and there has been a 20 mmHg change from baseline
c. The physician ask you to discontinue the test
d. The ventilator self cycles

A

d. The ventilator self cycles

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24
Q

. The family of the patient in bed 2 would like to discontinue care this afternoon. During you morning routine assessment of the patient, you notice copious amounts of oral secretions. Based on this information which of the following would you recommend to the physician

a. Salbutamol
b. Hypertonic Saline
c. Glycopyrrolate
d. Morphine

A

c. Glycopyrrolate

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25
Q

Member of the Outreach team should notify the Intensivist when

a. A patient requires BiPAP
b. An ABG is required
c. The outreach team has been called twice for the patient in one day
d. A chest X-ray needs to be ordered

A

a. A patient requires BiPAP

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26
Q

Which of the following may cause an increase in the AP diameter of the chest in a pediatric patient?

a. Cystic Fibrosis
b. Pneumonia
c. Pectus Excavatum
d. Kyphosis

A

a. Cystic Fibrosis

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27
Q

You are called to a stat call on the wards and perform an ABG on a patient due to decreased level of consciousness. He has a history of lung cancer and is currently recieveing treatment. You look in his chart and note he is a R2 level of care. This means

a. The patient has chosen comfort measure only
b. The patient would consider chest compression as an intervention
c. The patient does not want to go to ICU for care
d. The patient would consider intubation as an intervention

A

d. The patient would consider intubation as an intervention

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28
Q

What is the purpose of the Spontaneous Breathing Trial during the Airway Management Pathway

a. To demonatrate to family the accuracy of the Apnea Test
b. To predict how long it will take the patient to pass away after the disocntinuousation of care
c. To assess if the patient has an appropriate level of sedation for when they are taken off support
d. To assess the patient for excessive secretions

A

c. To assess if the patient has an appropriate level of sedation for when they are taken off support

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29
Q

Which type of Outreach team can be led by a RRT

a. Medical Emergency Team
b. Code Blue Team
c. Triage Team
d. Rapid Response Team

A

d. Rapid Response Team

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30
Q

In which Goals of Care designation would surgery never be considered

a. C1
b. M1
c. M2
d. C2

A

d. C2

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31
Q

In which period of fetal lung development is the diaphragm completely developed

a. Pseudoglandular
b. Canalicular
c. Embryonic
d. Saccular

A

c. Embryonic

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32
Q

In which phase of fetal lung development does the estimated age of viability occur

a. Pseudoglandular
b. Canalicular
c. Embryonic
d. Saccular

A

b. Canalicular

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33
Q

During fetal circulation

a. There are 2 umbilical veins and one artery
b. Oxygenated blood with an SaO2of 80% is carried away from placenta by umbilical vein
c. SVR is greater than PVR
d. The vast majority of oxygenated blood from the placenta passes through the ducts venous

A

b . Oxygenated blood with an SaO2of 80% is carried away from placenta by umbilical vein

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34
Q

Amniocentesis

a. Carries a risk of miscarriage
b. Commonly performed as a non-invasive test
c. Used primarily to determine gender
d. Relatively risk free

A

a. Carries a risk of miscarriage

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35
Q

What is the anticipated fetal outcome for a woman who is greater than 45 year old and about to deliver a baby?

a. Increased risk of genetic disorder
b. increased risk of fetal alcohol syndrome
c. Baby is more likely to be SGA
d. There is an increased likelihood of poor prenatal care
e. The baby is more likely to be post term

A

a. Increased risk of genetic disorder

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36
Q

You are assessing an infant and note the stethoscope you are about to use is cold. Before ausculatating tha baby you warm the diaphragm of the stethoscope in the isolate. You are trying to acoid heat loss due to

a. Convection
b. Evaporation
c. Radiation
d. Conduction

A

d. Conduction

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37
Q

What is the significance of an infant with RDS demonstrating a grunting during exhaalation

a. An attempt to overcome increased airway resistance
b. Resolution of the RDS
c. An effort to establish/maintain FRC
d. Impending death

A

c. An effort to establish/maintain FRC

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38
Q

What. Is the anticipated fetal outcome for a pregnant women who has diabetes mellitus

a. IUGR
b. Prematurity
c. Large for gestational age
d. Fetal Asphyxia

A

c. Large for gestational age

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39
Q

Assuming all other variable remain constant, as deadspace such as HME is added to neonatal circuit, you would expect

a. Decreased alveolar minute ventilation and decreased PaCO2
b. Increased alveolar minute ventilation and increased PaCO2
c. Decreased alveolar minute ventilation and increased PaCO2
d. Increased alveolar minute ventilation and decreased PaCO2

A

c. Decreased alveolar minute ventilation and increased PaCO2

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40
Q

Entonnox administered during labour

a. Should be used with caution as it causes respitroy depression
b. Mostly composed of oxygen
c. Common analgesic
d. Called nitric oxide

A

c. Common analgesic

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41
Q

A premature infant score 10 on the PIPP. This indicates

a. The infant should be wrapped for comfort
b. Fentanyl IV should be started
c. Tylenol should be administered
d. Infant has minimial pain

A

a. The infant should be wrapped for comfort

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42
Q

Which of these may be associated with cord prolapse during labor

a. An increased risk of infection
b. Dangerous bradycardia of the fetal heart rate monitor
c. Decreased RR
d. Alkaline scalp pH

A

b. Dangerous bradycardia of the fetal heart rate monitor

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43
Q

Which of these disorders may be treated with methylzanthines

a. Transient tachypnea of the newborn
b. Age of prematurity
c. infant respiratory distress syndrome
d. Congenital heart disease

A

b . Age of prematurity

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44
Q

A term neonate presents with central cyanosis, gasping respiration and a HR of 90. What is an appropriate action?

a. Observe for 30 seconds to assess if the baby is experiencing primary apnea
b. Provide CPAP with neopuff
c. Frimly shake the baby to stimulate
d. Commence positive pressure ventilation

A

d . Commence positive pressure ventilation

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45
Q

A symptomatic pneumothorax in a newborn would be treated with

a. Exposure to high FiO2
b. NCPAP and closely observe over the next 2 hours
c. Transillumination
d. Needle decompression

A

d . Needle decompression

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46
Q

You are assessing a term infant with a known congenital heart defect that is dependant on a patent ductus arteriosus. Which of the following options is appropriate for this circumstance?

a. Prostaglandin E1
b. Ligation
c. Oxytocin
d. Indomethacin

A

a. Prostaglandin E1

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47
Q

An expectant mom with pre-eclampsia is

a. At risk for placenta previa
b. At risk for hemolysis
c. At risk for sepsis
d. At risk for post term delivery

A

b . At risk for hemolysis

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48
Q

An expectant mom with pre-eclampsia is

a. At risk for placenta previa
b. At risk for hemolysis
c. At risk for sepsis
d. At risk for post term delivery

A

b . At risk for hemolysis

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49
Q

If an expectatnt mom’s membranes have ruptures for greater than 24 hours this is

a. Normal prior to delivery
b. Indication that the fetus is premature
c. Risk factor for possibility of baby developing sepsis
d. Normal in post mature infant

A

c. Risk factor for possibility of baby developing sepsis

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50
Q

If an expectatnt mom’s membranes have ruptures for greater than 24 hours this is

a. Normal prior to delivery
b. Indication that the fetus is premature
c. Risk factor for possibility of baby developing sepsis
d. Normal in post mature infant

A

c. Risk factor for possibility of baby developing sepsis

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51
Q

Which of the following is NOT considered an intrapartum risk factor

a. Epidural pain control
b. Meconium Stained amniotic lfuid
c. placenta abruption
d. premature labor

A

a. Epidural pain control

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52
Q

When comparing the anatomy of a neonate to an adult

a. A neonates tongue size is proportionally larger than an adults
b. Adults have twice the body surface are/body size ration
c. The diaphragm rests in a lower position in a neonate
d. A neonate trachea is less compliant than an adult

A

a .A neonates tongue size is proportionally larger than an adults

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53
Q

How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?

The percentage of infrared light that reaches the photodector reflects SpO2

The sum of the amount of red and infrared absorbed by the tissue determines the SpO2

The ratio of the red and infrared light that reaches the photodiodes signified SpO2

The percentage of red light that lands on the photodiode represents oxygen saturation as determines by the pulse oximetry

A

The ratio of the red and infrared light that reaches the photodiodes signified SpO2

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54
Q

Early decelerations are likely ___________ and probably reflect ______________

Worrisome, cord compression

Benign, nucal cord

Benign, head compression

Worrisome, decreased placental perfusion

A

Benign, head compression

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55
Q

Which of the following is responsible for maintaining lung inflation during fetal development

Amniotic fluid

Fetal lung fluid

Surfactant

Type II Pneumocytes

A

Fetal lung fluid

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56
Q

Mom is actively laboring, post membrane rupture. You notice bradycardias and profound decelerations on the tocodynamometer. Which of the following is most likely the cause?

Nuchal cord

Cord compression

Intrauterine pneumonia

Multiple knots in the cord

A

Cord compression

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57
Q

Which of the following applies to GBS status

Routinely tested for during prenatal care

All GBS positive females need to be on antibiotics when attempting to conceive

It is associated with an increased risk of premature labour

It is associated with an increased risk of placenta previa

A

Routinely tested for during prenatal care

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58
Q

You are looking at an intubated neonate in the nursery. A mainstream etCO2 is situated inline and an ABG has been correlating well. The PaCO2 on a recent ABG is 48. What would most likely reading on the etCO2 at the time this ABG was drawn

44

48

52

A mainstream etCO2 would never be used on a neonate

A

44

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59
Q

You are attending a c-section delivery in the operating room. Mom is estimated to be 39 weeks gestation, and the c-section was emergent due to late decelerations. The neonates arrives and is placed on the warmer. After drying, stimulating and suctioning about 1 minutes has passed You quickly assess the following and find

Ruddy appearing face, hands/feet look dusky

Respiration are irregular and shallow

Baby is active and moving its limbs

Baby is crying

HR is palpated from umbilicus is 90

The APGAR is

A

7

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60
Q

Blood pressure is higher in the pulmonary artery than in the aorta

Only after the umbilical cord is clamped

Prior to birth

Until 3 days post delivery

Once the baby takes the initial breath

A

Prior to birth

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61
Q

When comparing normal fetal to normal newborn pulmonary vascular resistance

There is no immediate change in PVR post partum

PVR in a fetus is the same as a newborn until 3 days post partum

PVR is lower in the newborn than in the fetus

PVR increases in the newborn compared to in utero

A

PVR is lower in the newborn than in the fetus

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62
Q

What is the name of the structure that allows mixing of blood between the atria

Foramen ovale

External iliac artery

Ductus venosus

Ductus arteriosus

A

Foramen ovale

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63
Q

The rhesus status of mom and dad is important because

An Rh- woman who develops antibodies may react to an Rh- baby

If the fetus inherits the Rh factor from dad and Mom is Rh negative. Mom’s body develop antibodies to the fetus

An Rh-baby cannot be carried by an Rh + mom

A baby who is Rh is at an increased risk of spontaneously aborting

A

If the fetus inherits the Rh factor from dad and Mom is Rh negative. Mom’s body develop antibodies to the fetus

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64
Q

Which of the following events cause cessation of right to left shunting through the foramen ovale

Increased levels of PaCO2 in fetal blood

Decreased SVR

Increased SVR

Decreased levels of PaO2 in the fetal blood

A

Increased SVR

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65
Q

A fetal heart rate that drops from baseline between 150-140 bpm at the beginning of a contraction and returns to 143 bpm as the contraction ends would be consistent with

A variable deceleration

Tight nuchal cord

Decreased placental perfusion

Benign and normal fetal outcomes

A

Benign and normal fetal outcomes

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66
Q

Which of the following would give the best indication of oxygenation status

Transcutaneous monitor set to a temperature of 37 degrees Celsius

Capillary blood gas with the limb appropriately arterialized

etCO2 monitor

Pulse oximeter that tis correlating with HR and is located on a well perfused limb

A

Pulse oximeter that tis correlating with HR and is located on a well perfused limb

67
Q

A transvaginal fetal scalp pH sample of 7.14

Would need to be repeated immediately to confirm accuracy

Should be repeated every 2 minutes

Is low normal

May necessitate a c-section

A

May necessitate a c-section

68
Q

Dilation and effacement of the cervix occurs during

Durign stage 3 of labour

1stphase of the 2ndstage of labour

In the 1st20 minutes of labor

During the first stage of labor

A

During the first stage of labor

69
Q

A healthy baby with normal amounts of fetal hemoglobin with have a PaO2 close to _______ when pulse oximeter is showing a saturation of 90%

60 mmHg

27mmHg

40 mmHg

70 mmHg

A

40 mmHg

70
Q

Which of the following is associated with maternal fever and premature rupture of the membranes

Congenital anomalies

Maternal diabetes

Pneumonia

MEC

A

Pneumonia

71
Q

Fetal Hemoglobin is _________ shift, demonstrating an __________ affinity for oxygen

Left, increased

Right, decreased

Left, decreased

Rght, increased

A

Left, increased

72
Q

The goal temperature for therapeutic hypothermia in a neonate is _________oC

  1. 5
  2. 5
  3. 5
  4. 5
A

33.5

73
Q

Placenta Previa

Always results in a c-section

Risk increased with young maternal age

Results in decreased vaginal bleeding because the uterus covers the birth canal

Occurs when the placenta covers the uterine opening

A

Occurs when the placenta covers the uterine opening

74
Q

Which of these best describes the condition of “polyhydramnios”

A large for gestational age fetus

A large amount of amniotic fluid in the amniotic sac

Too much fetal fluid

More than one fetus

A

A large amount of amniotic fluid in the amniotic sac

75
Q

A mom presents to labor and delivery with no prenatal care. You are present at the delivery and note the presence of lanugo. This indicates

The infant was born with the saccular phase of fetal lung development

The infant is large for gestational age

The neonate is not at a viable gestational age

The infant was born at 36 weeks gestation

A

The infant was born with the saccular phase of fetal lung development

76
Q

Respiratory epithelium in the developing fetus emerges

As an off shoot of the heart

From the ectoderm

From the foregut bud

From the placenta

A

From the foregut bud

77
Q

Which of these statement describes a “breech presentation”

When a baby presents with a should first through the birth canal

When the baby presents occiput first

When a baby presents with the face first through the birth canal

When a baby present with the feet or buttocks first

A

When a baby present with the feet or buttocks first

78
Q

A pregnant woman goes in for a prenatal checkup. At the end of her assessment the Biophysical Profile is calculated to be 9. What does this number indicate

This is a normal BPP

This is a high score that indicates poor fetal outcomes

An emergency c-section is necessary

This is a low score that indicates poor fetal outcomes

A

This is a normal BPP

79
Q

First Degree Heart Block

A

The PRI interval is long

No dropped beats

80
Q

Wenckebach

A

Type I

Going, Going, Gone (PRI Interval)

AV node “getting tired” and delays are longer each time until a beat is not conducted

Results in a specific pattern in the PRI: longer, longer, (longer)…then a dropped beat

81
Q

Second Degree Heart Block (Mobitz II)

A

When there is a PRI it will be constant but every so often a P wave will just not be there

AV node is unreliable results in dropped beats without warning; can be random or in a pattern (e.g. every third beat)

82
Q

3rd Degree Heart Block

A

P Wave and QRS Complex have no relation

Atria depolarizing as normal but no signal gets through; either junction or ventricles takes over pacing of ventricles (at inherent rate and associated QRS width)

These two events (atrial and ventricular depolarization) occur simultaneously but independently, thus, the apparent PRI is random and unrelated to the QRS

83
Q

Wandering Pacemaker

A

60-100 bpm (may be slower)

The p wave keeps changing

84
Q

Atrial Tachycardia

A

Usually between 150-250 bpm

the p wave is flattened, peaked, and diaphasic and may be hidden

If the p wave is hidden it is a SVT

85
Q

Premature Junctional Contraction

A

P Waves will be inverted

Underlying Rhythm

86
Q

Junctional Escape Rhythm

A

P wave is inverted and rate is 40-60 with bpm

87
Q

Accelerated Junctional

A

P wave is inverted and rate is 60-100 with bpm

88
Q

Junctional Tachycardia

A

P wave is inverted and rate is 100-180 with bpm

89
Q

PVC

A

Wil have an underlying rhythm and then there is a wide intrupting QRS

90
Q

Normal PRI

A

0.12-0.20

91
Q

Normal QRS

A

Less than 0.12

92
Q

Pulseless Electrical Activity (PEA)

A

Will be no electrical activty on the ECG monitor

Is any pulseless rhythm except for V fib, V tach, or asystole

93
Q

Idioventricular Rhythm

A

Will be regular

BPM is 20-40

No p wave

The QRS is greater the 0.12 (wide) and bizarre

94
Q

Ventricular Fibrillation

A

Shockable heart rhythm

Completely irregular

95
Q

Ventricular Tachycardia

A

150-250 bpm

Will look like a bunch of upsidedown U that are all the same shape and rate

Shockable heart rate

96
Q

Premature Ventricular Contraction

A

Will have a normal underlying sinus rhythm and then a random wide QRS complex in the middle of the rhythm

Define underlying rhythm

97
Q

Trigeminy PVC

A

Every third beat is a PVC

98
Q

Quadrigeminy PVC

A

Every fourth beat is a PVC

99
Q

Sinus Bradycardia

A

Rate is less than 60 bpm

P wave before very QRS

PRI is 0.12-0.20

QRS is less than 0.12

100
Q

Sinus Tachycardia

A

Rate is over than 100 bpm

P wave before very QRS

PRI is 0.12-0.20

QRS is less than 0.12

101
Q

Premature Atrial Contraction (PAC)

A

Will have an ectopic beat that intruppts the underlying regular rhythm

The P wave of the premature beat will look different than that of the underlying rhythm (this also may change the PRI interval as well)

102
Q

Wandering Pacemaker

A

The QRS will be consisent but the p wave will change shape and where it is located (sometime might not be there)

103
Q

Atrial Tachycardia

A

Bpm will usually be between 150-250

The shape of the p wave will be flattened, peaked, or diaphasic and can blend into the T wave

Unlike atrial flutter will still and an isoelctrical baseline (stright line where they originate from)

104
Q

Atrial Fibrillation

A

No true P wave only a squiggly line

QRS will be between 0.12-0.20 and all the same shape

105
Q

Atrial Flutter

A

Atrial rate between 250-350

Sawtooth patteren

QRS will be between 0.12-0.20 and all the same shape

106
Q
A

Sinus Tachycardia

107
Q

ECG Recording

A

All ECG will use the same paper which runs through the at the same speed (25 mm/sec)

Small Squares- 1 mm2

108
Q

Junctional Rhythms

A

Originate in junction, and retrograde conduction in atria

Inverted or absent p-wave

109
Q

Supraventricular Rhythm

A

Technically in order to classify the type/origin of the tachycardia you need to be able to see the p-wave

At rates greater than 150 bpm it is unlikely that you will be able to see p waves as they will be hidden in the t wave

SVT is a descriptive term applied to tachycardias that cannot be differentiated because the P waves are not able to be visualized

110
Q

Paroxysmal SVT

A

PSVT = paroxysmal SVT, it occurs and ends without warning

111
Q

Wolff-Parkinson White

A

A congential malformation resulting in a accessory atrioventricular pathway which allow the AV nose to activate ventricles prematurely

The risk is the potential rapid ventricular response

Atrial fibrillation will occur in 1/5 to 1/3 of WPW patients

More common in men

112
Q

Wolff Parkinson White ECG

A

Patient is usually in as normal sinus rhythm but re-entry causes a tachycardia

PR is usually < 0.12s

QRS complex > 0.11

Has a characteristic “slur” (delta wave)

113
Q

How do you find the QRS Complex

A

Look for the biggest QRS complex on a frontal plane lead and use the lead to determine.

Note: If the biggest deflection is negative then the axis is directly opposite of that l

114
Q

MAP Equation

A

MAP =(Systolic x 2 diastolic) / 3

115
Q

Systemic Vascular Resistance (SVR) Normal

A

1200-1600 dynes.sec.cm^ -5

116
Q

CVP Normal

A

CVP 2-8 mmHg

117
Q

Pulmonary Vascular Resistance (PVR) Normals

A

120-240 dynes.sec.cm^-5

118
Q

Pulmonary Artery Pressure (PAP) Normal

A

(20-30)/(6-15) mmHg

119
Q

Pulmonary wedge Pressure (PAWP) Normals

A

4-12

120
Q

Stroke Volume (SV) Normals

A

60-130 ml/beats

121
Q

Cardiac Index (CI) Equation

A

CI=CO/Body SA

122
Q

neurogenic shock

A

All hemodynamic readings are low and there will be no increase in HR and SVR to compensate

123
Q

hypovolemic shock,

A

In hypovolemic shock, we see decreased volumes, meaning decreased pressures and CO in the heart, however HR and SVR will increase to compensate (unlike in neurogenic shock)

124
Q

septic shock,

A

In septic shock, patient’s are fluid resuscitated, meaning they will have lots of fluid on boarding, leading to an increased CO.

The SVR will be decreased in septic shock as the blood is pooling in the extremities and not returning to the heart, leading to decreased BP.

Therefore the HR will increase to compensate for the hypotension and lack of perfusion (even though there is lots of fluid)

HR and SVR are in a direct relationship and are compensatory measures (except for in septic and neurogenic shock). They will increase to compensate for decreased CO and decrease to compensate for increased CO.

125
Q

SvO2

A

Measured in the PA port

Some have continuous monitoring via reflection spectrophotometry

126
Q

Ca-vO2

A

Can assess for left to rt shunt by measuring from CVP (Proximal port) and PA distal

127
Q

Mixed venous sampling

A
  • Will get this sample from dital port of pulmonary artery catheter (only place you can get a true mixed venous smaple!
  • Mixed venous is getting blood from all the body including blood from heart and lungs
  • SvO2 and C(a-v)O2
128
Q

Hypovoluemic shock

A

Everything is decreased so HR and SVR are trying to compensate

129
Q

Cardiogenic Shock

A

Everythgin goes up but BP and CO

130
Q

Septoc Shock

A

Everything goes down

CO can go up or down

HR and SVR go up to compensate

131
Q

Neurogenic Shock

A

Everything absolutely go down

132
Q

Obstructive Shock

A

CVP goes up

PAP and PAWP can go up or down

BP and CO go down

HR and SVR go up

133
Q

Arterial O2 Content (CaO2)

A

Total amount of oxygen contained in arterial blood; going to the body

Oxygen is carried by

  • Hemoglobin (Hb)-major carrier of O2
  • Dissolved in Plasma

CaO2 = (Hb x 1.34 ml/g) * SaO2 + (PaO2 x 0.003 ml/100ml/mmHg)

134
Q

Mixed Venous O2 Saturation (SvO2)

A

Saturation of the blood in the pulmonary artery

True mixed venous blood is in the pulmonary artery

The sample is drawn from the distal port of the PA catheter and analyzed on the blood gas machine

Some specialized PACs measure SvO2 continuously, in vivo

An early indicator of changes in O2 transport status

135
Q

•Mixed Venous O2 Content (CvO2)

A

CvO2 = (Hb x 1.34 ml/g) * SvO2 + (PvO2 x 0.003 ml/100ml/mmHg)

Normal = 13 - 16 mL/dL (vol%)

136
Q

•Oxygen Delivery (DO2)

A

Total oxygen delivered to body

  • Requires:
  • Arterial O2 content
  • Cardiac Output (C.O.) or (QT)

DO2 = QT * (CaO2 * 10)

137
Q

Shunt Fraction

A

<10%-Normal

10-19%-Seldom need vent support

20-29%Require PEEP or CPAP

30 or more- life threatening need mechanical vent with PEEP

138
Q

Epinephrine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Epinephrine

Trade: Adrenaline

Mechanism of Action: Will affect CO and SVR. Is an alpha and beta adrenergic agonist, vasopressor, chronotrope, and dromatatrope

Indications: Cardiac arrest (will be given as a bolus), pulseless arrythmia, Hypotension, Anaphylaxsis

139
Q

Norepinephrine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Norepinephrine

Trade: Levophed

Mechanism of Action: Will affect CO and SVR. Is an powerful alpha and beta1 which results in an increase in myocardial contractility

Indications: Hypotension, distributive shock

140
Q

Dopamine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Dopamine

Trade: Intropin

Mechanism of Action: Precurser to norepinphrine. Stimaultes alpha, beta, and dopmerginic recpetors. Only administered via IV

Indications:

Low Dose (1-5 mg/kg/min): Renal Dose (dilate renal arteries)

Medium Dose (5-10 mg/kg/min): Cardiac Dose (treat bradycardia by increase CO)

High Dose (1-5 mg/kg/min): Vasopressor Dose (treat hypothermia with alpha effects of decreaseing SVR and constrction)

141
Q

Phenylephrine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Phenylephrine

Trade: Neo-Synephrine

Mechanism of Action: Alpha agonists with minimal stimulation. Last 20 min (loner the epinephrine)

Indications: Hypotension and used in RSI for hypotension

142
Q

Vasopressin

A

Class of Drug: Inotrope, vasoactive agent

Generic: Vasopressin

Trade: ADH

Mechanism of Action: Non adrenergic peripheral vasoconstrictor

Indications: PEA, Hypotension,

NO BETA STIMULATION

143
Q

Dubutamine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Dubutamine

Trade: Dobutrex

Mechanism of Action: Syntheteic catecholamine taht produces predominately beta effects (iontrope) and change BP

Indications: Patients with heart pumping problems and a systolic BP of >70mmHg

144
Q

Isoproterenol

A

Class of Drug: Inotrope, vasoactive agent

Generic: Isoproterenol

Trade: Isuprel

Mechanism of Action: Nearly a pure beta agonists, patent iontrop and chronotrope, will decrease BP and increase SVR

Indications: Rarely used to treat bradycardia or b blocker overdose

145
Q

Imamrione and Mitrinone

A

Class of Drug: Inotrope, vasoactive agent

Generic: Imamrione and Mitrinone

Trade: Inocar and Primacor

Mechanism of Action: Causes iontropic effects in the heart, peripheral vasodilation (does not affect sympathetic NS)

Indications: Severe CHF, Refractory cardiogenic shock

146
Q

Atropine

A

Class of Drug: Chronotrope

Generic: Atropine

Trade: N/A

Mechanism of Action: Parasympathetic (enhance autonomacay of SA node which will increase rate through av conduction)

Indications: Symptomatic bradyarrhythmia but may not work in heart blocks

147
Q

Lidocaine

A

Class of Drug: Class I Anti-Arrthymias (Na Channel Blockers)

Generic: Lidocaine

Trade: Xylocaine

Mechanism of Action: Suppress ventricle arrthymias and decrease myocardial conduction and increase VF threshold

Indications: Refractory Shock, VF (pulseless), and VT management. Manage PVC irritability

148
Q

Class II Anti-Arrhythmias (B-Blockers)

A

Names: Mteoprolol, propranolol, labetalol, atenalol, esmalol

Mechanism of Action: Beta Blocker Adrenergic Receptor

Decrease the effect of catecholamines, decrease HR and BP, decrease myocardial contraction and O2 consumption

Avoid in diseases with bronchospasms

Indications: Acute Coronary syndrome, hypertension, actute tachycardia (SVT)

149
Q

Amiadarone

A

Category: Class III Anti-Arrhythmias (K Channel Blockers)

Generic Name: Amiarone

Trade Name: Cardarone

Mechanism of Action: Second line in ACLS

Indications: Refractory shock, pulsleless VF, VT, tachycardia,

Can cause amidarone lung or smurf lung

150
Q

Adenosine

A

Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)

Generic Name: Adenosine

Trade Name: Adenocard

Mechanism of Action: Endogenous compound that depresses both the SA and AV node

Indications: Treat SVT, warn patients of sensations of heat, chest pain, and flushing

Do not give to asthmatic patients

151
Q

Digoxin

A

Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)

Generic Name: Digoxin

Trade Name: Lanoxin

Mechanism of Action: Cardiac glycoside, derivities of digitalis, anti-arrhythmia and inotropic

Indications: Decreased ventricular repsonpe in atrial fibirllation or atrial flutter

Narrow Therapeutic Range

May cause arrhythmias and precitate cardiac arrest

152
Q

Nitroglycerin

Nitroprusside

A

Category: Nitric Vasodilator

Generic Name: Nitroglycerin, Nitroprusside

Mechanism of Action: Breaks down nitric oxide to produce vasodilation

Indications: Angina, AMI, CHF, hypertensive crisis

Can result in hypotension

153
Q

ACE Inhibitors

A

Category: ACE Inhibitors

Generic Name: Captropril

Mechanism of Action: Prevent sysnthesis of angotensin which will result in vasodilation

Indications: Hypertension, Myocardial infarction

154
Q

What are drugs with Positive Chronotropic Effects

A

Anything that stimulates B1 thus: epi, norepi, dopamine (moderate/cardiac dose), Dobutamine

Also, Atropine

155
Q

What is a drug that is a powerful alpha agent

A

Levophed, Phenylephrine and dopamine (high/pressor dose).

156
Q

What are the effects of beta 2 stimulation

A

Bronchodilation (for receptors in the lungs) and vasodilation (due to the receptors in the periphery)

157
Q

Cautions with beta 1 stimulation

A

The increased HR and contractility cause an increase in myocardial demand/oxygen consumption and myocardial irritability. Also decreased time in diastole…may impact filling time at high rates.

158
Q

Effects of Dopamine

A

Low Dose (1-5 mcg/kg/min) results in renal and splanchnic vasodilation (due to dopaminergic receptor stimulation)

Moderate Dose (5-10 mcg/kg/min) results in increased HR, contractility and rate of conduction due to B1 stimulation

High Dose (10-20 mcg/kg/min) results in increased SVR and increased BP due to a1 stimulation

159
Q

When is a bolus of Epinephrine given

A

In pulsesless states! VT, VFib, PEA and asystole

Vasopressin is also an alternative that can be given and it will have the advantage that there is no B1 stimulation thus doesn’t further stress the heart (beyond the increased afterload it results) with the increased HR and increased irritability

160
Q

How do “Iondilators” work and Why are they helpful in patients with CHF

A

Inhibit phosphodiesterase III (an enzyme that breaks down cAMP. Increased levels of cAMP in the heart results in increased inotropism and increased cAMP in peripheral smooth muscles causes vasodilation

161
Q

Heparin

Coumadin

A

Category: Anti-Thrombolytic/Coagulation

Generic Name: Heparin, Coumadin

Mechanism of Action: Heparin inhibits clotting pathway, Caumadin will use used post heparin

Indications: Treat thromboemobulism, PE, atrial fib, intravascular coagulation

CAUTION: Bleeding, bruising, hemorrhage

162
Q

ASA

Abciximab

Clopidagrel

A

Category: Anti-Thrombolytic/Platlet

Generic Name: ASA, Abciximab, Clopidagrel

Trade Name: Aspirin, Repro, Plavix

Mechanism of Action: prevent thromboxone fomation

Indications: Thrombolus embolism, myocardial infarction

Cation Increased risk of bleeding, relative contraindications when thrombolytics are used

163
Q

Alteplase

Retephase

Streptokinase

Tenecteplase

A

Category: Anti-Thrombolytic

Generic Name: Alteplase, Retephase, Streptokinase, Tenecteplase

Trade Name: tPA, Retavase, Streptose, TNK

Mechanism of Action: Lyse formed thrombi be degrading fibrin

Indications: Acute myocardial infarction, PE,

001 Respiratory Therapy (53 decks)

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