Resp procedures

Question 1

Pulse ox

Answer 1

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!!

Question 2

CXR

Answer 2

should be able to see 9-10 ribs (posterior) and 5-6 (anterior) if the patient inhales enough
*Neoplasia or Connective tissue disease

Question 3

CXR and LLD

Answer 3

helps you differentiate an effusion from a consolidation bc an effusion should settle at the bottom when you lay them down

Question 4

heart size on CXR

Answer 4

transverse size of the heart divided by the transverse diameter of the thorax (should be <0.5)

Question 5

hemidiaphragm on CXR

Answer 5

right usually 1.0-1.5 cm higher than the left (d/t the liver)

Question 6

Rotation

Answer 6

look at the first two ribs to see if they are about even

Question 7

Inspiration

Answer 7

look to see if you can visualize all the ribs

Question 8

Penetration

Answer 8

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

Question 9

limitations of CXR

Answer 9

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))

Question 10

common sites for arterial blood

Answer 10

radial
brachial
femoral
*Calculattes carboxyHb

Question 11

calculating arterial O2 sat

Answer 11

ABG cannot differentiate bw O2 and CO Hb
need a CO-oximeter!

O2sat-COHb=true saturation

Question 12

contraindications of ABG

Answer 12

coagulopathy (including thrombolytics)
PAD (ALLEN’S TEST)
Trauma or infection of skin
difficult to standardize (hyperventilation, breath holding, altitude, Ob)

Question 13

Allen’s test

Answer 13

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

Question 14

Intubation indications

Answer 14

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

Question 15

intubation contraindications

Answer 15

unskilled operator
trauma to face, neck, c-spine (relative)
inability to extend head and neck

Question 16

chest tube placement

Answer 16

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

Question 17

VQ scan contraindicaitons

Answer 17

Contraindications
Kidney failure
Allergy to radioactive materials

Question 18

VQ scan procedure

Answer 18

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

Question 19

FEV 1 < 1 L

Answer 19

system is not working

Question 20

FEV 1 >1 & <2 L

Answer 20

FEV 1 >1 & <2 L = severe

effects on ADL’s

Question 21

FEV 1 >2 L

Answer 21

moderate effects on ADL’s

Question 22

Best measure for exercise capacity

Answer 22

FEV1> partial pressure O2(ABG)

Question 23

FEV 1/FVC ratio < 40%

Answer 23

highly correlated w/ short life-span

Question 24

normal VQ scan

Answer 24

no perfusion deficit

excludes PE

Question 25

Low probability VQ

Answer 25

Perfusion deficit with matched ventilation deficit

< 20% probability of PE

Question 26

Intermediate VQ

Answer 26

Perfusion deficit that corresponds to parenchymal abnormality on chest x-ray
20% - 80% probability of PE

Question 27

High probability VQ

Answer 27

Multiple segmental perfusion deficits with normal ventilation
> 80% probability of PE