Respiratory Procedures Flashcards
pulse ox
5th vital sign
% O2 sat
and pulse rate
reads red of Hg
hypothermia
can cause low O2 sat
nail polish
mess up pulse ox
carboxyhemoglobin
need arterial blood gas**
-bc can’t distinguish oxyHg vs carboxyHg
CXR
most common in US
-heart, lung, aorta, esophagus, pleura, bronchial tree, thoracic lymph nodes, thoracic skeleton, chest wall, upper abdomen
usually PA and left lateral
CXR done right
9-10 ribs posteriorly
5-6 ribs anteriorly
bed bound patients
AP CXR view
when to order CXR
disease diagnosis
monitor life support device
-post-procedure CXR** important
pneumoperitoneum - gas in abdominal cavity
RIP
rotation
inspiration
penetration
look for these on CXR
heart size on CXR
transverse size of heart divided by transverse diameter of thorax should be < 0.5
hemidiaphragm
on CXR
-right 1-1.5cm higher than left
inspiration
diaphragm to rib 9-10
see vertebra through heart on CXR
over-penetrated
no vertebrae at all
under-penetrated
AP CXR
heart shadow falsely enlarged because of divergence of x-ray beams
PA view - posterior/anterior - gives better size of heart
limits of CXR
patient coop
skill of technician and physician
poor correlation with disease
pulmonary embolus
often normal CXR
arterial blood gases
pH PaO2 PaCO2 HCO3 O2 sat
comm sites for ABG
radial artery
brachial artery
femoral artery
acid base balance and O2 status
arterial blood gas
indications for ABG
hypoxia acid-base disorders home O2 use carboxyhemoglobin levels** calculate arterial O2 sat blood sample in difficult draws
O2 sat - CO Hg
= actual O2
equipment for ABG
sterile gloves
- ice
- ABG kit - heparinized syringe with 25 gauge needle
lidocaine for ABG
if patient wants one
allens test
to check collateral circulation of the hand
hold ulnar and radial - squeeze hand - should turn white
release ulnar - should revascularize
if it does - than its ok to go ahead and stick the radial
ABG technique
palpate artery and allen test cleanse anesthetize if desired 45 degree angle with bevel up collect 2-3mL then remove needle firm pressure over site and hold for up to 5 minutes
transport sample on ice - ASAP
indications for intubation
resp failure
airway protection
maintenance airway
positive P ventilation
prep for ET tube placement
ensure IV access**
remove foreign bodies
hyperventilate with high O2 if possible
monitor BP, pulse ox, cardiac status
size of ET tube
should be size of pinky finger
sedation
for conscious patient
- rapid sequence intubation
- propofil, thiopental, midazolam
- look at BP
then muscle relaxant - succinylcholine, rocuronium
sellick maneuver
cricoid pressure
intubation sequence
hyperventilate
cricoid pressure (sellick)
sniffing position (extend at OA)
jaw thrust or chin lift
curved blade
under epiglottis
straight blade
on top of epiglottis
to check ET Tube placement
listen to abdomen - shouldn’t hear abdominal sounds
if only breath sounds one lung - went down bronchi
check with CXR
chest tube placement
5th and 6th ICS MAL
-below this - risk of injury for liver or diaphragm
go on TOP of rib - to avoid neurovascular bundle
incision - finger blunt dissection
suture it in - gauze seals it
pneumothorax
chest tube 22-24 french straignt
hemothorax or pleural effusion
chest tube 32-26 french straight
