ROTHFIELDS

Question 1

What are the goals of a respiratory therapist?

Answer 1

1. Don’t kill the patient
2. Maintain oxygen delivery
3. Keep the pH (+- pCO2) reasonable
4. Provide comfort
5. Expectations:
   - RNs - help with the airway
   - Physicians -manage the ventilator
   - Administrators - be cost effective
   - Everyone - be reliable, informed and a team player

Question 2

WHAT IS DO2?

Answer 2

DO2 = cardiac output (CO) x 1.34hgb x sat x 10
- you may need to calculatet the sturation for PO2. You may also have to know the 30-60-90 rule and pO2 >90 = 100% Sat

When DO2 is inadequated patient may develop lactic (metabolic acidosis.

Also known as anaerobic metabolist

Question 3

Mechanisms of Hypoxemia

Answer 3

Low a/A ratio
must calculate a/A ratio
pAO2 = 700x fio2 - pco2
a/A = paO2/pAO2 (.80 is low limit of normal)

High pco2
Often ixists in addition to low v/q

Altitude - must ben givven the Pbar or the PiO2 (Pbarx fio2). a/A normal

Diffusion block Mention this ONLY if the patient has a pulmonary hypertension or very severe COPD

Question 4

PaO2 = 50fio2 0.3
pCO2 = 40

How would you change the FIO2 to get a paO2 of 90?

Answer 4

The a/A ratio will not change

1. paO2/PAO2 = 50/ 700xfio2 - Pco2 = 50/ 700x.3 - 40 = .29
2. 0.29 = paO2/pAO2

(Desired PaO2) 90/ 0.29 = 310

3. PAO2 = 700x FIO2 - PCO2

Fio2 = (PAO2 = PCO2)/700
FIO2 = 310+400/700=.50

Question 5

WHAT IS THE 2 MINUTE ASSESSMENT

Answer 5

1. The current problem
2. Respiratory background
3. Pulse
4. B/P
5. Resp Rate (actually measured)
6. Appearance of patient and chest
7. Normal breath sounds
8. Adventitious breath sounds
9. PFT assessment (PEFR) first exam and each if asthma/COPD
   this often the only measurement that can tell anxiety from obstruction
   in asthma.
10. Oxygen assessment

Question 6

What should you always look at in a BLOOD GAS?

Answer 6

1. look at the pO2 and fio2 first
2. State whether “adequate, high or low” pO2
3. Calculate and comment on the a/A ratio
4. Does the saturation match?Too low: increased CO2, increased 2,3 DPG, Increased temp, increased acidToo high: Opposite directins of the 3

Cause decreased a/A ratio: Pulmononary edema, ards, asthma

Question 7

ACID BASE PART 1

State what the respiratory (PCO2) and metabolic (BE) status is

Answer 7

1. alkolosis/acidosis/neither
2. If both the same pH direction: combined
3. If opposite pH direction: possibly comensatory
   
   • the one in the direction of the pH is primary
   • if pH is normal, both are primary

Question 8

what is the common cause of respiratory acidosis

Answer 8

Altered mental status
opiode use, sedation, stroke
Severe obstruction

Question 9

What’s the common cause respiratory alkalosis

Answer 9

Pain, anxiety, fear

Metabolic acidosis

Question 10

What’s the common cause of metabolic acidosis

Answer 10

Sepsis, or lactic acidosis

Diabetic ketoacidosis (only if diabetes is mentioned

Question 11

What is the most common cause of metabolic alkalosis

Answer 11

volume depletion, dehydration

Question 12

What to look for in an cxr

Answer 12

Tubes

Obstruction
        trachea
        Heart
             More than half on the left
             atleast some on the right
        Diaphragm
              left lower than right, but some intersection

Pneumothorax

Infiltrates
         One side: PNA
         Bilateral
                ARDS
                CHF
         Upper mostly: TB or aspiration

Cardiac size: less than half the entire width of the chest