RESPIRATORY Flashcards
Best objective measurement for asthma
Peak flow
Chronic, reversible, triggers, children can have apenic periods/decreased HR
Asthma
What is the problem with asthma? What phase is prolonged? When does wheezing occur?
Problem with air getting out due to vasoconstriction. Expiratory phase is prolonged. Wheezing initially on exhalation and then worsens to inhalation.
What is a big risk for patients with bronchiolitis?
Dehydration due to increased RR and poor feeding - give humidified oxygen
Intermediate step b/t O2 and intubation
CPAP/BiPAP
What kind of CXR infiltrate typically is seen with PNA? TB?
PNA = middle/LL
TB = upper lobe
When do antibiotics need to be given for strep PNA?
Within 4 hours
cramping hands/feet d/t hyperventilation
carpopedal spasms
What 6 things are risk factors for a pneumothorax?
-Marfans
-Ehlers Danlos
-Smoking
-Drugs
-Meds
-Prior PTX
When do we get a CXR for PTX patients with a chest tube?
Immediately after insertion and at 4 hours
What lung sounds do we hear in pts with a PTX?
absent or markedly decreased
How much blood in a patient with a hemothorax needs OR/open thoracotomy?
> 1000 mL
What kind of shock does a tension PTX cause?
Obstructive due to pressure on the mediastinum
How do we treat a tension pneumo?
Immediately with a 14g/3.25” or larger needle @ 2nd ICS MCL affected side, reassess, will need chest tube and OR
What symptom does a PE cause? What kind of shock can a large PE lead to?
Progressive and unexplained SOB
Obstructive shock
Diffuse inflammatory response in lungs; sudden, progressive, severe; diffuse b/l infiltrates; commonly assoc with pulm contusion
ARDS
What are the 7 Ps in RSI?
-Prepare
-Pre-oxygenate (also “do-nitrogenation” - 100% O2 x 3 minutes with NRB)
-Pre-treat (sedate, consider lido for ICP protection and atropine in peds to prevent bradycardia)
-Paralyze
-Placement (Sellick = crich pressure)
-Proof (observe, listen, ETCO2, CXR)
-Post-intubation
What kind of pressure do we typically have? What kind of pressure does a vent use?
We use negative pressure; vent uses positive
What are 4 causes of vent alarms?
DOPE
Dislodged
Obstruction
Pneumothorax
Equipment
What is normal with a chest tube?
Water seal with intermittent bubbling and mild fluctuations with patients respirations
What usually means a leak in a chest tube? Where do we normally see a leak?
continuous bubbling = leak
leak is usually at insertion site
What is the maximum amount of time we can clamp a chest tube?
1 minute
How do we ventilate with a combitube/dual lumen? What do we do with the other lumen?
Ventilate using whatever port makes chest go up and down, clamp off the other tube
What does acidity (pH <7.35) cause? (3)
-decreased cardiac contraction force
-decreased vascular response to catecholamines
-decreased action of some meds
What does alkalosis (pH >7.45) interfere with? (3)
-tissue oxygenation
-neuro function
-muscular function
Partial pressure of CO2 dissolved in the bloodstream
PaCO2
What is a normal PaCO2?
35-45
This is the amount of excess or insufficient amount of bicard in the system
Base excess
What is a normal base excess?
-2 to +2, with a negative BE meaning HCO3 deficit in the blood
What buffers pH rapid but crude?
What buffers pH slow but precise?
Lungs / respiratory
Kidneys / metabolic
What is caused by any condition that causes hypoventilation?
Respiratory Acidosis
What is caused by any condition that causes hyperventilation?
Respiratory Alkalosis
pH <7.35, PaCO2 >45
Respiratory Acidosis
pH >7.45, PaCO2 <35
Respiratory Alkalosis
What 6 things might cause a metabolic acidosis?
-DKA
-renal failure
-starvation
-ASA OD
-shock
-sepsis
What 3 things might cause a metabolic alkalosis?
this is RARE
-antacid OD
-excess use of bicarb
-acid loss through vomiting
pH <7.35, HCO3 <22
Metabolic Acidosis
pH >7.45, HCO3 >26
Metabolic Alkalosis
ABGs: uncompensated
Problem system ?
Functioning system ?
pH ?
Problem system abnormal
Functioning system WNL
pH abnormal
ABGs: partially compensated
Problem system ?
Functioning system ?
pH ?
Problem system abnormal
Functioning system abnormal
pH abnormal
ABGs: compensated
Problem system ?
Functioning system ?
pH ?
Problem system abnormal
Functioning system abnormal
pH WNL
pH: 7.30
PaCO2: 36
HCO3: 14
PaO2: 70
pH: 7.30 = acidosis
PaCO2: 36 = normal
HCO3: 14 = acidosis
PaO2: 70 = low
Uncompensated Metabolic Acidosis
pH: 7.47
PaCO2: 30
HCO3: 18
PaO2: 81
pH: 7.47 = alkalosis
PaCO2: 30 = alkalosis
HCO3: 18 = acidosis
PaO2: 81 = normal
Partially Compensated Respiratory Alkalosis
pH: 7.52
PaCO2: 50
BE: +3
PaO2: 81
pH: 7.52 = alkalosis
PaCO2: 50 = acidosis
BE: +3 = alkalosis
PaO2: 81 = normal
Partially Compensated Metabolic Alkalosis
pH: 7.38
PaCO2: 27
HCO3: 17
PaO2: 80
pH: 7.38 = WNL (more acid)
PaCO2: 27 = alkalosis
HCO3: 17 = acidosis
PaO2: 80 = normal
Compensated Metabolic Acidosis
pH: 7.37
PaCO2: 58
BE: +14
pH: 7.37 = WNL (more acid)
PaCO2: 58 = acidosis
BE: +14 = alkalosis
Compensated Respiratory Acidosis
