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Pulmonary diagnostic testing Flashcards

1
Q

Three primary sites for obataining arterial blood gas

A

Radial
Brachial
Femoral

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2
Q

The Modified Allen’s test

A

used to assess the collateral circulation
Hand should pink up within 1-2 sec

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3
Q

ABG Hazards and Problems

air bubbles

effects on pH, PaCo2, PaO2

A
  • PaCO2 decreases toward 0
  • PaO2 increases or decreases toward 150 torr
  • pH increases
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4
Q

ABG Hazards and Problems

Improper cooling

effects on pH, PaCO2, PaO2

A
  • PaCO2 increases
  • PaO2 decreases
  • pH decreases
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5
Q

Capillary samples are used to obtain blood gas samples in

heel sticks

A

infants

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6
Q

capillary sample

PO2 values do/do not correlate well with ___

A
  • do not
  • arterial blood
    especially true when the arterial po2 is above 60torr
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7
Q

Capillary gases should not be used to monitor

A

oxygen therapy

Only pH and PCO2 correlate with arterial

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8
Q

Name harzards and problems of an arterial sample

A
  • Disruption of blood flow
  • clotting
  • Bleeding
  • Vessel spasm
  • Tissue trauma
  • Air bubbles
  • improper cooling
  • too much liquid heparin
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9
Q

Capillary blood samples correlate with arterial blood samples

A

pH and PCO2

not PO2

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10
Q

Umbilical arterial catheter tip placement

A

at L-3 which is above the bifurcation of the aorta but below the renal arteries

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11
Q

Unbilical artery PO2 may be used to regulate

A

FiO2

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12
Q

Advantages of umbilical artery catheter (UAC)

A
  1. allows continuous monitoring of blood pressure
  2. Arterial samples of ABG and other lab analysis
  3. Blood transfusion
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13
Q

Arterial line: If transducer is above the catheter, displayed pressure is

A

lower than actual

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14
Q

Arterial line: if transducre is below catheter, displayed pressure is

A

higher than actual

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15
Q

Blood Gas analyzers

Severinghaus electrode

A

PCO2 -
partial pressue of carbon dioxide in sample

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16
Q

Blood Gas analyzers

Clark electrode

A

PO2
Patrial pressure of oxygen in sample

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17
Q

Blood Gas analyzers

Sanz electrode

A

Acid base status

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18
Q

Blood Gas analyzers

Quality Control : when the blood gas machine is functioning correctly, the mesured control valies ..

A

will be close to the mean and withing +/- 2 standar deviations

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19
Q

Blood Gas analyzers

Westgard rules

A

a comon set of rules developed to differentiate between random errors and true out of control situations
* Called multiple-rule method

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20
Q

Blood Gas analyzers

Out of control situations

A
  • one control observation exceeds the mean +- 3 SD
  • Two consecutive control observations exceed the mean +2 SD or the mean -2SD
  • The difference between consecutive control runs exceed 4SD
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21
Q

Point of care testing

A

anytype of lab testing done at the bedside

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22
Q

List laboratory test that can be perfored by point of care testing

A
  • blood glucose
  • arterial blood gas
  • hematrocit
  • serum electrolytes
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23
Q

Intravenous infusionis used to administer ____, ____, and ____ continuously to the pt

A
  • medications
  • blood products
  • supplemental nutrition/ fluids
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24
Q

Venipuncture is performed to provide ____

A

vascular access for continuous infusion or for blood sampling for laboratory analysis

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25
Alveolar Air equation | Definition
Calculates the partial pressure of oxygen (PO2) in the alveoli | PAO2
26
PAO2 | equation
= (PB-Ph2o) FiO2 - (Paco2/0.8) | (747-47) Fio2 - Paco2/ 0.8 ## Footnote Fio2 is NOT in percent
27
A-a gradient | Definition
Measures the difference between alveolar and arterial PO2
28
A-aDO2 | equation
PAO2 -PaO2
29
A-aDO2 normal value
25-65 torr on 100%
30
A-aDO2 66-300 torr | interpretation
V/Q mismatch
31
A-aDO2 : >300 | interpretation
Shunting
32
A-a gradient of 190 torr | what would be a treatment ?
give O2 therapy
33
A-a gradient of 350 torr | what would you recommend
give positive pressure therapy
34
P/F ratio | definition
ratio of the partial pressure of arterial O2 to the inspired fractional concentration of oxygen
35
Used in determination of ALI or ARDS
P/F ratio
36
Measures the efficiency of oxygen transfer across the lung
P/F ratio
37
P/F ratio : normal value
>380 torr
38
P/F ration : < 300 signifies
ALI
39
P/F ration : < 200 signifies
ARDS
40
Arterial oxygen content | definition
best measurement of oxygen delivered to the tissues , or the bes index of oxygen transport
41
best measurement of oxygen delivered to the tissues , or the best index of oxygen transport
Arterial oxygen content (CaO2)
42
CaO2 | equation
(Hb x 1.34 x SaO2) + (PaO2 x 0.003) | shortcut: Hb x 1.34 x SaO2 or Hb x 1.34
43
Normal value for CaO2 | arterial oxygen content
17-20 vol % (mL/dL)
44
Mixed venous oxygen content | definition
total amount of oxygen carried in the mixed venous blood | equation like CaO2 but with venous
45
CvO2 normal value
12-16 vol %
46
arterial- venous oxygen content difference | definition
measures the oxygen consumption of the tissues
47
C(a-v)O2 | equation
CaO2 - CvO2
48
C(a-v)O2 normal value
4-5 vol%
49
CvO2 values will __ when C.O __ | What about SvO2?
* decrease * decreases * SvO2 values also decrease if C.O decreases | C.O decreases, CvO2 decreases
50
The percentage of the hemoglobin that is bounde by oxygen
Arterial Oxygen Saturation SaO2
51
PaO2 value can be estimated by
subtracting 30 from the SaO2
52
measure the amount of ventilation support required to provide the level of oxygenation
Oxygen Index
53
Oxygen Index equation
(Paw- Fio2 / PaO2 ) x 100 | Fio2 is a decimal not a percent
54
Normal OI
<10
55
An increase in the pt venous oxygen content would indicate that
C.O increased
56
Deadspace to tidal volume ratio | VD/VT
the percentage of the VT that does not participate in gas exchange | Ventilation without perfusion
57
# oxygen index Recomend __ for newborns with __
* ECMO for newborns withOI >40
58
Normal VD/VT ratio | deadspace
20-40% (up to 60% with ventilator pt )
59
Desired minute volume equation
current Ve x current PaCO2 = desired Ve x desired PaCO2
60
PaO2 value Below 80 | interpretation
Hypoxemia can be caused by * Poor ventilation * V/Q mismatch
61
Hypoxemia can be caused by | PaO2 below 80
* Poor ventilation * V/Q mismatch
62
Response for hypoxemia
* increase ventilation * increase FiO2 up to 60% * add PEEP
63
PaO2 bellow 80 with 60% + fio2 | interpretation. What does the pt have?
Shunt, refractory hypoxemia, venous admixture
64
Shunt, refractory hypoxemia, venous admixture | RESPONCE
decrease Fio2, PEEP or CPAP
65
When pH is inside aceptable range | its called
Compensated or Chronic
66
When pH outside the acceptable range | its called
Non-compensated or Acute
67
# abg sample Higher PaO2 values (>140) would indicate
supplemental oxygen in use , bubble in sample or technical error
68
Lower PaO2 values may indicate
V/Q mismatch, diffusion defect, shunting or venous blood
69
Treatment for CO poisoning
100% oxygen and hyperberic oxygen therapy
70
comfirm Pulmonary embolus with
V/Q scan, CT scan, pulmonary angiography
71
Supect embolus in | pt with
* post op pt * bedridden pt * history of deep vein thrombosis * women in advance stages of pregnancy * Venous stasis * obesity * Trauma * atrial fibrillation
72
Loss of metabolic acids, dehydration, electrolyte imbalance (due to vomiting) | Treatment
Administer potassium chloride (KCl) and oxygen
73
normal PaCO2 of a newborn
< 50 torr
74
normal PaO2 of a newborn
>60 torr
75
Normal newborn pH
>7.30 | slightly acidotic
76
# ABG results do not match clinical appearance Type 1 Type 2
* type 1 - ABG loos good / pt looks and feels bad * type 2 ABG looks bad / pt loosk and feels fine
77
Bedside assesment for Pulm. embolus shows
hyperpnea | increased rate and depth of ventilation
78
treatment for pulmonary embolus
1. prevent with aticoagulants (heparin) 2. support ventilation and oxygenation treat existing clots with thrombolytic agens (streptokinase)
79
Dissociation Curve | a shift to the left
increased affinity * pH increases * PCO2 decreases * Temp decreases * 2-3 DPG decreases
80
Dissociation curve | shift to the right
decreased affinity * pH decreases * PCO2 increases * Temp increases * 2-3 DPG increases
81
Spirometers measure
volume and flow rates
82
# Pneumotachometers (flow) Turbine device | Wright respirometer
measures flow, may display volume
83
# Pneumotachometers (flow) Pressure differential (Fleisch) pneumotachometer
measures flow can be used to cotinuously measure minute ventilation (Ve)
84
device used to measure and monitor PEFR for patients with asthma
Peak flow meter
85
Pt exhales forcefully through a device which incorporates a resistor and a moveable indicator
Peak flow meter
86
peak flow value | healthy adult
10 L/sec or 600L/min
87
Plethysmography | whats another name
Body box
88
# Plethysmography Based on ___ law which states that pressure and volume ___ ___ if temperature is constant
* Boyle's Law * vary inversely
89
Measure thoracic gas volume (TGV)
Body Box | Plethysmography
90
Plethysmography measures __ which is the same as __
* Thoracic Gas Volume (TGV) * FRC
91
State the name of the standards that all PFT equipment must meet?
ATS - ERS
92
Body box should be calibrated prior to procedure using:
* mouth pressure transucer - water or mercury barometer * Box pressure tranducer - sine wave ratory pump * Flow transducer - rotameter
93
Measures airway resistance wich is the difference in pressure between the mouth and alveoli
Body Box | Plethysmography
94
# PFT equipment Volume calibration and leak test are performed by using a ..
large volume syringe or standard syringe volume of 3.0 Liters
95
# PFT equipment daily calibration with a
3.0 L syringe
96
# Calibration and quality control Acuracy range of daily calibration
+/- 3.5% (2.895 L - 3.105 L)
97
used to monitor and asses the readiness to wean in ventilator patients
MIP
98
MIP: assess the degree of respiratory musce impairment in pts with ___ and ___
Guillain-Barré and Myasthenia Gravis
99
Norma MIP
80 cmH20 | negative number
100
a MIP of <20 cmh20 indicates
inspiratory muscle weakness
101
Helpfull in evaluating a pt's ability to maintain an airway and clear secretions (cough effectively)
MEP
102
Normal MEP
160 cmh2o
103
MEP < 40 cmh2o indicates
poor ability to clear airway secretions
104
Patient is instructed to take a maximal inspiration followed by a maximal exhalation WITHOUT FORCE
Vital Capacity | Slow Vital Capacity
105
Decreased Volumes indicate | restrictive or obstuctive ?
Restrictive Disease
106
The __ will provide the important volumes used to identify restrictive disease
*Slow vital capacity (SVC)
107
_____ is the best indicator of restrictive lung disease
Decreased vital capacity
108
Forced vital capacity
The volume that can be expired as forcefully and as rapidly as possible after a maximum inspiration
109
The FVC procedure will provide the imporatnt Flow rates used to identify ___
obstructive disease
110
Measured during the FVC maneuver
* FEV1.0 - forced expiratory volume in 1 sec * FEF 200-1200 - forced expiratory flow 200-1200 * FEF 25-27 - forced expiraoty flow 25-75 * PEFR - peak expiratory pressure flow rate
111
FVC should be equal to
Slow vital capacity | FVC can be used as a substitute to SVC
112
FVC is not a ___, its a ____
* flow * volume | should be equal to svc
113
What is a good indicator of obstructive disease
a decreased FEV1
114
List the volumes and capacities that can be measured from a vital capacity maneuver
* IC * ERV * IRV * VT * VC
115
What is the minimum acceptable value for the FEV1/FVC ratio?
> 70% | normal
116
FEV/FVC or FEVt%
FEV/FVC x100 = FEV/FVC ratio
117
decreased FEV1.0/FVC is the best indicator of
obstructive disease
118
FEV1.0/FVC decresed values =
obstructive disease
119
If FVC is smaller than the SVC, it indicates
obstructive disease
120
FEV1.0/FVC normal values =
not obstructive (may still be restrictive
121
IF the FEV1 is decreased but the FEV1/FVC ratio is normal then the pt has
restrictive disease only
122
Measured Flow that comes from the medium and small size airways
Forced expiratory Flow 25% to 75%
123
sometimes used to evaluate asthmatic patients, pre &post bronchodilators
Peak expiratory flow rate | PEFR
124
Used to measure the reversibility of an obstructive pattern
pre & post bronchodilator testing
125
# pre & post bronchodilator testing a minimum of ____ and___ in the FEV1 ,post study is considered significant
* 12% AND 200mL
126
Flow -volume loop shape : Restivive
skinny and tall loop
127
Flow -volume loop shape : Obstructive
short and wide loop
128
Describe a flow- volume loop
* Flow is on the y axis (vertical) * Volumes are on the x axis (horizontal) * expiratory flows are above the base line * inspiratory flows are below the base line
129
# Interpreatation of spirometry ATS-ERS 80-100% of predicted
normal
130
# Interpreatation of spirometry ATS-ERS 70-79% of predicted
Mild disorder
131
# Interpreatation of spirometry ATS-ERS Mild disorder
70-79% of predicted
132
# Interpreatation of spirometry ATS-ERS 60-69 % of predicted
moderate disorder
133
# Interpreatation of spirometry ATS-ERS Moderate disorder
60-69 % of predicted
134
# Interpreatation of spirometry ATS-ERS 50-59 % of predicted
Mod-Severe
135
# Interpreatation of spirometry ATS-ERS <50% of predicted
Severe
136
# Interpreatation of spirometry ATS-ERS Severe
<50% of predicted
137
# Interpreatation of spirometry ATS-ERS <30% of predicted
very severe
138
# Interpreatation of spirometry ATS-ERS very severe
<30% of predicted
139
What indicates : * restrictive * obstruction * confirms obstruction
* FVC --> restictive * FEV1 --> obstruction * FEV1/FVC (%) --> confirms obstruction
140
Restrictive has decreased ___ Obstructive has decreased_
Res: volumes (VC or FVC) Obs:flows (FEV1,FEV1/FVC)
141
Obstructive diseases: CBABE
Cystic fibrosis bronchitis asthma bronchiectasis emphysema
142
# Restrictive or Obstructive? Cystic fibrosis
obstructive
143
# Restrictive or Obstructive? bronchitis
obstructive
144
# Restrictive or Obstructive ? asthma
obstructive
145
# Restrictive or Obstructive? bronchiectasis
obstructive
146
# Restrictive or Obstructive ? emphysema
Obstructive
147
Name restrictive diseases:
pulmonary fibrosis inflammatory diseases cardia disease neurological/ meuromuscular pleural disease throacic/ spinal deformities | it continues...
148
# FVC maneuver Best test is the trial that results in the largest sum of
FVC +FEV1 | test should not differ more than 5% or 200mL
149
The volume of air exhaled during rapid force breathing for at least 12 seconds
Maximum volunatry ventilation (MVV)
150
Pt with lower than normal MVV is at risk of
atelectasis and pneumonia
151
used to evaluate resp. muscle reserve, edurance or fatigue
Maximum voluntary ventilation
152
state the formula used to caluclate the percent of predicted
actual value / predicted value = %
153
List conditions that will have a decreased maximum voluntary ventilation (MVV)
obstructive lung disease increased airways resistanc RAW Respiratory muscle weakness Decreased lung compliance poor patient effort
154
Airway resistance normal value | Raw
0.6-2.4 cmH2O/L/sec
155
Normal Lung compliance
60-100 mL/cmH2O
156
identify the three methods availanble to determine functional residual capacity
* helium dilution * nitrogen wash out * Plethysmography / body box
157
# Describe Nitrogen wash out
The FRC is washed out of the lung by having the patient inspire 100% oxygen to replace nitrogen in the FRC the amount of nitrogen removed is used to calculate FRC
158
Normal DLco
25 mL CO/min/mmHg
159
Name 5 pathologies that wil result in decreased DLco
Pulmonary fibrosis Sacoidosis ARDS Pulmonary edema Emphysema
160
FRC
the volume of gas left in the lungs at the end of normal expiration
161
Diffusion Capacity Test
Assesses the integrity of the alveolar-capillary membrane
162
Test looks at the capacity for carbon monoxide to diffuse through the lungs into the blood
Gas diffusion capacity | DLco
163
Helium dilution method: how to identify obstructive disease
RV,FRC,TLC that is more than 120% of the predicted value
164
Helium dilution method: how to identify restrictive disease
RV,FRC,TLC that is less than 80% of the predicted value
165
Nitrogen wash out time: normal restrictive obstructive
* Normal 3-4 min * restricive 3 min * obstructive 7 min | failure to wahout in 7 min should be reported
166
volume of gas measured by a spirometer from a slow, complete expiration after a maximal inspiration
Vital Capacity
167
hollow metal tube that also functions as an airway
Rigid Bronchoscope allows ventilation through the scope during the procedure
168
Perfered scope for therapeutic procedures
Rigid Bronchoscope
169
Flexible rubber scope with fiberoptic bundles as a light source
Flexible bronchoscope
170
Prefered scope for diagnostic indications
Flexible bronchoscope
171
# Bronchoscopy diagnostic reasons
suspected foreign body suspected malignancy bronchial washings hemoptysis
172
# bronchoscopy Therapeutic reasons | use rigid broncho.
Foreign body atelectais secretion removal bronchia lavage airway stenosis | rigid
173
# Bronchoscopy list the most common complication when performing bronchoscopy using the nasal route
epistaxis (nasal bleading)
174
# bronchoscopy most cases can be controlled with saline lavage and time
localized hemorrhage following tissue biopsy
175
Steps that should be taken to treat serious bleeding that occurs during bronchoscopy prodedure
* instill epinephrine * compress the site with the scope * insert a Fogarty catheter
176
# Bronchoscopy anesthetics that you can give to prepare the pt
* lidocaine * benzocaine * cetacaine * novocain | all have cain
177
Asthma patient might have a RAW of
airway resistance of 2.8 cmh2o/L/sec
178
# SVC VC less than 80% of predicted
patient is restrictive
179
# SVC VC is 80% or greater
patient has no restriction
180
DLco range
20-25 mL CO/min/mmhg
181
PaCO2 above 45 response
initiate ventilation or remove/ decrease deadspace or increase current ventilation
182
PaCO2 below 35 response
* don't put the pt on mv * decrease ventilation (if PaO2 is high) * or consider other causes (hypoxemia, metabolic acidosis )
183
what kind of bronchoscope do you recommend for intubating pts with severe neck fracture
flexible bronchoscope

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