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Kick Ass Respiratory Exam > Special procedures > Flashcards

Special procedures Flashcards

1
Q

What is the purpose of hyperbaric oxygen therapy?

A

Means of increasing the PO2 by increasing the barometric pressure

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2
Q

What are some disorders frequently treated by hyperbaric oxygen therapy?

A

CO2 poisoning

Decompression sickness,

Transplants or graphs

Anaerobic infections

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3
Q

What is the purpose of helium oxygen therapy?

A

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

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4
Q

What are indications for helium oxygen therapy?

A

Postextubation Strider

Status asthmaticus

Obstructive tumors

Foreign object aspiration,

Partial vocal core paralysis

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5
Q

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

A

1.8

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6
Q

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

A

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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7
Q

What are the indications for inhaled nitric oxide?

A

Primary pulmonary hypertension

Refractory hypoxemia related to increased pulmonary artery pressure

Increased pulmonary vascular resistance.

Right heart failure

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8
Q

What are side effects of iNO therapy?

A

Methemoglobin (MetHb)
Nitrogen dioxide

Rebound, pulmonary hypertension

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9
Q

What is the standard initial dose of iNO?

A

20-40 ppm

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10
Q

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

A

Reduce dosage by half until 5 ppm, then discontinue.

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11
Q

What is the purpose of a thoracentesis?

A

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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12
Q

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

A

A plural effusion

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13
Q

What is the procedure for a thoracentesis?

A

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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14
Q

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

A

Serous fluid

CHF

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15
Q

 An empyema or pyothorax will cause what pleural fluid to appear

A

Opaque exudate

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16
Q

How would you describe pleural fluid caused by infections?

A

A yellow or milky exudate

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17
Q

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

A

Malignancy or cancer

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18
Q

What is chyle?

A

Lymphatic exudative fluid

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19
Q

What is the definition of loculated?

A

Very thick

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20
Q

What is the definition of mucopurulent?

A

Containing mucus and pus

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21
Q

What is an empyema or pyothorax?

A

A pus filled cavity

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22
Q

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

A

Exudate

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23
Q

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

A

Chest movement

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

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24
Q

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

A

An index of severity that combines apneas with hypopneas

16-30per hour

25
Q

What are the treatment recommendations for sleep apnea?

A

CPAP therapy starting at 3 to 5 cm of H2O and titration as tolerated to eliminate symptoms

Weight loss

Surgery

Respiratory stimulants-prematurity

Tracheostomy

26
Q

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

A

<15%

27
Q

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

A

Air-second intercostal space midclavicular line

Fluid 5th to 7th intercostal space mid axillary line

28
Q

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

A

Collection bottle

Water seal bottle

Suction control bottle

29
Q

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

A

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

2 cm

30
Q

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.

A

Spontaneous-bubbling during exhalation

Positive pressure, ventilation – bubbling during inspiration

31
Q

What does continuous bubbling in the water seal bottle indicate?

A

An air leak

32
Q

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

A

Pulmonary edema

33
Q

What is the purpose of the suction control bottle?

A

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

34
Q

What does continuous bubbling indicate in the suction control bottle?

A

Proper suction pressure set on vacuum regulator

35
Q

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

A

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

36
Q

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

A
  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.
37
Q

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

A

Increase suction pressure

38
Q

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

A

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

39
Q

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

A

Decrease tidal volume and increase respiratory rate

40
Q

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

A
  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.
41
Q

What are the indications for a Cardo pulmonary stress test?

A

Complaint of dyspnea and exertion
Ventilatory or cardiac limitations to work

Disability purposes


42
Q

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

A

Deadspace

43
Q

What is the purpose of bronchoalveolar lavage (BAL)

A

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

44
Q

What is the purpose of a mini-BAL procedure?

A

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

45
Q

What are the risk factors for SIDS?

A

One more apparent life-threatening episodes (ALTE)

Sibling of a SIDS baby

PRETERM INFANT WITH SIGNIFICANT APNEA PERIODS

Snoring in infants

46
Q

What is an impedance pneumogram?

A

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

47
Q

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

A

60 to 80 bpm

48
Q

When will you discontinue an apnea monitor

A

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

49
Q

When is the cardioversion delivered on an ECG?

A

During the R wave

50
Q

What is the strong short acting sedative given prior to cardioversion

A

Midazolam

51
Q

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

A

No response

No breathing

No pulse

52
Q

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

A

81-150

53
Q

What is the formula for the respiratory quotient?

A

RQ=VCO2/VO2

54
Q

What is an indirect calorimetry?

A

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

55
Q

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

A

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

56
Q

What is palliative care?

A

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

57
Q

How would you test and confirm for brain death?

A

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.

58
Q

What symptoms could you treat when withdrawing life-support?

A

Anxiety – anxiolytics

Pain – analgesics

Tachypnea, and dyspnea – benzodiazepines and barbiturates

59
Q

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

A

80 ppm

Kick Ass Respiratory Exam (9 decks)

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