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Respiratory > Respiratory TMC > Flashcards

Respiratory TMC Flashcards

1
Q

What is the difference between obstructive and central sleep apnea?

A

If effort is being made, its obstructive, and if an effort is not being made then its central

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2
Q

Obstructive sleep apnea (OSA)

A

related to obsessive amount of soft tissue in the upper airway (people w/obesity, increased neck circumference. The trachea falls over the tracheal opening and obstructs the airway. The patient is trying to breathe but they can’t. SPO2 drops when the patient starts breathing

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3
Q

How is OSA treated?

A

certain level of CPAP

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4
Q

Apnea Hypopnea Index (AHI)

A

0-4 (normal)
5-14 (mild)
15-29 (moderate)
>30 (severe, and the next step is a titration study to see how much CPAP or BIPAP pressure us appropriate.

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5
Q

Central Sleep Apnea

A

no signal from the brain to breathe (when the patient goes to sleep the brain also goes to sleep). It is typically associated with a congenital defect

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6
Q

How is central sleep apnea treated?

A

mechanical ventilation, diaphragmatic breathing, pacemakers, or pharmacological agents (methylxanthine)

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7
Q

Guillain Barre
(ground up)

A

associated with circulating antibodies (some type of precluding infection or acute illness). The antibodies attack the body’s own nervous system. This leads to the demyelination of neural sheath. It begins from the lower extremities and move up

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8
Q

How is Guillain Barre treated?

A

monitor patient with MIP maneuver and vital capacity maneuver

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9
Q

What should you do if the MIP maneuver is ever <-20 (Guillain Barre)?

A

the patient has to be put on mechanical ventilation (the diaphragm is no longer strong enough and has severe weakening of it)

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10
Q

What does it mean if the vital capacity (VC) is <10 ml/kg (Guillain Barre)?

A

The patient has lost the ability to take a deep breath and blow it all the way out

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11
Q

What are some other treatments for Guillain Bare?

A

plasmapheresis (replacing bad antibodies with good ones) and IVIG

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12
Q

Myasthenia Gravis

A

related to an increased number in antibodies, but it doesn’t have to do with the myelin sheath. This deals with the neuromuscular junction, which is where ACH attaches to receptors (cholinergic) that make muscle movements. Antibodies impairs the ACH attaching to the receptors and allow the patient to move. Starts with the head then goes down to the feet

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13
Q

How may patients present with Myasthenia Gravis?

A

dysphasia (difficulty swallowing), dysphonia (difficulty speaking, droopy eyelids)

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14
Q

How is Myasthenia gravis treated?

A

can be treated with drugs for AcH, Tensilon test, monitor MIP <20 and VC< 10ml/kg (intubate if this is the case), and plasmapheresis

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15
Q

Obstructive Lung Diseases (CBABE)

A

-Cystic Fibrosis
-Bronchiectasis
-Asthma
-Chronic Bronchitis
-Emphysema
*Everything else is restrictive

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16
Q

What is the problem with all obstructive diseases?

A

They are all obstructive to expiratory flows. They are all accompanied with air trapping, barrel chest, or pursed lip breathing

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17
Q

What kind of things would you expect to see on an x-ray for a pt with an obstructive disease?

A

hyperinflation, more radiolucency, flattened diaphragm, or increased intercostal spaces

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18
Q

Asthma

A

associated with a reactive airway that leads to acute bronchospasm (smooth muscle of the airway is going to constrict; constriction causes airway to get smaller

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19
Q

How does a pt with Asthma present in the ER?

A

with expiratory wheezes, which is due to constriction and increased mucous production to the inflammatory process caused by something. This leads to an increase in airway resistance (RAW). This is why the patients purse lip breathe to extend exhalation, so they can take in a healthy tidal volume

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20
Q

Extrinsic Asthma

A

-Allergy
-High eosinophil count
-FeNO (biproduct of broken down eosinophil

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21
Q

Intrinsic asthma

A

something that causes asthma internally such as: obesity, exercise, pre-menstrual, night time or sleep associated asthma

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22
Q

Peak Flow Monitoring
(Patient inhales and blasts air out)

A

80-100% (good)
50-80% (need to increase meds)
<50% (seek medical attention)

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23
Q

What are some asthma key interventions?

A

-O2 therapy initially, in the absence of conclusive data like SPO2 and ABGs
-Xanthene’s medication given (IV/aminophylline, etc)
-Promote pulmonary hygiene
-Corticosteroids such as oral or IV prednisone

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24
Q

What should you do if a repeated bronchodilator does not work?

A

consider possible diagnosis of status asthmaticus. Instruct patient on the use of our Asthma Action Plan, a plan to self monitor and record daily results

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25
Q

What should you do when doing PFTs for a patient with Asthma?

A

ALWAYS do a pre and post bronchodilator study. Considered effective

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26
Q

Pleural Diseases

A

Associated with diseases in the pleural space, not within the alveoli. The space in between the viscera and parietal pleura

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27
Q

Pleural effusion

A

build up of fluid in the pleural space. This can be caused by exudative or transudative

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28
Q

Exudative

A

related to problems infectious in nature (ex: pneumonia,or lung cancer). Also contains a higher amount of cellular debri; proteins

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29
Q

Transudative

A

associated with pressure changes (ex: CHF or fluid overload); contains very low content of proteins and a very low amount of cellular debri because it is not related to an infectious process

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30
Q

Hemothorax

A

blood gathers in the pleural space (most commonly associated with things like blunt chest trauma or any trauma; post-op cardiac surgeries)

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31
Q

Empyema

A

pus in the pleural space (associated with anaerobic organisms that get into pleural space and create thick nasty fluid) Going to need larger chest tube

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32
Q

How does a pleural effusion get drained?

A

-Thoracentesis to remove fluid if small (#1 remedy)
-Chest tubes in the pleural space lung is more than 20% collapsed

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33
Q

What clinical evidence shows that a pleural effusion is present?

A

-sharp chest pains
-mediastinal shift AWAY from the effusion
-obliteration of costophrenic angles on x-ray (lateral decubitus)
-fluid may shift when pt is in different positions of pleural effusion

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34
Q

Closed pneumothroax

A

air enters through visceral pleura (associated with things like barotrauma from mechanical vent

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35
Q

Open pneumothroax

A

air entering from parietal pleura; air coming in from the outside

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36
Q

Tension pneumothorax

A

described TRACHEAL DEVIATION, where air is so great, its pushing the trachea over to the opposite side; also accompanied by a reduction in blood pressure (tachycardia and severe hypotension)

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37
Q

What needs to be performed if a patient has a tension pneumothorax?

A

a needle decompression

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38
Q

Obstructive

A

can’t get air out

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39
Q

Restrictive

A

can’t get air in, because the alveoli are stiff and don’t want to stretch (reduction in compliance)

40
Q

What should you do when something goes wrong during a patients therapy?

A

-stop the therapy
-stabilize the pt
-notify the healthcare team

41
Q

A cuff should not exceed…..?

A

20 mmHg

42
Q

Anytime a speaking valve is in use with a cuffed tracheostomy tube, the cuff has to be?

A

down

43
Q

What are indications that a patient needs to be suctioned?

A

-remove retained secretions
-maintain patency of airway
-obtain sputum sample

44
Q

What are some suctioning hazards?

A

-hypoxemia
-atelectasis
-cardiac arrythmias (bradycardia,pvs)
-hypotention
-vagal response
-tissue trauma

45
Q

What should be done if any hazards happen during suctioning a patient?

A

Stop suctioning and provide 100% O2, and ventilate the patient effectively. Administer atropine if the patient is experiencing bradycardia

46
Q

Nasopharyngeal (NPA)

A

maintain a patent airway

47
Q

Oropharyngeal airway

A

only used in unconscious or comatose patients

48
Q

King/ combitube airway

A

used in the field/ shor term and inserted blindly

49
Q

Laryngeal Mask airway (LMA)

A

-blind insertion
-short term use surgery

50
Q

Double Lumen ETT

A

for independent lung ventilation

51
Q

What is the max time for suctioning a patient?

A

15 secs.

52
Q

What is the formula for calculating catheter size?

A

< 1/2 of ET tube or ET tube X 2, then go down 2 sizes

53
Q

What is the adult max for vacuum pressure?

A

120-150

54
Q

What is the pediatric max for vacuum pressure?

A

100-120

55
Q

What is the neonates max for vacuum pressure?

A

80-100

56
Q

Total flow calculation

A

O2 Air/O2 ration
24% 25:1
28% 10:1
30% 8:1
35% 5:1
40% 3:1
60% 1:1

57
Q

Mean Arterial Blood Pressure (MAP)

A

(1xsystolic)+(2xdiastolic)/3

58
Q

What is the purpose of the helium dilution and nitrogen washout?

A

To determine the FRC

59
Q

TLC=

A

IC+FRC OR VC+RV

60
Q

IC=

A

IRV+VT

61
Q

FRC=

A

ERV+RV

62
Q

Normal DLCO=

A

25mL/CO/min/mmHg

63
Q

What is the only obstructive disease associated with a poor DLCO?

A

-Emphysema, because it indicates destruction of the alveoli
-Less than 80% predicted (<20 CO/min/mmHG)

64
Q

What values are looked at for restrictive diseases?

A

SVC and FVC <80% predicted

65
Q

What values are looked at for obstructive diseases?

A

Fev1/FVC <70%
Fev1 <80%

65
Q

Best test=

A

highest (FEV1+FVC)

66
Q

3.0L super syringe for calibration acceptable range?

A

2.85-3.15L

67
Q

Acceptable dead space ration ratio range

A

20-40%, 60% if the patient is on the ventilator (usually relates to pulmonary embolus if high

68
Q

Deadspace ratio formula (VD/VT)=

A

(PaCO2-PECO2)/PaCO2 X 100

69
Q

Alveolar oxygen tension equation (PAO2)

A

(O2% X 7)- (PaCO2+10)

70
Q

A-a Gradient (A-aDO2)=

A

PAO2 - PaO2

71
Q

A-a Gradient (A-aDO2) acceptable range

A

25-65mmHg

72
Q

What does it mean if the A-a Gradient (A-aDO2) is above 65 but LESS than 300 mmHg?

A

V/Q mismatch

73
Q

What does it mean if the A-a Gradient (A-aDO2) is above 300 mmHg?

A

Shunt, Also known as venous admixture

74
Q

Arterial Oxygen Content (CaO2)=

A

(HB X 1.34 X SaO2) + (PaO2 X .003) OR (Hb X 1.34)

75
Q

What is an acceptable Arterial Oxygen Content (CaO2) range?

A

17-20%

76
Q

Venous Oxygen Content (CvO2)=

A

Hb

77
Q

What is an acceptable Venous Oxygen Content (CvO2) range?

A

14-16 vol%

78
Q

Arterial - venous oxygen content difference C (a-v) O2

A

CaO2- CvO2

79
Q

What is an acceptable range for Arterial - venous oxygen content difference C (a-v) O2?

A

4-5vol%

80
Q

P/F ratio=

A

PaO2/FIO2

81
Q

A normal P/F Ratio range is

A

380 or greater

82
Q

A P/F Ratio that is 300 or less signifies what?

A

Acute lung injury (ALI)

83
Q

A P/F Ratio that is 200 or less signifies what?

A

Acute respiratory distress syndrome (ARDS)

84
Q

Oxygen Index (OI)=

A

(mean airway pressure X %O2)/ PaO2

85
Q

A normal OI =

A

20 or less (the less the better)

86
Q

If the OI is >30 then what should be used?

A

the ARDSnet protocol

87
Q

If the OI is >40 then what is indicated?

A

ECMO therapy is indicated

88
Q

(QS/QT shorcut)=

A

take the first digit of A-aDo2, then add + 1, then multiply times 5

89
Q

What can cause the oxygen dissociation curve to shift to the right?

A

increased body temp, blood acidosis (decreased arterial pH, decreased affinity between hemoglobin and oxygen

90
Q

What can cause the oxygen dissociation curve to shift to the left?

A

Hypothermia, alkalosis, increased affinity between hemoglobin and oxygen

91
Q

How are all oxygen dissociation curve to shift treated?

A

with oxygen

92
Q

CO

A

heart rate X stroke volume

93
Q

Cardiac index=

A

C.O./BSA or C.O. 2 m2

94
Q
A

Respiratory (2 decks)

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