Special procedures Flashcards
What is the purpose of hyperbaric oxygen therapy?
Means of increasing the PO2 by increasing the barometric pressure
What are some disorders frequently treated by hyperbaric oxygen therapy?
CO2 poisoning
Decompression sickness,
Transplants or graphs
Anaerobic infections
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
What are indications for helium oxygen therapy?
Postextubation Strider
Status asthmaticus
Obstructive tumors
Foreign object aspiration,
Partial vocal core paralysis
What is the flow factor in a helium oxygen mix of 80/20
1.8
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
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
What are side effects of iNO therapy?
Methemoglobin (MetHb)
Nitrogen dioxide
Rebound, pulmonary hypertension
What is the standard initial dose of iNO?
20-40 ppm
To prevent rebound pulmonary hypertension, when using iNO, how would you discontinue therapy?
Reduce dosage by half until 5 ppm, then discontinue.
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.
What is the most common plural disorder that requires a thoracentesis?
A plural effusion
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
What is another name for Transudate pleural fluid and what disease state is it associated with?
Serous fluid
CHF
 An empyema or pyothorax will cause what pleural fluid to appear
Opaque exudate
How would you describe pleural fluid caused by infections?
A yellow or milky exudate
Bloody, hemothorax or serosanguineous pleural fluid is indicative of what?
Malignancy or cancer
What is chyle?
Lymphatic exudative fluid
What is the definition of loculated?
Very thick
What is the definition of mucopurulent?
Containing mucus and pus
What is an empyema or pyothorax?
A pus filled cavity
What type of Pleural fluid is indicated ny a pH less than 7.30?
Exudate
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
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?
- clamp chest tube
- If bubbling stops, patient connection and look for severe pulmonary air leak
- 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?
- Clamp the chest tube for 24 hours and observe patient.
- CXR
- Remove during valsalva maneuver
- Apply gauze with petroleum ointment
- 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
