Respiratory Labs Flashcards
respiratory system
-gas exchange:
-blood gas
-electrolytes- anion gap
-fluid analysis- pleural space
-secretion- bronchoalveolar lavage
WHY?
-infections
-asthma
-respiratory distress- not enough surfactant
-COPD
-sepsis
-lung cancer
major causes of respiratory disease
-tumors
-infections
-airway disease- shunting, (asthma and COPD)
-pulmonary vasculature disease (PE and pulmonary HTN)
-interstitial lung disease (sarcoidosis, pneumoconiosis, and many others)
diagram of airways-ventilation
-can be blocked by embolism- complete ventilation, no perfusion
-thickened alveolar-capillary barrier with impaired gas transfer (interstitial)
-thickness of membrane, temperature, distance- influence diffusion
-airway obstruction
modified allen test / radial artery ABG
-pts hand is held high while the fist is clenched and both radial and ulnar arteries are compressed
-blood will drain from hand
-then lower the hand
-open fist
-release ulnar artery but not the radial
-color should return to hand within 6s
-indicates pt ulnar artery and an intact superficial palmar arch
-if flow is not restored to hand -> you cant do an ABG on this hand -> no collateral flow
-collateral flow to fingers via ulnar and radial
-radial artery is palpated between distal radius and tendon of flexor carpi radialis
components of typical arterial blood gas kit
-arterial blood gas syringe
-protective needle
-syringe cap
-iodine and alcohol preparation swabs
-gauze
-pt label
-biohazard ice bag
-adhesive bandage
-sample goes on ice
femoral artery anatomy/puncture
-outside to inner- femoral nerve, artery, vein
-NAVEL
-femoral artery can be palpated just below midpoint of inguinal ligament
-blood draw- 90 degree angle
-catheter (snake a line)- 45 degree angle
blood gas
-Partial pressure of Oxygen
-Partial pressure of carbon dioxide
-pH
-Lungs respond within minutes ->
-ex. if you put a pt on a ventilator, the lungs respond in mins, redraw ABG can be done within mins
-Renal response takes hours/days
-Hypoxemia
-Hypercapna
-Respiratory Acidosis
-Metabolic Acidosis
-Respiratory Alkalosis
-Metabolic Alkalosis
effect of temperature on blood gas measurements
-higher temp -> lower pH
-lower temp -> higher pH
-temp affects pH
-put sample on ice
Reasons for ABG
causes of respiratory alkalosis
causes of metabolic alkalosis
-lax
-vomiting
-NG
-diuretics
-primary mineralocorticoid excess
major causes of metabolic acidosis
-DKA- tx IV insulin
electrolytes and anion gap
-Sodium
-Potassium
-Chloride
-Bicarbonate
-Anion Gap:
-Difference between major free cations and free anions.
-Used for evaluation of acidosis
-Amount of increased GAP is
BMP: chart
calculate anion gap
-Na - (Cl + HCO3)
-normal < 12
ANION GAP
-Methanol
-Uremia
-Diabetic ketoacidosis
-Propylene glycol
-Iron tablets or INH
-Lactic acidosis
-Ethylene glycol
-Salicylates
NORMAL ANION GAP
-Hyperalimentation
-Addison’s disease
-Renal tubular acidosis
-Diarrhea
-Acetazolamide
-Sprionolactone
-Saline infusion
thoacentesis
-asses:
-color
-characteristics
-odor
-exudate
-transudate
-transudative:
-low protein and LDH
-increased hydrostatic pressure or low osmotic pressure
-water/fluid (clear) in lungs
-ex. CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia
-exudative:
-high protein and LDH
-inflammation and increased capillary permeability
-ex. pneumonia, cancer, TB, viral infection, PE, autoimmune
-pus, yellow, odor, thick
lights criteria for pleural effusions
bronchalveolar lavage fluid analysis
-scope down trachea, bronchus -> view and obtain specimen
-Diagnostic:
-Pulmonary infections
-Acquired PNA
-Interstitial lung diseases
-Lung cancers
-Lung transplant monitoring
-Culture, WBC count, Gram Stain
-Bloody- Avelolar hemorrhage
-Cloudy- Pulmonary alveolar proteinosis
-Microscopy / Biomarkers
PNA
-Community Acquired PNA
-S. pneumoniae
-Mycoplasma pneumoniae
-F. Influenzae
-Legionella
-Bordetella perstussis
-Viral PNA:
-Influenza
-COVID 19
-Ventilator Infections:
-Drug Resistant:
-K. pneumonia
-P. aeruginosa
-A. Baumanii
-MRSA
-Travel?
-TB
-Fungal
-Depressed Immunity?
-HIV- Pneumocystis or CMV
-Neutropenic- Aspergillus
PNA- testing
Bacterial
Fungal
Parasitic
Viral
-Gram stain
-Sputum Culture
-Acid Fast Staining (TB)- culture/nucleic acid amplification test
-PCR assays
-KOH preps
-NAAT for viral infections
-Rapid Antigen Test for Flu
asthma
-spirometry
-pulmonary function tests
-CXR
-allergy testing
COPD
-Pulmonary Function Tests
-CBC
-Rule out infections
-Symptoms
-r/o Alpha-1 antitrypsin Deficiency, elastin degradation
acute respiratory distress syndrome (ARDS)
-Rapid onset respiratory failure.
-Systemic inflammation, trauma, severe infection
-Significant morbidity & mortality
-Hypoxia, bilateral infiltrates, respiratory failure without cardiovascular insult or pulmonary HTN.
-Dx: Hx, CXR, CT, ABG, Echo, Cardio biomarkers,
-Tx: Oxygen, IV fluids, underlying disease
-if in preterm labor- give steroids to increase lung maturity in baby
neonatal respiratory distress syndrome
-Incomplete development, preterm infants
-Deficiency in surfactant, which prevents alveolar collapse during exhalation
-Have perfusion but lack ventilation… hypoxia & respiratory acidosis.
-Steroids 48hrs before birth.
-Lamellar body count test for fetal lung maturity in amniotic fluid
sepsis
-Severe physiological and biochemical response to a global infection.
-Response to infection is no longer localized.
-Systemic Inflammatory Response Syndrome (SIRS), proinflammatory cytokines cause fever, leukocytosis, activation of endothelial cell function and coagulation
-LEFT SHIFT- neutrophils (banded), leukocytosis
-Signs: Temperature >38C or <36C, WBC >12 or <4, RR>20 /min, HR>90 bpm.
-Shock hypotension and organ failure
-70 % mortality
-Lactate elevation, WBC with neutrophil elevation (left shift)
lung cancer
-CXR, CT, MRI
-Tissue histological & immunohistochemical analysis
-Molecular testing, mutations direct therapy. Gene protein mutations, amplifications or rearrangments.
-Cytokeratin 19 fragments in serum may be used in prognosis.
immunohistochemical and histochemical stains useful in diff dx of various carcinomas
