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Year 2 PCM III > Respiratory Procedures- Stasio > Flashcards

Respiratory Procedures- Stasio Flashcards

1
Q

What can make pulse oximetry readings less accurate

A

hypothermia- decreased peripheral circulation
fingernail polish
cannot discriminate between oxyhemoglobin and carboxyhemoglobin

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2
Q

If dont correctly what will a CXR show you

A

9-10 ribs posteriorly and 5-6 anteriorly

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3
Q

When do you order a CXR

A

suspect disease in that area
suspect systemic disease with chest involvement
monitor life-support devices
pneumoperitoneum (gas in abcdominal cavity)

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4
Q

What is RIP when reading CXR

A

rotation, inspiration and penetration

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5
Q

normal heart size on CXR is what

A

transverse size of heart divided by transverese diameter of thorax shoul dbe <.5

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6
Q

What side of diaphragm is higher on CXR

A

the right is higher from liver

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7
Q

What does penetration refer to on CXR

A

under or over penetrated

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8
Q

what does inspiration of CXR refer to

A

ddiaphragm to the 9-10 rib

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9
Q

on PA view the heart looks enlarged, why?

A

divergence of x ray beams

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10
Q

What is seen on CXR of early COPD/chornic bronchitis/asthma

A

hyperinflation, loss of vascular markings, flattened hemidiaphragms, inc PA diamteres, inc retrosternal air space

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11
Q

ABG is used to determine what

A 
pH of blood
pp O2 in blood
pp CO2 in blood
HCO3 level
O2 sat Hb
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12
Q

Where are the common sites to pull ABG from

A

radial a, brachial a and femoral

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13
Q

what are indications for ABG

A

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)

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14
Q

How do you calculate actual O2 sat in ABG

A

O2 sat- CO Hb = actual O2 sat

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15
Q

What are the absolute contraindications to ABG

A

none

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16
Q

what are the relative contraindications to ABG

A

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

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17
Q

What is equipment for ABG collection

A 
sterile gloves
rolled towel
ice for transport
ABG kit
and lidocaine if desired
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18
Q

What is in ABG kit

A

2 ml heparinized syringe with 25 gauge needle, iodophor and alcohol pads, 2x2 sterile gauze and band-aid

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19
Q

describe cleaning process before arterial draw

A

cleab with iodophor then wipe once with alcohol pad

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20
Q

at what angle do you insetrt needle for ABC

A

45 to skin, bevel up and slowly advance till artery is puntured

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21
Q

how much blood do you collect for ABG

A

2-3mL

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22
Q

how long do you apply pressure after stick

A

5 minutes or until no bleeding occurs

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23
Q

describe traction on skin for ABG draw

A

locate a with index and middle finger and speard apart

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24
Q

What are indications for ET/NT intubation

A 
respiratory failure
airway protection
maintenance of airway
facilitate pulm Tx and medication
use + P ventilation
maintain adequate oxygenation
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25
Q

what are contraindications to ET/NT intubation

A

operator unskilled to administer tube
excessive trauma to face, neck and c spine
inability to extend head and neck

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26
Q

What is key for reparing ET tube placement

A 
most appropriate method
all equipment must be functioning
have adequate IV access!
removed any foreign bodies
hyperventialte
monitor BP, pulse ox and cardiac status
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27
Q

What is equipemnt for ET tube

A 
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
28
Q

what are the ET tube sizing for males and females

A

7-8mm females

8-9 mm males

29
Q

If sedating patient for ED tube (conscious) what do you use

A

rapid IB admin of sedative :propofol thiopental, midazolam

fast aciting muscle reacanat too (succinnylcholine)

30
Q

What is risk for sedation of ET tube placement patient

A

risk if sudden drop BP

31
Q

What is intubation sequence for ET tube

A

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

32
Q

what is sniffing position

A

extending head at OA joing, jaw thurst or chin lift if needed

33
Q

Correct placement of ET tube is at what level in females and adults

A

21 cm mark on tube- women

23 mark on tube- men

34
Q

you want the tip of ET tube where in body

A

3-4 cm above carina

35
Q

Where is the tip for a straight blade laryngoscope

A

just below epilottis

36
Q

What do you do tog verifty ET tube placement

A

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

37
Q

what are indications for chest tubes

A 
pneumo casing resp distress
hemothorax
large pleural effusions
empyema
pos thoracotomy
38
Q

What are contraindiciations for chest tubes

A

small pneumonthorax not causing resp distress
pleura adherent to chest wall
coagulopathy
previous chest tube in same site

39
Q

describe prep for chest tube plcaement

A

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

40
Q

What is on equipment list for chest tube

A

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

41
Q

what is appropriate size chest tube for pneumo?

hemotthorax or pleural effusion?

A

pneumothorax- # 22-24 french straigh

hemothorax or pleural effusion- #32-36 french straight or right angled

42
Q

describe chest tube procedure

A

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

43
Q

where do you direct tube for pneumothorax

A

posteriorly and toward apex

44
Q

where do you direct tube for fluid

A

posteriolry and dependent position

45
Q

how do you prevent lung injury with chest tube

A

grip th clamp with other hand so that the distance from hand to tip is just greater than chest wall thickeness

46
Q

What do you do once you verify! chest tube is in place

A

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

47
Q

What is on a simple spirometry graph plot

A

volume as function of time

48
Q

what is on a pulm function test plot

A

flow-volume loops
expiratory against volumes
expiratory and inspiratory flow rates against volumes
diffusion rates of gases

49
Q

what are indications for spirometry/PFT

A

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

50
Q

What are spirometry limitations and contraindications

A

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

51
Q

What is FEV1

A

forced expiratory volume in 1 sec

52
Q

what is FVC

A

forced vital capacity (total exhaled volume)

53
Q

when does average flow of expiration occur

A

during middle 50% of FEF forced xpiratory flow

54
Q

diminished FVC is a reliable and valid index of what

A

significant impairement in patients with interstitial lung disease

55
Q

FEV1/FVC ratio is <40% what does this correlate with

A

shortened life span

56
Q

What is a better correlation of exercise capacity: FEV1 or ppO2 ABG

A

FEV1

57
Q

What are indications for V/Q scan

A

presence of blood clots or other abnormalities in ventilation and circulation
evaluate COPD or pneumonia

58
Q

What are contraindicaitons to V/Q scans

A

kdiney failure, allergy to radioactive materials

59
Q

what are risks with v/Q scans

A

radiation exposure, renal toxicity

60
Q

What gase is used for ventialtion component of v/q scan

A

xenon or technetium

61
Q

what is used for perfusoin part of VQ scan

A

IV technectium

62
Q

What type camera is for vq scan

A

gamm camera

63
Q

What are the possible results of a vq scan

A

normal

low probability 80%

64
Q

describe interpretation of intermediate probability vq scan

A

perfusoin deficit that corresponds to parenchymal abnormality on CXR

65
Q

describe high probability of vq scan

A

multiple segmental perfusion deficits with normal ventilation

Year 2 PCM III (5 decks)

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