Respiratory Procedures- Stasio Flashcards
What can make pulse oximetry readings less accurate
hypothermia- decreased peripheral circulation
fingernail polish
cannot discriminate between oxyhemoglobin and carboxyhemoglobin
If dont correctly what will a CXR show you
9-10 ribs posteriorly and 5-6 anteriorly
When do you order a CXR
suspect disease in that area
suspect systemic disease with chest involvement
monitor life-support devices
pneumoperitoneum (gas in abcdominal cavity)
What is RIP when reading CXR
rotation, inspiration and penetration
normal heart size on CXR is what
transverse size of heart divided by transverese diameter of thorax shoul dbe <.5
What side of diaphragm is higher on CXR
the right is higher from liver
What does penetration refer to on CXR
under or over penetrated
what does inspiration of CXR refer to
ddiaphragm to the 9-10 rib
on PA view the heart looks enlarged, why?
divergence of x ray beams
What is seen on CXR of early COPD/chornic bronchitis/asthma
hyperinflation, loss of vascular markings, flattened hemidiaphragms, inc PA diamteres, inc retrosternal air space
ABG is used to determine what
pH of blood pp O2 in blood pp CO2 in blood HCO3 level O2 sat Hb
Where are the common sites to pull ABG from
radial a, brachial a and femoral
what are indications for ABG
assess for hypoxia
evaluate acid base
need for home O2?
measure carboxyHb levels in smoke inhalation patients or exposure (CO)
calculate arterial O2 sat
blood sample in dificult draw patients (obese)
How do you calculate actual O2 sat in ABG
O2 sat- CO Hb = actual O2 sat
What are the absolute contraindications to ABG
none
what are the relative contraindications to ABG
invasive procedure
coagulopathy
severe PAD with poor collaterals (allens test)
trauma of infection at draw site
difficult to standarize from factors: hyperventilation, breath holding, altitude, obesity
What is equipment for ABG collection
sterile gloves rolled towel ice for transport ABG kit and lidocaine if desired
What is in ABG kit
2 ml heparinized syringe with 25 gauge needle, iodophor and alcohol pads, 2x2 sterile gauze and band-aid
describe cleaning process before arterial draw
cleab with iodophor then wipe once with alcohol pad
at what angle do you insetrt needle for ABC
45 to skin, bevel up and slowly advance till artery is puntured
how much blood do you collect for ABG
2-3mL
how long do you apply pressure after stick
5 minutes or until no bleeding occurs
describe traction on skin for ABG draw
locate a with index and middle finger and speard apart
What are indications for ET/NT intubation
respiratory failure airway protection maintenance of airway facilitate pulm Tx and medication use + P ventilation maintain adequate oxygenation
what are contraindications to ET/NT intubation
operator unskilled to administer tube
excessive trauma to face, neck and c spine
inability to extend head and neck
What is key for reparing ET tube placement
most appropriate method all equipment must be functioning have adequate IV access! removed any foreign bodies hyperventialte monitor BP, pulse ox and cardiac status
What is equipemnt for ET tube
bag-valve-mask and O2 source laryngoscop handles and blades (2)- one curved and one straight(adult size 3) severeal ET tubes oral and nasal airways available stylet (lubricated) forceps and suction tape or strap to secure tube 10 mL syringe to inflate cuff
what are the ET tube sizing for males and females
7-8mm females
8-9 mm males
If sedating patient for ED tube (conscious) what do you use
rapid IB admin of sedative :propofol thiopental, midazolam
fast aciting muscle reacanat too (succinnylcholine)
What is risk for sedation of ET tube placement patient
risk if sudden drop BP
What is intubation sequence for ET tube
recheck all equipment is functiong
hyperventilate patiend
cricoid pressure by assistant
position patient in sniffing position
place laryngoscop in right side mouth and sweep blade to left displacing tongur
curved blade tup inserted into vallevula and lift scope up and forward then insert tip between vocal cords 2-3 cm below and removed scope and inflate cuff
what is sniffing position
extending head at OA joing, jaw thurst or chin lift if needed
Correct placement of ET tube is at what level in females and adults
21 cm mark on tube- women
23 mark on tube- men
you want the tip of ET tube where in body
3-4 cm above carina
Where is the tip for a straight blade laryngoscope
just below epilottis
What do you do tog verifty ET tube placement
look for symmetrical rise and equal breath sounds b/l over epigastrum
secure tube to skin
do CXR to confirm correct placement
monitor rep valuse and confirm proper function
what are indications for chest tubes
pneumo casing resp distress hemothorax large pleural effusions empyema pos thoracotomy
What are contraindiciations for chest tubes
small pneumonthorax not causing resp distress
pleura adherent to chest wall
coagulopathy
previous chest tube in same site
describe prep for chest tube plcaement
written consent
lateral decubitus with affected side up
prep and drape steril, 5th-6th ICS MAL
***Do not go below because risk of injuring the diaphragm
What is on equipment list for chest tube
skin prep(betadine)
steril gloves, mask, gogles, fenestrated draope
lidocaine, 10 mL syringe 22 gauge-1.5 in needle
scalpel blad with hangle
curved clamp
appropriate size chest tube
multi chamber water seal
needle holder, suture, scissors, gauze with petroleum jelly on it
sterile sponges and elastic adhesive
what is appropriate size chest tube for pneumo?
hemotthorax or pleural effusion?
pneumothorax- # 22-24 french straigh
hemothorax or pleural effusion- #32-36 french straight or right angled
describe chest tube procedure
anesthetize subcut tissues along top edge of rib
slowly advance while infiltratin along costa periosteum until air of fluis is aspirated in pleural space
make small incision throught fact and mm superior to lower rib
enlarge incision with curved clamp and perforate into pleural space
where do you direct tube for pneumothorax
posteriorly and toward apex
where do you direct tube for fluid
posteriolry and dependent position
how do you prevent lung injury with chest tube
grip th clamp with other hand so that the distance from hand to tip is just greater than chest wall thickeness
What do you do once you verify! chest tube is in place
attach opp end of tube to multi chamber water seal with suction at 20 cm water
have patient cough (should have bubble appear)
suture through skin and tie tube down
place petroleum gauze around tube exit
apply sterile gauze and secure with tape
CXR to confirm placement
continue to monitor for resolution of problem
What is on a simple spirometry graph plot
volume as function of time
what is on a pulm function test plot
flow-volume loops
expiratory against volumes
expiratory and inspiratory flow rates against volumes
diffusion rates of gases
what are indications for spirometry/PFT
screening(smoker, toxic exposures, asthma, COPD)
Dx testing: obstrutive lung disease and restrictive lung disease
evaluate efficacy of treatments
tracking course of disease
disability determinations
What are spirometry limitations and contraindications
results bery patient dependent
severe debilitation and excessive tiring
severe or moderately severe resp distress
patient not motivated or desiring to take test
medication affecting resp cycle of function of chest mm
What is FEV1
forced expiratory volume in 1 sec
what is FVC
forced vital capacity (total exhaled volume)
when does average flow of expiration occur
during middle 50% of FEF forced xpiratory flow
diminished FVC is a reliable and valid index of what
significant impairement in patients with interstitial lung disease
FEV1/FVC ratio is <40% what does this correlate with
shortened life span
What is a better correlation of exercise capacity: FEV1 or ppO2 ABG
FEV1
What are indications for V/Q scan
presence of blood clots or other abnormalities in ventilation and circulation
evaluate COPD or pneumonia
What are contraindicaitons to V/Q scans
kdiney failure, allergy to radioactive materials
what are risks with v/Q scans
radiation exposure, renal toxicity
What gase is used for ventialtion component of v/q scan
xenon or technetium
what is used for perfusoin part of VQ scan
IV technectium
What type camera is for vq scan
gamm camera
What are the possible results of a vq scan
normal
low probability 80%
describe interpretation of intermediate probability vq scan
perfusoin deficit that corresponds to parenchymal abnormality on CXR
describe high probability of vq scan
multiple segmental perfusion deficits with normal ventilation
