Special procedures Flashcards by Shawn McGurran

What is the purpose of hyperbaric oxygen therapy?

Means of increasing the PO2 by increasing the barometric pressure

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What are some disorders frequently treated by hyperbaric oxygen therapy?

CO2 poisoning

Decompression sickness,

Transplants or graphs

Anaerobic infections

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What is the purpose of helium oxygen therapy?

Decrease the patient’s worker breathing by delivering low gas density gas that can easily maneuver around obstructions

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What are indications for helium oxygen therapy?

Postextubation Strider

Status asthmaticus

Obstructive tumors

Foreign object aspiration,

Partial vocal core paralysis

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What is the flow factor in a helium oxygen mix of 80/20

1.8

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What is the purpose and advantage of inhaled nitric oxide (iNO)?

INI is a gas that acts a potent pulmonary vasodilator which improves pulmonary blood flow and PaO2, but does not affect systemic blood pressure

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What are the indications for inhaled nitric oxide?

Primary pulmonary hypertension

Refractory hypoxemia related to increased pulmonary artery pressure

Increased pulmonary vascular resistance.

Right heart failure

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What are side effects of iNO therapy?

Methemoglobin (MetHb)
Nitrogen dioxide

Rebound, pulmonary hypertension

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What is the standard initial dose of iNO?

20-40 ppm

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To prevent rebound pulmonary hypertension, when using iNO, how would you discontinue therapy?

Reduce dosage by half until 5 ppm, then discontinue.

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What is the purpose of a thoracentesis?

A diagnostic or therapeutic procedure in which in needle is insurgent into the chest to remove fluid from the pleural space.

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What is the most common plural disorder that requires a thoracentesis?

A plural effusion

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What is the procedure for a thoracentesis?

Patient sitting up and waiting forward

Insert needle in seventh or eighth intercostal space just above the rib at the site of Maximal dullness

Withdraw 100 to 300 ml with a 50 ml syringe

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What is another name for Transudate pleural fluid and what disease state is it associated with?

Serous fluid

CHF

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An empyema or pyothorax will cause what pleural fluid to appear

Opaque exudate

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How would you describe pleural fluid caused by infections?

A yellow or milky exudate

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Bloody, hemothorax or serosanguineous pleural fluid is indicative of what?

Malignancy or cancer

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What is chyle?

Lymphatic exudative fluid

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What is the definition of loculated?

Very thick

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What is the definition of mucopurulent?

Containing mucus and pus

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What is an empyema or pyothorax?

A pus filled cavity

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What type of Pleural fluid is indicated ny a pH less than 7.30?

Exudate

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What does an inductive plethysmography measure and how is it done?

Chest movement

A series of elastic bands are placed around the chest to measure chest movement and breathing frequency

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What is the apnea hypopnea index (AHI) and what range indicates moderate severity?

An index of severity that combines apneas with hypopneas

16-30per hour

What are the treatment recommendations for sleep apnea?

CPAP therapy starting at 3 to 5 cm of H2O and titration as tolerated to eliminate symptoms Weight loss Surgery Respiratory stimulants-prematurity Tracheostomy

What percent of pneumothorax may not require treatment unless the patient shows signs of significant distress

<15%

Describe the placement of a chest tube for air and for fluid

Air-second intercostal space midclavicular line Fluid 5th to 7th intercostal space mid axillary line

What are the three bottles in a chest drainage system starting with the one closest to the patient?

Collection bottle Water seal bottle Suction control bottle

What is the purpose of the water seal bottle and what level should the water be set to?

Functions is a one-way valve to allow air to leave the pleural cavity, but prevents air from entering the pleural cavity. 2 cm

In the presence of a pneumothorax, bubbling will be observed in the water seal bottle. Please indicate when it will happen in a spontaneous versus positive pressure situation.

Spontaneous-bubbling during exhalation Positive pressure, ventilation – bubbling during inspiration

What does continuous bubbling in the water seal bottle indicate?

An air leak

In a situation where you create a sudden reexpansion of the lung, what may result

Pulmonary edema

What is the purpose of the suction control bottle?

Regulates the amount of negative pressure being applied above the water seal

What does continuous bubbling indicate in the suction control bottle?

Proper suction pressure set on vacuum regulator

What should you do if the chest drainage system breaks in both spontaneous and positive pressure ventilation?

Spontaneous-Submerge chest tube in a glass of water Positive pressure ventilation – leave the tube open to air until new system can be set up

What steps should you take if there’s continuous bubbling in the water seal bottle?

1. clamp chest tube 2. If bubbling stops, patient connection and look for severe pulmonary air leak 3. If bubbling continues, replace chest drainage system.

What steps should you take if there’s no bubbling in the suction control bottle

Increase suction pressure

When using a chest drainage system, how do you measure the volume loss through the chest tube?

It’s the difference between the set tidal volume and exhaled tidal volume

If the volume loss through the chest tube is high, what are changes you can make to maintain minute ventilation?

Decrease tidal volume and increase respiratory rate

What are the steps you should take before removing a chest tube?

1. Clamp the chest tube for 24 hours and observe patient. 2. CXR 3. Remove during valsalva maneuver 4. Apply gauze with petroleum ointment 5. Repeat chest x-ray.

What are the indications for a Cardo pulmonary stress test?

Complaint of dyspnea and exertion Ventilatory or cardiac limitations to work Disability purposes

What is the only physiological response that should decrease in a stress test?

Deadspace

What is the purpose of bronchoalveolar lavage (BAL)

The diagnosis and treatment of alveolar proteinosis, interstitial pneumonia, cystic fibrosis, pneumocystis pneumonia and alveolar hemmorhage

What is the purpose of a mini-BAL procedure?

To obtain a distal lung specimen for diagnosis of ventilator required pneumonia

What are the risk factors for SIDS?

One more apparent life-threatening episodes (ALTE) Sibling of a SIDS baby PRETERM INFANT WITH SIGNIFICANT APNEA PERIODS Snoring in infants

What is an impedance pneumogram?

Electrodes attached the chest that sent changes and impedance as the lungs, expand and contract, causing the distance between electrodes to increase and decrease

What do you set the low heart rate alarm at in an infant apnea monitor

60 to 80 bpm

When will you discontinue an apnea monitor

Two months free of events no monitor alarms on apnea settings of > 20 seconds and heart rate < 60 a minute

When is the cardioversion delivered on an ECG?

During the R wave

What is the strong short acting sedative given prior to cardioversion

Midazolam

An automatic external defibrillator should be used only when a victim has all of these clinical findings

No response No breathing No pulse

When transporting a patient, what is the range of miles that would require a helicopter

81-150

What is the formula for the respiratory quotient?

RQ=VCO2/VO2

What is an indirect calorimetry?

A method of calculating resting energy expenditure (REE) by measuring the whole body, VO2 and VCO2

What is the normal respiratory quotient range and what does high and low results indicate?

Normal = 0.67-1.3 High numbers indicate overfeeding and low numbers indicate underfeeding

What is palliative care?

Control of pain and symptoms of terminally ill patients to maximize well-being

How would you test and confirm for brain death?

Apnea test on 100% oxygen and look for respiratory movements and SPO2 Confirmed diagnosis with the cerebral perfusion scan. Also known as a cerebral angiogram.

What symptoms could you treat when withdrawing life-support?

Anxiety – anxiolytics Pain – analgesics Tachypnea, and dyspnea – benzodiazepines and barbiturates

To avoid major side effects, what dosage of inhaled nitric oxide should not be exceeded

80 ppm