Resp procedures Flashcards
Pulse ox
reads the color red refraction
hypothermia can cause falsely low O2 sat
fingernail polish can be an issue, use the earlobe
carboxyHb: pulse ox cannot differentiate it from oxyHb (need an ABG) exp in smokers!!
CXR
should be able to see 9-10 ribs (posterior) and 5-6 (anterior) if the patient inhales enough
*Neoplasia or Connective tissue disease
CXR and LLD
helps you differentiate an effusion from a consolidation bc an effusion should settle at the bottom when you lay them down
heart size on CXR
transverse size of the heart divided by the transverse diameter of the thorax (should be <0.5)
hemidiaphragm on CXR
right usually 1.0-1.5 cm higher than the left (d/t the liver)
Rotation
look at the first two ribs to see if they are about even
Inspiration
look to see if you can visualize all the ribs
Penetration
you should be able to see vertebrae until the heart begins, but not thereafter (if you can see the vert thru the heart, it is over penetrated) if you cannot see the vertebrae then it is underpenetrated
limitations of CXR
patient cooperation
skill of the technician and the interpreter
**Normal CXR can correlate poorly with actual disease (early pneumonia, PE, early COPD/bronchitis, interstitial disease (asbestosis))
common sites for arterial blood
radial
brachial
femoral
*Calculattes carboxyHb
calculating arterial O2 sat
ABG cannot differentiate bw O2 and CO Hb
need a CO-oximeter!
O2sat-COHb=true saturation
contraindications of ABG
coagulopathy (including thrombolytics)
PAD (ALLEN’S TEST)
Trauma or infection of skin
difficult to standardize (hyperventilation, breath holding, altitude, Ob)
Allen’s test
Occlude the radial and ulnar until the hand turns white
release the ulnar and see if the hand reperfuses
because you are going to stick the radial, you need to make sure that the ulnar a is functioning in case you lacerate the radial
Intubation indications
Respiratory failure
Airway protection for patients at risk of compromise
Maintenance of airway
Help facilitate pulmonary treatments and medication
Use positive pressure ventilation
Maintain adequate oxygenation
intubation contraindications
unskilled operator
trauma to face, neck, c-spine (relative)
inability to extend head and neck
chest tube placement
needs to occur in the 5th or 6th ICS MAL
don’t go lower or else you can damage the diaphragm or liver
insert needle ON TOP of rib
direct tube posterior and towards apex (pneumo) (dependent position)
CXR should be done to confirm
VQ scan contraindicaitons
Contraindications
Kidney failure
Allergy to radioactive materials
VQ scan procedure
two scans: radioactive gas for ventilation
IV technetium for perfusion
a gamma camera acquires the images
results are Normal, low prob, intermediate prob, high prob
FEV 1 < 1 L
system is not working
FEV 1 >1 & <2 L
FEV 1 >1 & <2 L = severe
effects on ADL’s
FEV 1 >2 L
moderate effects on ADL’s
Best measure for exercise capacity
FEV1> partial pressure O2(ABG)
FEV 1/FVC ratio < 40%
highly correlated w/ short life-span
normal VQ scan
no perfusion deficit
excludes PE
Low probability VQ
Perfusion deficit with matched ventilation deficit
< 20% probability of PE
Intermediate VQ
Perfusion deficit that corresponds to parenchymal abnormality on chest x-ray
20% - 80% probability of PE
High probability VQ
Multiple segmental perfusion deficits with normal ventilation
> 80% probability of PE
