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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
Q

Alveolar Air equation

Definition

A

Calculates the partial pressure of oxygen (PO2) in the alveoli

PAO2

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26
Q

PAO2

equation

A

= (PB-Ph2o) FiO2 - (Paco2/0.8)

(747-47) Fio2 - Paco2/ 0.8

Fio2 is NOT in percent

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27
Q

A-a gradient

Definition

A

Measures the difference between alveolar and arterial PO2

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28
Q

A-aDO2

equation

A

PAO2 -PaO2

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29
Q

A-aDO2 normal value

A

25-65 torr on 100%

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30
Q

A-aDO2
66-300 torr

interpretation

A

V/Q mismatch

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31
Q

A-aDO2 : >300

interpretation

A

Shunting

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32
Q

A-a gradient of 190 torr

what would be a treatment ?

A

give O2 therapy

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33
Q

A-a gradient of 350 torr

what would you recommend

A

give positive pressure therapy

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34
Q

P/F ratio

definition

A

ratio of the partial pressure of arterial O2 to the inspired fractional concentration of oxygen

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35
Q

Used in determination of ALI or ARDS

A

P/F ratio

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36
Q

Measures the efficiency of oxygen transfer across the lung

A

P/F ratio

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37
Q

P/F ratio : normal value

A

> 380 torr

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38
Q

P/F ration : < 300 signifies

A

ALI

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39
Q

P/F ration : < 200 signifies

A

ARDS

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40
Q

Arterial oxygen content

definition

A

best measurement of oxygen delivered to the tissues , or the bes index of oxygen transport

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41
Q

best measurement of oxygen delivered to the tissues , or the best index of oxygen transport

A

Arterial oxygen content
(CaO2)

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42
Q

CaO2

equation

A

(Hb x 1.34 x SaO2) + (PaO2 x 0.003)

shortcut: Hb x 1.34 x SaO2 or Hb x 1.34

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43
Q

Normal value for CaO2

arterial oxygen content

A

17-20 vol % (mL/dL)

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44
Q

Mixed venous oxygen content

definition

A

total amount of oxygen carried in the mixed venous blood

equation like CaO2 but with venous

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45
Q

CvO2 normal value

A

12-16 vol %

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46
Q

arterial- venous oxygen content difference

definition

A

measures the oxygen consumption of the tissues

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47
Q

C(a-v)O2

equation

A

CaO2 - CvO2

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48
Q

C(a-v)O2 normal value

A

4-5 vol%

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49
Q

CvO2 values will __ when C.O __

What about SvO2?

A
  • decrease
  • decreases
  • SvO2 values also decrease if C.O decreases

C.O decreases, CvO2 decreases

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50
Q

The percentage of the hemoglobin that is bounde by oxygen

A

Arterial Oxygen Saturation
SaO2

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51
Q

PaO2 value can be estimated by

A

subtracting 30 from the SaO2

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52
Q

measure the amount of ventilation support required to provide the level of oxygenation

A

Oxygen Index

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53
Q

Oxygen Index equation

A

(Paw- Fio2 / PaO2 ) x 100

Fio2 is a decimal not a percent

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54
Q

Normal OI

A

<10

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55
Q

An increase in the pt venous oxygen content would indicate that

A

C.O increased

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56
Q

Deadspace to tidal volume ratio

VD/VT

A

the percentage of the VT that does not participate in gas exchange

Ventilation without perfusion

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57
Q

oxygen index

Recomend __ for newborns with __

A
  • ECMO for newborns withOI >40
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58
Q

Normal VD/VT ratio

deadspace

A

20-40%
(up to 60% with ventilator pt )

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59
Q

Desired minute volume equation

A

current Ve x current PaCO2 = desired Ve x desired PaCO2

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60
Q

PaO2 value
Below 80

interpretation

A

Hypoxemia
can be caused by
* Poor ventilation
* V/Q mismatch

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61
Q

Hypoxemia
can be caused by

PaO2 below 80

A
  • Poor ventilation
  • V/Q mismatch
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62
Q

Response for hypoxemia

A
  • increase ventilation
  • increase FiO2 up to 60%
  • add PEEP
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63
Q

PaO2 bellow 80
with 60% + fio2

interpretation. What does the pt have?

A

Shunt, refractory hypoxemia, venous admixture

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64
Q

Shunt, refractory hypoxemia, venous admixture

RESPONCE

A

decrease Fio2, PEEP or CPAP

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65
Q

When pH is inside aceptable range

its called

A

Compensated or Chronic

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66
Q

When pH outside the acceptable range

its called

A

Non-compensated or Acute

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67
Q

abg sample

Higher PaO2 values (>140) would indicate

A

supplemental oxygen in use , bubble in sample or technical error

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68
Q

Lower PaO2 values may indicate

A

V/Q mismatch, diffusion defect, shunting or venous blood

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69
Q

Treatment for CO poisoning

A

100% oxygen and hyperberic oxygen therapy

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70
Q

comfirm Pulmonary embolus with

A

V/Q scan, CT scan, pulmonary angiography

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71
Q

Supect embolus in

pt with

A
  • post op pt
  • bedridden pt
  • history of deep vein thrombosis
  • women in advance stages of pregnancy
  • Venous stasis
  • obesity
  • Trauma
  • atrial fibrillation
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72
Q

Loss of metabolic acids, dehydration, electrolyte imbalance (due to vomiting)

Treatment

A

Administer potassium chloride (KCl) and oxygen

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73
Q

normal PaCO2 of a newborn

A

< 50 torr

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74
Q

normal PaO2 of a newborn

75
Q

Normal newborn pH

A

> 7.30

slightly acidotic

76
Q

ABG results do not match clinical appearance

Type 1
Type 2

A
  • type 1 - ABG loos good / pt looks and feels bad
  • type 2 ABG looks bad / pt loosk and feels fine
77
Q

Bedside assesment for Pulm. embolus shows

A

hyperpnea

increased rate and depth of ventilation

78
Q

treatment for pulmonary embolus

A
  1. prevent with aticoagulants (heparin)
  2. support ventilation and oxygenation
    treat existing clots with thrombolytic agens (streptokinase)
79
Q

Dissociation Curve

a shift to the left

A

increased affinity
* pH increases
* PCO2 decreases
* Temp decreases
* 2-3 DPG decreases

80
Q

Dissociation curve

shift to the right

A

decreased affinity
* pH decreases
* PCO2 increases
* Temp increases
* 2-3 DPG increases

81
Q

Spirometers measure

A

volume and flow rates

82
Q

Pneumotachometers (flow)

Turbine device

Wright respirometer

A

measures flow, may display volume

83
Q

Pneumotachometers (flow)

Pressure differential (Fleisch) pneumotachometer

A

measures flow
can be used to cotinuously measure minute ventilation (Ve)

84
Q

device used to measure and monitor PEFR for patients with asthma

A

Peak flow meter

85
Q

Pt exhales forcefully through a device which incorporates a resistor and a moveable indicator

A

Peak flow meter

86
Q

peak flow value

healthy adult

A

10 L/sec
or
600L/min

87
Q

Plethysmography

whats another name

88
Q

Plethysmography

Based on ___ law which states that pressure and volume ___ ___ if temperature is constant

A
  • Boyle’s Law
  • vary inversely
89
Q

Measure thoracic gas volume (TGV)

A

Body Box

Plethysmography

90
Q

Plethysmography measures __ which is the same as __

A
  • Thoracic Gas Volume (TGV)
  • FRC
91
Q

State the name of the standards that all PFT equipment must meet?

92
Q

Body box should be calibrated prior to procedure using:

A
  • mouth pressure transucer - water or mercury barometer
  • Box pressure tranducer - sine wave ratory pump
  • Flow transducer - rotameter
93
Q

Measures airway resistance wich is the difference in pressure between the mouth and alveoli

A

Body Box

Plethysmography

94
Q

PFT equipment

Volume calibration and leak test are performed by using a ..

A

large volume syringe or standard syringe volume of 3.0 Liters

95
Q

PFT equipment

daily calibration with a

A

3.0 L syringe

96
Q

Calibration and quality control

Acuracy range of daily calibration

A

+/- 3.5%
(2.895 L - 3.105 L)

97
Q

used to monitor and asses the readiness to wean in ventilator patients

98
Q

MIP: assess the degree of respiratory musce impairment in pts with ___ and ___

A

Guillain-Barré and Myasthenia Gravis

99
Q

Norma MIP

A

80 cmH20

negative number

100
Q

a MIP of <20 cmh20 indicates

A

inspiratory muscle weakness

101
Q

Helpfull in evaluating a pt’s ability to maintain an airway and clear secretions (cough effectively)

102
Q

Normal MEP

103
Q

MEP < 40 cmh2o indicates

A

poor ability to clear airway secretions

104
Q

Patient is instructed to take a maximal inspiration followed by a maximal exhalation WITHOUT FORCE

A

Vital Capacity

Slow Vital Capacity

105
Q

Decreased Volumes indicate

restrictive or obstuctive ?

A

Restrictive Disease

106
Q

The __ will provide the important volumes used to identify restrictive disease

A

*Slow vital capacity (SVC)

107
Q

_____ is the best indicator of restrictive lung disease

A

Decreased vital capacity

108
Q

Forced vital capacity

A

The volume that can be expired as forcefully and as rapidly as possible after a maximum inspiration

109
Q

The FVC procedure will provide the imporatnt Flow rates used to identify ___

A

obstructive disease

110
Q

Measured during the FVC maneuver

A
  • 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
Q

FVC should be equal to

A

Slow vital capacity

FVC can be used as a substitute to SVC

112
Q

FVC is not a ___, its a ____

A
  • flow
  • volume

should be equal to svc

113
Q

What is a good indicator of obstructive disease

A

a decreased FEV1

114
Q

List the volumes and capacities that can be measured from a vital capacity maneuver

A
  • IC
  • ERV
  • IRV
  • VT
  • VC
115
Q

What is the minimum acceptable value for the FEV1/FVC ratio?

A

> 70%

normal

116
Q

FEV/FVC or FEVt%

A

FEV/FVC x100 = FEV/FVC ratio

117
Q

decreased FEV1.0/FVC is the best indicator of

A

obstructive disease

118
Q

FEV1.0/FVC
decresed values =

A

obstructive disease

119
Q

If FVC is smaller than the SVC, it indicates

A

obstructive disease

120
Q

FEV1.0/FVC
normal values =

A

not obstructive (may still be restrictive

121
Q

IF the FEV1 is decreased but the FEV1/FVC ratio is normal then the pt has

A

restrictive disease only

122
Q

Measured Flow that comes from the medium and small size airways

A

Forced expiratory Flow 25% to 75%

123
Q

sometimes used to evaluate asthmatic patients, pre &post bronchodilators

A

Peak expiratory flow rate

PEFR

124
Q

Used to measure the reversibility of an obstructive pattern

A

pre & post bronchodilator testing

125
Q

pre & post bronchodilator testing

a minimum of ____ and___ in the FEV1 ,post study is considered significant

A
  • 12% AND 200mL
126
Q

Flow -volume loop shape :
Restivive

A

skinny and tall loop

127
Q

Flow -volume loop shape :
Obstructive

A

short and wide loop

128
Q

Describe a flow- volume loop

A
  • 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
Q

Interpreatation of spirometry ATS-ERS

80-100% of predicted

130
Q

Interpreatation of spirometry ATS-ERS

70-79% of predicted

A

Mild disorder

131
Q

Interpreatation of spirometry ATS-ERS

Mild disorder

A

70-79% of predicted

132
Q

Interpreatation of spirometry ATS-ERS

60-69 % of predicted

A

moderate disorder

133
Q

Interpreatation of spirometry ATS-ERS

Moderate disorder

A

60-69 % of predicted

134
Q

Interpreatation of spirometry ATS-ERS

50-59 % of predicted

A

Mod-Severe

135
Q

Interpreatation of spirometry ATS-ERS

<50% of predicted

136
Q

Interpreatation of spirometry ATS-ERS

Severe

A

<50% of predicted

137
Q

Interpreatation of spirometry ATS-ERS

<30% of predicted

A

very severe

138
Q

Interpreatation of spirometry ATS-ERS

very severe

A

<30% of predicted

139
Q

What indicates :
* restrictive
* obstruction
* confirms obstruction

A
  • FVC –> restictive
  • FEV1 –> obstruction
  • FEV1/FVC (%) –> confirms obstruction
140
Q

Restrictive has decreased ___
Obstructive has decreased_

A

Res: volumes (VC or FVC)
Obs:flows (FEV1,FEV1/FVC)

141
Q

Obstructive diseases:
CBABE

A

Cystic fibrosis
bronchitis
asthma
bronchiectasis
emphysema

142
Q

Restrictive or Obstructive?

Cystic fibrosis

A

obstructive

143
Q

Restrictive or Obstructive?

bronchitis

A

obstructive

144
Q

Restrictive or Obstructive ?

asthma

A

obstructive

145
Q

Restrictive or Obstructive?

bronchiectasis

A

obstructive

146
Q

Restrictive or Obstructive ?

emphysema

A

Obstructive

147
Q

Name restrictive diseases:

A

pulmonary fibrosis
inflammatory diseases
cardia disease
neurological/ meuromuscular
pleural disease
throacic/ spinal deformities

it continues…

148
Q

FVC maneuver

Best test is the trial that results in the largest sum of

A

FVC +FEV1

test should not differ more than 5% or 200mL

149
Q

The volume of air exhaled during rapid force breathing for at least 12 seconds

A

Maximum volunatry ventilation (MVV)

150
Q

Pt with lower than normal MVV is at risk of

A

atelectasis and pneumonia

151
Q

used to evaluate resp. muscle reserve, edurance or fatigue

A

Maximum voluntary ventilation

152
Q

state the formula used to caluclate the percent of predicted

A

actual value / predicted value = %

153
Q

List conditions that will have a decreased maximum voluntary ventilation (MVV)

A

obstructive lung disease
increased airways resistanc RAW
Respiratory muscle weakness
Decreased lung compliance
poor patient effort

154
Q

Airway resistance normal value

Raw

A

0.6-2.4 cmH2O/L/sec

155
Q

Normal Lung compliance

A

60-100 mL/cmH2O

156
Q

identify the three methods availanble to determine functional residual capacity

A
  • helium dilution
  • nitrogen wash out
  • Plethysmography / body box
157
Q

Describe

Nitrogen wash out

A

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
Q

Normal DLco

A

25 mL CO/min/mmHg

159
Q

Name 5 pathologies that wil result in decreased DLco

A

Pulmonary fibrosis
Sacoidosis
ARDS
Pulmonary edema
Emphysema

160
Q

FRC

A

the volume of gas left in the lungs at the end of normal expiration

161
Q

Diffusion Capacity Test

A

Assesses the integrity of the alveolar-capillary membrane

162
Q

Test looks at the capacity for carbon monoxide to diffuse through the lungs into the blood

A

Gas diffusion capacity

DLco

163
Q

Helium dilution method: how to identify obstructive disease

A

RV,FRC,TLC that is more than 120% of the predicted value

164
Q

Helium dilution method: how to identify restrictive disease

A

RV,FRC,TLC that is less than 80% of the predicted value

165
Q

Nitrogen wash out time:
normal
restrictive
obstructive

A
  • Normal 3-4 min
  • restricive 3 min
  • obstructive 7 min

failure to wahout in 7 min should be reported

166
Q

volume of gas measured by a spirometer from a slow, complete expiration after a maximal inspiration

A

Vital Capacity

167
Q

hollow metal tube that also functions as an airway

A

Rigid Bronchoscope
allows ventilation through the scope during the procedure

168
Q

Perfered scope for therapeutic procedures

A

Rigid Bronchoscope

169
Q

Flexible rubber scope with fiberoptic bundles as a light source

A

Flexible bronchoscope

170
Q

Prefered scope for diagnostic indications

A

Flexible bronchoscope

171
Q

Bronchoscopy

diagnostic reasons

A

suspected foreign body
suspected malignancy
bronchial washings
hemoptysis

172
Q

bronchoscopy

Therapeutic reasons

use rigid broncho.

A

Foreign body
atelectais
secretion removal
bronchia lavage
airway stenosis

rigid

173
Q

Bronchoscopy

list the most common complication when performing bronchoscopy using the nasal route

A

epistaxis (nasal bleading)

174
Q

bronchoscopy

most cases can be controlled with saline lavage and time

A

localized hemorrhage following tissue biopsy

175
Q

Steps that should be taken to treat serious bleeding that occurs during bronchoscopy prodedure

A
  • instill epinephrine
  • compress the site with the scope
  • insert a Fogarty catheter
176
Q

Bronchoscopy

anesthetics that you can give to prepare the pt

A
  • lidocaine
  • benzocaine
  • cetacaine
  • novocain

all have cain

177
Q

Asthma patient might have a RAW of

A

airway resistance of 2.8 cmh2o/L/sec

178
Q

SVC

VC less than 80% of predicted

A

patient is restrictive

179
Q

SVC

VC is 80% or greater

A

patient has no restriction

180
Q

DLco range

A

20-25 mL CO/min/mmhg

181
Q

PaCO2 above 45
response

A

initiate ventilation or
remove/ decrease deadspace or
increase current ventilation

182
Q

PaCO2 below 35
response

A
  • don’t put the pt on mv
  • decrease ventilation (if PaO2 is high)
  • or consider other causes (hypoxemia, metabolic acidosis )
183
Q

what kind of bronchoscope do you recommend for intubating pts with severe neck fracture

A

flexible bronchoscope

RRT (12 decks)

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