Respiratory Procedures

Question 1

pulse ox

Answer 1

5th vital sign

% O2 sat
and pulse rate

reads red of Hg

Question 2

hypothermia

Answer 2

can cause low O2 sat

Question 3

nail polish

Answer 3

mess up pulse ox

Question 4

carboxyhemoglobin

Answer 4

need arterial blood gas**

-bc can’t distinguish oxyHg vs carboxyHg

Question 5

CXR

Answer 5

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

Question 6

CXR done right

Answer 6

9-10 ribs posteriorly

5-6 ribs anteriorly

Question 7

bed bound patients

Answer 7

AP CXR view

Question 8

when to order CXR

Answer 8

disease diagnosis

monitor life support device
-post-procedure CXR** important

pneumoperitoneum - gas in abdominal cavity

Question 9

RIP

Answer 9

rotation
inspiration
penetration

look for these on CXR

Question 10

heart size on CXR

Answer 10

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

Question 11

hemidiaphragm

Answer 11

on CXR

-right 1-1.5cm higher than left

Question 12

inspiration

Answer 12

diaphragm to rib 9-10

Question 13

see vertebra through heart on CXR

Answer 13

over-penetrated

Question 14

no vertebrae at all

Answer 14

under-penetrated

Question 15

AP CXR

Answer 15

heart shadow falsely enlarged because of divergence of x-ray beams

PA view - posterior/anterior - gives better size of heart

Question 16

limits of CXR

Answer 16

patient coop
skill of technician and physician
poor correlation with disease

Question 17

pulmonary embolus

Answer 17

often normal CXR

Question 18

arterial blood gases

Answer 18

pH
PaO2
PaCO2
HCO3
O2 sat

Question 19

comm sites for ABG

Answer 19

radial artery
brachial artery
femoral artery

Question 20

acid base balance and O2 status

Answer 20

arterial blood gas

Question 21

indications for ABG

Answer 21

hypoxia
acid-base disorders
home O2 use
carboxyhemoglobin levels**
calculate arterial O2 sat
blood sample in difficult draws

Question 22

O2 sat - CO Hg

Answer 22

= actual O2

Question 23

equipment for ABG

Answer 23

sterile gloves

• ice
• ABG kit - heparinized syringe with 25 gauge needle

Question 24

lidocaine for ABG

Answer 24

if patient wants one

Question 25

allens test

Answer 25

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

Question 26

ABG technique

Answer 26

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

Question 27

indications for intubation

Answer 27

resp failure
airway protection
maintenance airway
positive P ventilation

Question 28

prep for ET tube placement

Answer 28

ensure IV access**
remove foreign bodies
hyperventilate with high O2 if possible
monitor BP, pulse ox, cardiac status

Question 29

size of ET tube

Answer 29

should be size of pinky finger

Question 30

sedation

Answer 30

for conscious patient

• rapid sequence intubation
• propofil, thiopental, midazolam
• look at BP

then muscle relaxant - succinylcholine, rocuronium

Question 31

sellick maneuver

Answer 31

cricoid pressure

Question 32

intubation sequence

Answer 32

hyperventilate
cricoid pressure (sellick)
sniffing position (extend at OA)
jaw thrust or chin lift

Question 33

curved blade

Answer 33

under epiglottis

Question 34

straight blade

Answer 34

on top of epiglottis

Question 35

to check ET Tube placement

Answer 35

listen to abdomen - shouldn’t hear abdominal sounds

if only breath sounds one lung - went down bronchi

check with CXR

Question 36

chest tube placement

Answer 36

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

Question 37

pneumothorax

Answer 37

chest tube 22-24 french straignt

Question 38

hemothorax or pleural effusion

Answer 38

chest tube 32-26 french straight