Respiratory Procedures Flashcards
5th vital sign
pulse ox
messed up pulse ox
fingernail polish
hypothermia - decreased periph circulation
carboxy-hemoglobin
carboxyhemoglobin
pulse ox doesn’t discriminate oxyhemoglobin vs. carboxyhemoglobin
carbon monoxide - may give false high pulse ox
CXR
typically P-A and left lateral studies**
correct CXR
9-10 ribs posteriorly
5-6 anteriorly
when to order CXR
disease of lung, mediastinum, heart, chest wall
systemic disease with chest involvement
monitor life support devices** ensure correct placement
pneumoperitoneum - gas in abdominal cavity
reading a CXR
technical quality of film
RIP - rotation, inspiration, penetration
white on Xray
opacity - more dense tissue
black - air
heart size on CXR**
transverse size of heart divided by transverse diameter of hemi-thorax should be <0.5
hemi-diaphragm
on CXR
right usually higher (due to liver)
AP CXR?**
with AP - heart will be enlarged
so PA - will show not falsely enlarged heart
limits of CXR
patient cooperation
technician skill
normal CXR can correlate poorly with actual disease**
early pneumonia
may not show infiltrate on CXR
pulmonary embolus
normal CXR
COPD, chronic bronchitis, asthma
increased PA diameter
increase retrosternal air space
ABG
arterial blood gas
-acid-base and oxygen status of patient
pH PaO2 PaCO2 HCO3 O2 sat
common sites of arterial blood
radial artery
brachial artery
femoral artery
ABG indications
assess for hypoxia acid-base disorders home O2 use measure carboxyhemoglobin** calculate O2 sat blood sample - difficult draw patients - very obese patients**
calculating arterial O2 sat with CO poisoning
O2 sat - CO Hg
ABG machine - cannot differentiate O2 and CO hemoglobin
ABG machine
cannot differentiate between O2 and CO
allens test
severe PAD with poor collaterals
contraindication for ABG
ABG collection
- sterile gloves
- put it on ice
- lidocaine - maybe - you’re just sticking patient 2x
allens test
radial and ulnar - occlude
squeeze hands until pale
release ulnar - to make sure it works
ABG collection
- palpate artery
- allens test
- 45 degree to skin bevel up**
- blood will fill syringe
- apply firm pressure with gauze - up to 5 minutes**
- put sample on ice
ET/NT tube intubation indications
resp failure airway protection maintain airway faciitate pulmonary tx and meds positiv pressure ventilation maintain oxygenation
ET/NT tube intubation CIs
unskilled operator
facial trauma
inability to extend head and neck for endotracheal**
only way to give 100% oxygen
through intubation
C spine injury
use a nasotracheal
prep for ET tube placement
- determine method
- make sure equipment works
- ensure IV access**
- remove foreign bodies
- hyperventilate
- monitor
- have appropriate staff
before ET tube placement
ensure IV access
rule of pinky finger
for size of ET tube
contemplate sedation
for conscious patient
rapid sequence intubation
to sedate - rapid sedative - propofol, thiopental, midazolam
risk is sudden drop of BP
sellick maneurver
cricoid pressure
to assist intubation
intubation position
sniffing position
curved blade insertion
into vallecula - over epiglottis
with cords in view - insert tip - to 21cm mark women or 23 mark men
tip should be 4cm above carina
straight blade insertion
just below epiglottis
lift scope up and forward
insert tip with cords in view
verify ET tube placement
look for asymmetric chest wall
listen for equal breath sounds b/l and over epigastrium
do a CXR
chest tube placement
5th and 6th ICS MCL - least amout of muscle
don’t go below - risk of injury to diaphragm/liver
patient - lateral decubitus
pneumothorax
22-24 french straight
hemothorax or pleural effusion
32-36 french straight or right angled
chest tube procedure
anesthetize subQ tissue
avoid neurovascular bundle - inferior aspect of rib
incision just superior to lower rib of interspace
pneumothorax tube direction
posteriorly toward apex
fluid tube direction
posteriorly keeping in dependent position
water seal
at 20cm of water suction
petroleum gauze
once chest tube in place
- water seal it
- have pt cough
- sterile gauze
- CXR to confirm placement**
spirometry
quantitative measure of lung function based on air flow rates and lug volumes
simple graph plot - volume as function of time
PFT - flow-volume loop
spirometry limitations
pt debilitation
severe resp distress
not motivated
meds affecting resp cycle
FEV1
forced exp volume in 1 second
FVC
total exhaled volme
average flow of rate during middle 50% of FVC
FEF 25-75
V-Q scan
evaluate presence of blood clots or other abnormalities in ventilation/circulation
CI VQ scan
kidney failure
two step scan
VQ
ventilation - gas xenon or technetium
perfusion - IV technetium
gamma camera
VQ results
normal
low probability 80%
multiple segmental perfusion deficits with normal ventilation
high probability
