Respiratory Boards Exam Review
What is the pack years equation?
# of packs per day X number of years smoked
MCL1 is placed where?
+ = 4th ICS RSB - = Left Shoulder Ground = Right Shoulder
Lead II is placed where?
+ = Left Abdomen - = Right shoulder Ground = Left shoulder
What are the two types of emulsions for quality control of an ABG analyzer?
- Aqueous - Fluorocarbon-Based
What should be prepared before a Bronchoscopy?
- Oxygen - Suction - Specimen collection equipment (Forceps, Lukens trap) - Syringes with flush solution (Epinephrine or iced saline) - Anesthetics - Sedatives
Shunting is also known as?
- Refractory Hypoxemia - Venous Admixture
What are some things that commonly cause stridor?
- Supraglottic swelling (Epiglottis) - Subglottic swelling (Croup/post extubation)
What are the four life functions and what order do they go in to fix an issue?
- Ventilation - Oxygenation - Circulation - Perfusion
Oxygen Analzyers (Galvanic Fuel Cells) are affected by what?
- Water on the sensor - High System pressures - Changes in Altitude
When is an Inline suction catheter (Ballard) indicated?
- high oxygen/PEEP requirements (60% or above O2/PEEP of 15 or above) - Pulmonary Infections (Pneumonia) - Frequent suctioning needed - Hemodynamic Instability (Bp drops when off Ventilator) - HIV or Hepatitis
How much oxygen is carried by one Hb?
1.34 mL
The external diameter of the suction catheter should be no greater than ______ the inside diameter (ID) of the endotracheal or trach tube?
1/2
What is a normal Sodium (Na+) range?
135-145 mEq/L
A Manual resuscitation bag (Self-inflating) is set to what liter flow?
15 Lpm
What PEEP level is the start for being considered High pressure?
15 PEEP
When suctioning a patient, what is the maximum amount of time the suction catheter should be in the airway?
15 seconds or less
What is a normal Platelet (Plt) Value?
150,000-400,000 mm3
What is a normal MEP?
160 cmH20 < 40 cmH20 = poor ability to clear airway secretions
What is a normal CaO2?
17-20 Vol % (mL/dL)
What should the water level be set to for a water seal bottle?
2 cm of water
What should the acceptable efforts be within when performing a DLCO?
2 mL CO/min/mmHg (STPD) Inspired volume should be greater than 90% of the SVC from spirometery
Most HBO is conducted between _____ to _____ ATM?
2-3 atmosphere (Chamber can go between 2-6 ATM)
How many pack years are significant and usually indicate possible COPD?
20 pack years
If apnea is longer than _______ it is considered abnormal for an infant?
20 seconds
Carbon Monoxide (CO) poisoning is considered at what %? What do we use to treat it?
20% = CO poisoning Treat with 100% O2 Hyperbaric Chamber
What should cuff pressure be inflated to?
20-25 mmHg 25-35 cmH2O
What is the standard dosage of Nitric Oxide?
20-40 ppm (DO NOT EXCEED 80ppm)
What is a normal Deadspace to Tidal Volume Ratio?
20-40% (Anything less than 60%)
What is a normal Bicarbonate (HCO3-) range?
22-26 mEq/L
How do you determine a patients maximum heart rate?
220 - Age in years Example: Patient age = 55 220-55 = 165 Heart rate max
How long should the chest tube be clamped for before removal?
24 hours (To assume normal intrapleural pressure is back to normal)
What is the desired FiO2 for COPD patients?
24%-28% 1-2 L
What is a normal DLCO?
25 mL CO/min/mmHg (STPD)
Scoring system for APGAR 2,1,0?
2: - Completely pink - >100/min - Cough or sneeze - Active motion - Regular strong cry 1: - Body pink extremities blue - < 100/min - grimace - Some flexion of extremities - Slow irregular weak cry 0: - Blue or pale all over - Absent - No response - Limp no movement - Absent no cry
What is the starting ratio for Inverse Ratio Ventilation (IRV)?
2:1 or greater
What is a normal Lecithin/Sphingomyelin (L/S) ratio? What does it mean if it is low?
2:1 or higher ratio is good If low it indicates higher risk of HMD/IRDS
When is a patient considered ventilator dependent?
3 months of failed weaning attempts
If a patient has a Laryngectomy (Removal of vocal cords), how long will the tube be in and what happens afterwards?
3-6 week, when tube is removed there will be permanent stoma
What is a normal Potassium (K+) range?
3.5-4.5 mEq/L
What is the therapeutic oxygen range?
30%-60%
Normal Respiratory Rate for infant?
30-60 breaths per minute
What is a normal birth weight for an infant?
3000g or 3 kg
What should the Body box be calibrated with each day and in what range?
3L super syringe Accuracy +/-3.5% (2.895-3.105 L)
Calculate the pack years: 4 packs per day 10 years of smoking
4 packs x 10 yeas = 40 pack years
How can you estimate PaO2 vs SaO2?
4,5,6,7,8,9 rules PaO2: 40 50 60 SaO2: 70 80 90 (Remember "P" (PaO2) comes before "S" (SaO2) in the alphabet)
What is a normal C(a-v)O2?
4-5 Vol %
What is the normal value for Red Blood Cells (RBC)?
4-6 mill/mm3
What is a normal Cardiac Output?
4-8 L/min
High flow nasal cannula can deliver flow rates up to _____ and almost ______ humidity?
40 L/min 100% body humidity
What is a normal urine output?
40 mL/hr (approximately 1 Liter/day)
What is a normal Pulse pressure?
40 mmHg
What is a normal Hematocrit?
40-50%
The skin should be heated between ___ to ____ C to improve capillary blood flow?
43-45C
When performing a Body box PFT, the Thoracic gas volumes must be within _________ % of each other?
5%
What is a normal White Blood Cell (WBC) value?
5,000-10,000 mm3
What are the initial settings for Tidal Volume (TV) on a ventilator?
5-10 mL/kg of ideal body weight
What is a normal Intracranial Pressure (ICP)?
5-10 mmHg
What is the therapeutic range for HFCWO (Vest)?
5-25 Hz (300-1500 cycles min) 30 minutes (1-6 times a day)
What is a normal Clotting time? (Time it takes for the body to stop bleeding)
6 minutes
There are 12 leads on an ECG and 10 electrodes, where are they?
6 on chest 1 on each arm 1 on each leg 10 total
What is a normal pulse for an adult?
60-100 bpm
What are the normal Peak Expiratory Flow rate ranges?
80-100% = Green 50-79% = Yellow < 50% = Red
What is a normal White Blood cell value in a Newborn?
9,000-30,000 mm3 (12 weeks old)
Normal range for Pulse Oximeter?
93-97%
What is a normal Brain Natriuretic Peptide (BNP) Value?
< 100 pg/mL
What is a normal Systemic Vascular Resistance (SVR)?
< 1600 Dynes/sec/cm^-5
What is a normal Pulmonary Vascular Resistance (PVR)?
< 200 Dynes/sec/cm^-5
Respiratory Quotient > 1.1 vs < 0.7?
> 1.1 = Over feeding < 0.7 = Under feeding
When should you treat Increased Intracranial Pressure (ICP)?
> 20 mmHg
When do you treat COHb poisioning?
> 20% Leave on 100% O2 until < 10% COHb
When do you need to treat a pneumothorax?
> 20% requires a chest tube
What are the Brain Natriuretic Peptide (BNP) levels used to determine how bad a patient has potential heart failure?
> 300 pg/mL = mild heart failure > 600 pg/mL = moderate heart failure > 900 mg/mL = Sever heart failure (CHF)
If a pulse pressure is greater than 40mmHg it shows? If lower it shows?
> 40 mmHg = ↑ CO < 40 mmHg = ↓ CO
What are the Obstructive Values to interpret PFT's?
> 70% = Normal 60-69 = Mild 50-59 = Moderate 35-50 = Severe < 35 = Very Severe
What are the Restrictive Values to interpret PFT's?
> 80% = Normal 79-70 = Mild 60-69 = Moderate 50-59 = Moderate Severe 35-50 = Severe < 35 = Very Severe
At what % should an ABG be drawn if a Pulse Oximeter is lower than?
> 80% = accurate < 80% = ABG needed to confirm
APGAR stands for?
A = Appearance P = Pulse G = Grimace A = Activity R =Respiration
What is Cotinine?
A breakdown product of nicotine (Can be detected in the blood and urine for 2-4 days after smoking)
What does Pleural friction rub sound like?
A coarse grating, raspy, or crunching sound
What is Pressure Regulated Volume Control (PRVC)?
A form of ventilation that keeps pressure at the lowest level by providing automatic breath-to-breath pressure regulation while providing a preset volume (Volume control)
How is a Helium dilution performed?
A known concentration of Helium is diluted by the patient FRC (Change in Helium is used to determine FRC)
What is a Holter Monitor?
A portable ECG monitor
What is the shortcut for the shunt equation to determine % shunt?
A-a gradient, for each 100 Torr add 5% then add 5% for normal anatomical shunt Example: A-aDO2 = 300 torr C(a-v)O2 = 3.6 Vol % 300 torr = 15% shunt + 5 % anatomical shunt = 20% shunt
What are the limb leads for AVR, AVL, AVF?
AVR = Right arm (Away) AVL = Left arm (Toward) AVF = Left foot (Toward) (So impulse is down and to the left so the impulse is toward except on Right arm because it is not down and to the left)
If there is an axis deviation on an ECG, this show?
Abnormal Finding
What does Adventitious mean?
Abnormal breath sounds
Fine crackles/rales indicates?
Alveoli are full of fluid - CHF - Pulmonary Edema
Pectus Carinatum shows what?
Anterior protrusion of the sternum (Pigeon Chest/Bird beak)
What is another name for Airway Pressure Release Ventilation (APRV)?
Bi-Level
What is another name for a CT scan?
CAT scan
ECO2, ETCO2, and PETCO2 are known as?
Capnography
Transcutaneous PO2 and PCO measurement are done by which electrodes?
Clark = PO2 Severinghaus = PCO2
Sellick maneuver is also known as?
Cricoid pressure
What is the advantage of using a Pulsed-Dose Oxygen Delivery System in the home setting?
Device sense the start of inspiration and delivers oxygen only during inspiration (Helps use less oxygen, cylinders last longer)
Helium dilution (Closed method) is used to determine?
FRC
Disadvantage of Guide channel?
Have to move screen like a computer screen to see it if at wrong angle
If another value from an ABG is not pH, PaCO2, and PaO2, then it is estimated based on what?
Hb and Body temperature
What is the preferred method of establishing an airway during CPR?
Head-tilt/Chin-lift
If there is constant condensation in a ventilator tubing setup, what can we use?
Heated wire circuits (To prevent rain out, condesation)
What does Atrophy mean?
Muscle wasting
What does Diaphoresis mean?
Profuse/heavy Sweating
Rapid weight loss vs Rapid weight gain?
Rapid weight loss = Cancer Rapid weight gain = Fluid overload
What is Serial Coughs?
Small breath and cough then large breath and cough then deep breath and hard cough
What is the initial settings for infants on a ventilator: - TV - PIP - Respiratory Rate - FiO2 - PEEP - Peak flow - I-time
TV = 4-6 mL/kg PIP = 20-30 cmH2O RR = 20-30 bpm Peak flow = 5-6 L/min I-time = .5-.6 seconds FiO2 = 40-60 % or previous level PEEP = 2-4 cmH2O (Max of 8 cmH2O)
What equations can be used to set minimum flow for ventilator patient?
TV x RR x (I + E) or MV x (I + E)
What is the equation for Dynamic Compliance?
TV/PIP-PEEP
What is the equation for Static Lung Compliance?
TV/PLP-PEEP
Oscilloscope or ECG monitor is also known as?
Telemetry
What is Quad coughing?
Therapist applies pressure to the patients abdomen during exhalation
Why are Helium dilution and Nitrogen washout not as good as a Body Box (Plethysmography)?
They are calculated values, while the FRC is actually measured during a Body Box
How do you know if a patient is unstable?
They are symptomatic
Why are platelets important?
They help blood clot (Stop bleeding)
What is a bad side affect of using topical anesthetics that end in "Caine"?
They raise MetHb Levels
What is the cycling variable during pressure control ventilation?
Time Cycled
What does Medication Reconciliation mean?
To check whether or not the medications that a patient is on match the ones they use at home if possible
What is the purpose for a Cardiac Catheterization?
To find a possible narrowing so we can place a stint to open it up
Purpose of a Recruitment Maneuver?
To increase pressure in lungs to open as many collapsed alveoli as possible
Purpose of Hyperbaric Oxygen Therapy (HBO)?
To increase the PaO2 by increasing the barometric pressure
What is the purpose of an Airway exchange catheter/Gum Elastic Bougie?
To replace damaged ET tubes
What is the preferred method of providing an airway for patients who require long term ventialtion?
Tracheostomy
How do you test for peripheral circulation?
Using Capillary Refill by blanching the hand and waiting for color to return
What does the acronym VANE stand for?
V = Valium/versed = Sedative A = Atropine = Bradycardia N = Narcan = Narcotic Overdose E = Epinephrine = Asystole
How is Alveolar Minute Ventilation calculated?
VE = (VT- VD) x RR
What is the best way to prevent Nosocomial infections?
Washing your hands
44mg/L at 37C is known as?
Water Vapor Content
47 mmHg is known as?
Water Vapor Pressure
What is the name of the rules used to calibrate for a quality control of an ABG analzyer?
Westgard rules
When does a Flow-Inflating Resuscitation (Anesthesia) bag inflate?
When the gas source is turned on and opening of bag is seal (Mask placed tightly on neonates face)
What type of humidifier do we use for intubated patients?
Wick Humidifier (100% humidity @ 37C, because it is by passing the upper airway which usually humidifies for us)
What is needed before a chest tube is removed?
X ray to evaluate
What gas does a Ventilation/Perfusion Scan use (VQ scan)?
Xenon gas
What does a rapid sequence intubation mean?
You do NOT know the last time the patient ate something
What is a heart murmur?
abnormal heart sound is typically due to a leaky valve (Blood going the wrong direction)
How do you measure mmHg vs cmH2O when determining cuff inflation?
mmHg = Pressure Manometer cmH2O = Cufflator
Airway resistance looks like what on a graphic loop?
skinny flat blob (After suctioning or bronchodilator it should be bigger and more round)
What does Bruits mean?
sound made when turbulent blood is going through a narrowing (Carotid artery is a good place to check)
How do you determine the best test from a FVC manuever?
whichever test has the largest FVC + FEV1 sum
If carbohydrates are increased, how does that affect the RQ (Respiratory Quotient)?
↑ Carbohydrates = ↑ RQ = ↑ CO2
If flow is Increased how are I time and E time affected?
↑ Flow = ↓ I time = ↑ E time
Accessory muscle use indicates?
↑ Work of breathing
Chronic hypoxemia is defined as?
↓ PaO2 for a long period of time
What is a normal Capillary Refill?
≤ 3 seconds = normal
What is an acceptable Vital Capacity (VC)?
≥ 10 mL/kg (2 x TV)
What is the initial settings for respiratory rate on a ventilator?
10-20 bpm
What should the expiratory pressure range from?
10-20 cmH2O mid exhalation
What is the normal range for diagnostic fluid aspirated from a pleural effusion?
100 mL - 300 mL (Performed with a 50 mL syringe)
How do you treat CO poisoning?
100% O2 and HBO Chamber
How is a Nitrogen washout performed?
100% O2 inspired to replace nitrogen in the FRC (Amount of nitrogen removed is used to calculate FRC)
Normal Heart rate for infant?
110-160 bpm
What is a normal CvO2?
12-16 Vol% (14 Vol%)
What is a normal Hb value?
12-16 gm/dL
What is a normal respiratory rate for adults?
12-20 bpm
What is a normal Blood pressure Systolic/Diastolic for an adult?
120/80 mmHg
The Endotracheal Tube should rest ____ to _____ cm above the ______? Or it should be at the level of what?
2-6 cm above the carina or at the level of the Aortic Knob
Nasogastric tubes should rest _____ to _____ cm below the _______?
2-6 cm below the diaphragm
What is the initial settings for PEEP on a ventilator?
2-6 cmH2O - Unless known PEEP then set at previous level
What is a normal Cardiac Index (CI)?
2.5-4.0 L/min/m2
A change in _____ bpm indicates an adverse reaction?
20 bpm or more increase means we need to stop the treatment
SVC maneuver should be at least ________ Seconds?
6 seconds
What is normal lung compliance?
60-100 mL/cmH20
What is a normal Vital Capacity (VC)?
65-75 mL/kg (10 x TV)
What level should the right hemidiaphragm be at on an CXray?
6th anterior rib
When using an Oxygen hood for an infant, what flow range do we use and why?
7-14 Lpm to prevent CO2 buildup and maintain FiO2 without sealing the infants neck around the hood
What is a normal Venous saturation?
70%
What is a normal Cerebral Perfusion Pressure and what must it be minimum to oxygenate?
70-90 mmHg (Must be at least 70mmHg to Oxygenate the brain)
Where do you insert a large bore needle for a thoracentesis?
7th-8th ICS above the rib at maximal sight of dullness (Make sure to use local anesthetic (lidocaine) before)
What is the minimum amount of volume a spirometer must be able to measure?
8 Liters
At what day should you give a Ventilator patient a Tracheostomy according to the NBRC?
8 days
What is a normal Blood urea nitrogen (BUN) range?
8-25 mg/dL
What is the minimum size for a flexible bronchoscope for a ventilator patient?
8.0 mm ID
What is a normal MIP?
80 cmH20 < 20 cmH20 = inspiratory muscle weakness
What are the two concentrations of Heliox used?
80% He / 20% O2 = 1.8 70% He / 30 % O2 = 1.6
What is a normal Chloride (Cl-) range?
80-100 mEq/L
Chest tube placement for Air vs Fluid?
Air = 2nd-3rd ICS MCL Fluid = 5th-7th ICS MAL
What Xray sign is shown with Pneumonia?
Air bronchogram
What is a pneumothorax?
Air in the pleural space with little or no fluid
Extrapulmonary air means?
Air outside the lungs
If the right hemidiaphragm is higher than 6th anterior rib on a CXray, it indicates?
Air trapping
Straight or Horizontal ribs indicates?
Air trapping (Ribs should have some curvature)
What is the best type of cylinder used during an MRI?
Aluminum (Because it is non-ferrous)
What are the initial settings for Tidal Volume of Asthma and ARDS patients on a ventilator?
Asthma = 4 mL/kg IBW ARDS = 6-8 mL/kg IBW
DPI is usually used to treat what patients?
Asthma and COPD
MDI are used on what patients the most?
Asthma and COPD
How do you troubleshoot an oxygen concentrator having no flow directed by the patient?
Ask the patient to put the nasal cannula in a glass of water and check for bubbles
When checking optical fibers before a bronchoscopy, if you see ________ the optic is broken and needs replaced?
Block dots appear
Atrial Fibrillation can lead to a Pulmonary Embolism why?
Blood just laying in the ventricles
Another name for a T-piece SBT is?
Blow by setup
Acrocyanosis means what?
Bluish extremities and it is not true cyanosis
What is the adaptor called that allows a patient to still receive positive pressure ventilation during a bronchoscopy?
Bodai Adaptor
Barrel Chest is usually seen in what type of patients?
COPD (Due to lose in elasticity in lung muscles from air trapping for a long amount of time)
What patient does decelerating inspiratory flow help with the most?
COPD (Less air trapping)
What is another name for the Polarographic Oxygen Analzyer?
Clark Electrode
Calibration of Clark vs Severinghaus Electrode?
Clark: High PO2 = room air = PO2 = 150 torr Low PO2 = Electronic zeroing Severinghaus: High PCO2 = 10% CO2 Low PCO2 = 5% CO2
What does transudate fluid look like?
Clear and has a light straw color
When using a Illuminated stylet/light wand (Bonfils), if you can see or barely see the light these indicate?
Clearly seen light = in trachea (Good) Barely or not visible = in esophagus (Bad)
What is the preferred method for analyzing O2 when using an Oxygen hood?
Continuously monitor the O2 near the infants Face
What patients are prone to developing Bronchiectasis from retained secretions?
Cystic Fibrosis
What are the Tank factors?
D = 0.16 E = 0.28 H/K = 3.14
What value should the ABG electrodes be calibrated within?
+/- 2
Oxygen Analzyers must be within what % accuracy of the known value?
+/- 2%
What is the accuracy precision on Air-Oxygen Proportioners (Blenders)?
+/- 3%
What should the quality control for the body box be in what range?
+/- 5% of the volume of the lung model
How is Peripheral Edema Rated?
+1, +2, +3, etc. the higher the number, the greater the swelling
When can you discontinue an apnea monitor for infants?
- 2 months free of events - No monitor alarms on apnea settings > 20 seconds and heart rate < 60 bpm
SVC should be performed how for quality assurance?
- 3 acceptable attempts - 6 seconds minimum
FVC should be performed how for quality assurance?
- 3 acceptable attempts - Not differ more than 5% or 200mL
How do you treat Severe airway obstruction in infants?
- 5 back blows Turn over then - 5 chest thrusts (If infant becomes unresponsive then activate emergency response system)
What are the 3 controls used for quality control of an ABG analyzer?
- Acidosis - Normal - Alkalosis
When should NIPPV be used over a ventilator if possible?
- Acute exacerbation of chronic respiratory failure (COPD) - CHF/Pulmonary Edema - DNI/ DNR
What are the two main indications for mechanical ventilation besides apnea?
- Acute ventilatory failure/Acute respiratory failure - Impending ventilatory failure
If it fails to cycle into inspiration when using an IPPB what is the issue?
- Adjust sensitivity - Tight seal around mouthpiece
What is the main objectives of Pulmonary Rehabilition?
- Alleviate or control as many medical symptoms of respiratory impairment as possible - Teach the patient how to maximize his/her ability to carry out activities of daily living
What causes Decreased lung compliance?
- Atelectasis - Pulmonary Edema - ARDS - Pneumonia
What are some advantages of automation over manual charting?
- Automation of day to day procedures - Standardization of care - Improved accuracy of charting - Bedside data entry is more efficient and accurate
What are some advantages of NIPPV?
- Avoids Ventilator associated pneumonia (VAP) - Avoids complications of artificial airway - Avoids complications of mechanical ventilation
How do you treat tachypnea or dyspnea when withdrawing someone from life support?
- Benzodiazepines - Barbiturates (or low dose morphine)
What should you look for and do after intubation?
- Bilateral chest rise - Auscultation of breath sounds - Capnography - Chest xray for tube position
What are some immediate (Within 24hrs) complications from a Tracheostomy?
- Bleeding (Major hazard) - Pneumothorax - Air embolism - Subcutaneous Emphysema
What are some options that are bad to pick during your clinical simulations?
- Blind finger sweep - STAT ABG - STAT Xray - Repeat ABG
What can cause an obstructed/pressure dampened catheter?
- Blood clot - Bubble - Kinking in tubing
What Xray sign is shown with Pleural Effusion?
- Blunting/obliteration of costophrenic angles - Basilar infiltrates with meniscus - Concave superior interface/border
What are the two main drugs used to help smokers with withdrawals from nicotine when trying to quit?
- Bupropion hydrochloride (Zyban/Wellbutrin) - Varenicline (Chantix)
What causes Peripheral Edema?
- CHF (Congestive Heart Failure) - Renal Failure
What patients show Biot's?
- CNS problems - Brain injury
What Xray sign is shown with Tuberculosis?
- Cavity Formation - Hilar Nodule
What are the three ways you can test to see if a patient has been exposed to Carbon Monoxide (CO)?
- CoHb levels in blood - Exhaled CO levels (FeCO) - Cotinine levels in blood and urine (To prove from smoking)
Give some examples of CVP being high?
- Cor pulmonale - Right heart failure - Tricuspid valve stenosis
How do we verify if a sputum collection came from the lower respiratory tract and not the saliva?
- Counting the number of squamous epithelial cells - Should be < 25 squamous cells per low power microscope field
C(a-v)O2 will increase if?
- CvO2 is ↓ - CO ↓ - Too much PEEP
What types of patients use Bronchial Hygiene therapy the most?
- Cystic Fibrosis - Bronchiectasis
What are the normal muscles of ventilation?
- Diaphragm - External intercostals
When is a Double-Lumen endotracheal tube (DLT)/Endobronchial tube/Carlens tube used?
- Lung Abscess - Surgery (Pneumonectomy, esophageal resection, aortic aneurysm repair) - Bronchopleural fistulas
What drug is used to remove fluid from the brain in high Intracranial pressure (ICP) patients?
- Mannitol (best choice) - Hypertonic Saline
If the patient inhales and the bag does not slightly contract when using a Non-Rebreather, what should you do?
- Mask is not tight so seal it better - Non-Rebreather valve is stuck so replace the mask
What are some side affects of Nitric Oxide?
- MetHb Increases - Nitrogen Dioxide (NO2) increase and are toxic to the body (> 10 ppm = toxic) - Rebound pulmonary hypertension (Occurs when Nitric Oxide is discontinued too rapidly)
What are some common sedatives used?
- Midazolam (Versed) - Diazepam (Valium) - Lorazepam (Ativan) "Lam/Pam" (The drugs that make people not care about what is being performed)
What can be used to calibrate a body box?
- Mouth pressure transducer (Water or mercury barometer) - Box pressure transducer (Sine wave rotary pump)
If it fails to cycle off when using an IPPB what is the issue?
- Mouthpiece/Mask seal - Cuff leaking - Fenestrated trach tube open - Loose equipment connection
What are the low flow devices?
- Nasal Cannula - Simple mask - Partial Rebreather
What is the most two most common signs of respiratory distress in infants?
- Nasal Flaring - Grunting
What items are needed for an intubation?
- Neuromuscular blocking agent (Succinylcholine) - Hyperoxygenation before and after (2 minutes) - Laryngoscope - ET tube
What are the 5 types of White Blood Cells (WBC)?
- Neutrophils (64%) = Bacterial - Eosinophils (2%) = Allergic reaction/Asthma Attack - Monocytes (3%) = Tuberculosis/Chronic Infection - Lymphocytes (30%) = Viral - Basophils (1%) = Cancer
What causes MetHb poisoning?
- Nitrates - Local Anesthetics "Caines" - Tylenol Overdose - D6PG (Kentucky Blue people gene)
Disadvantages to a Jackson Trach tube?
- No cuff - Not for resuscitation or Positive Pressure Ventilation
What type of ventilator must be used during an MRI?
- Non-electric/gas powered (The magnetic field would disrupt the electronic devices in the ventilator if an electrical one was used)
What type of gas cylinders can you take to an MRI?
- Non-ferrous (Aluminum gas cylinders are used instead of Steel)
When is Cardioversion indicated?
- Non-life threatening arrhythmias - Unstable A-fib - Unstable A-Flutter - Stable Ventricular Tachycardia
If there is Excessive pressure when using an IPPB what is the issue?
- Obstruction - Excessive flow
What are the 3 types of sleep apnea disorders and how are they defined?
- Obstructive Sleep Apnea (OSA) = apnea due to blockage of upper airway - Central Sleep Apnea (CSA) = Apnea due to loss of ventilation effort - Mixed Sleep Apnea = Combination of Central and Obstructive types
If a whistling noise is heard from a Bubble Humidifier, what can the problem be?
- Oxygen flow is excessively high - Obstruction or kink in tubing
What is a standard Xray?
- PA - Left Lateral
Croup (Laryngotracheobronchitis) shows what sign and what Xray is used?
- PA of Neck - Steeple Sign - Picket Fence - Pencil Point - Hourglass (Best one)
What are some controls that directly affect Mean Airway Pressure (PAW)?
- PIP - RR - I-time - PEEP (Most influence) - Peak flow - TV - Inflation Hold
What is the initial settings for Pressure control on a ventilator?
- PLP from Volume control - To achieve target TV - ≤ 35 cmH2O
What Xray sign is shown with Atelectasis?
- Patch infiltrates - Platelike infiltrates - Crowded pulmonary vessels - Crowded air bronchograms
When should the cuff to a Tracheostomy tube be inflated?
- Patient is eating - Positive pressure ventilation (To prevent aspirations)
What is Pleural friction rub usually indicated in?
- Pleurisy - Tuberculosis - Pneumonia (Possibly)
What kind of Ventilator is the Mark 7?
- Pneumatically powered - Pressure cycled (Set a pressure and once it is reached it cycles into exhalation)
If a patient has fine crackles/rale, what should we do?
- Positive pressure - Positive inotropic agents - Diuretics
What are the 5 ways the Trigger Variable can be initiated?
- Pressure - Flow - Volume - Time - Manual
What are the two main things required for patient safety in home care? (What must their house have)
- Properly grounded 3 prongs electrical outlets used for all electrical equipment - Circuit breakers should be used instead of fuses (To quickly reset in case of power issue)
Give some examples of PAP being high?
- Pulmonary Embolism - Pulmonary Hypertension - Air Embolism
Decreased DLCO occurs in patients with?
- Pulmonary Fibrosis - Sarcoidosis - ARDS - Pulmonary Edema - Emphysema
Indications for Inhaled Nitric Oxide?
- Pulmonary Hypertension - Refractory Hypoxemia related to increased PAP - Increased PVR - Cor pulmonale/RHF
When is Defibrillation indicated?
- Pulseless Ventricular Tachycardia - Ventricular Fibrillation
What are the 4 primary sites for an Arterial Blood Gas?
- Radial - Brachial - Femoral - Dorsalis Pedis
What are the cough control techniques?
- Serial Coughs - Huff Coughing - Splinting - Quad Cough
When using a Blender with a Large Volume Nebulizer, what needs set?
- Set Blender at desired FiO2 - Set air-entrainment port on LVN at 100% (Closed) (Basically you set the blender at whatever FiO2 you want then close the window on the LVN) So if you want 37% FiO2 you set that on the blender then close the LVN
What is the initial settings for FiO2 on a ventilator?
- Set at same level as before if FiO2 known - If not set at therapeutic range of 40-60%
Retractions are usually seen in what type of patients?
- Severe airway obstruction - Respiratory Distress
Laryngeal Mask Airway (LMA) has what advantages?
- Size 6 ET tube can be inserted directly through the LMA into the trachea - Can NOT cause VAPS because above the vocal cords - Emergency situations when trauma to the face or nasal route has happened
What is the ideal breathing pattern when performing breathing techniques?
- Slow and deep inspiration - Inspiratory pause/hold for 1-3 seconds - Exhalation is passive and relaxed
When is supplemental oxygen added to a patient in a sleep study?
- SpO2 ≤ 88% while in the supine position breathing room air (Should start at 1 L and be titrated by 1 L increments until SpO2 > 90%
What are 3 types of breathes the Ventilator can be used with?
- Spontaneous (All patient) - Mandatory Breath (Ventilator controls all) - Assisted (Patient initiates the breath then ventilator controls all)
What are the types of Tracheostomy tubes?
- Standard Tracheostomy tube - Fenestrated Tube - Tracheal Button - Extended Tracheostomy Tube - Jackson Trach tube - Foam Cuff (Kamen-Wilkinson, Bivona) - Tracheal Speaking devices (Passy Meir/Kisner Valve)
What are the 4 commons ways to physically disinfect something?
- Steam under pressure (steam autoclave) - Pasteurization (moderate temperatures to kill organisms) - Incineration - Irradiation (gamma rays used to sterilize pre packed equipment)
How do you perform an Extubation?
- Suction airway above and below the cuff - Deflate the cuff (Listen for leak) - Have the patient inhale deeply - Remove tube at peak inspiration to prevent vocal cord damage - Give O2 and humidity as indicated (Vocal cord is open during inhalation)
What are the 3 most common thrombolytics?
- TPA (Tissue Plasminogen Activator) - Streptokinase - Urokinase
What is the ARDSnet protocol?
- TV = 8mL/kg IBW then reduce to 6 mL/kg IBW - Maintain PLP < 30 cmH2O - Consider Permissive hypercapnea and subsequent respiratory acidosis - Switch from VC to PC (Low compliance and high ventilation pressures)
When should a patient be switched from CPAP to BiPAP?
- They can NOT tolerate high pressures on CPAP - They are continued Obstructive respiratory events when CPAP reaches 15 cmH2O
What are the 2 ways a cuff pressure can be monitored?
- Three way stopcock, syringe, and pressure manometer - Cufflator
If the light does not work on a Laryngoscope, what should you do to trouble shoot it?
- Tighten Bulb - Check Handle attachment - Change blade - Check batteries (If none of these work, get a new one)
Purpose of Tracheal Button?
- To maintain stoma (Keep it open) - Used in some patients with OSA (Obstructive sleep apnea)
If an electrode is unable to be calibrate you should check what first?
- Torn membrane - Poor connections - Bubbles in contact
What are the 4 primary variables during positive pressure mechanical ventialtion?
- Trigger Variable - Control/Target Variable - Limit Variable - Cycling Variable
What are some hazards/contraindications for Bronchial hygiene therapy?
- Unstable cardiovascular system - Unstable pulmonary system - Unstable post-operative status - Untreated tuberculosis
What are the FiO2 Air to oxygen ratios for .28, .40,and .60?
.28 = 10:1 = 11 Factor .40 = 3:1 = 4 Factor .60 = 1:1 = 2 Factor
How is a Capnograph calibrated?
0% room air 5% CO2 concentration Compared with PCO2 from ABG at time of Capnograph sampling and should be 5 mmHg less
What is a normal COHb?
0-1%
What is the Silverman Score used for and how is it measured?
0-10 and it is used for assessment of respiratory distress in infants (Higher the score the Worse the distress)
APGAR Score system?
0-3 = Resuscitate 4-6 = Support (Stimulate, warm, give O2) 7-10 = Monitor (Routine Care)
Non-Rebreather Mask can deliver at what % FiO2?
0.21-1.0
T-Piece (Briggs Adapter) can deliver how much FiO2 %?
0.21-1.0
What is a normal Work of breathing value?
0.5 +/- 0.2 Joules/L
Normal Airway resistance is?
0.6 - 2.4 cmH20/L/Sec
What is a normal Airway Resistance (RAW)?
0.6-2.4 cmH2O/L/sec
What is a normal range for Respiratory Quotient?
0.67-1.3
What is a normal Creatinine (Cr-) range?
0.7-1.3 mg/dL
How do we get rid of a blood clot in a Pulmonary artery catheter?
1 = Aspirate 2 = Flush the catheter 3 = Rotate the catheter (AWAY FROM THE PATIENT)
What is the proper order for using Laryngoscopic visualization devices?
1 = Illuminated stylet/light wand (Bonfils) 2 = Guide channel 3 = Laryngoscope blade video (Glidescope)
If a patient is unstable, what is the best order for treatment of a pneumothorax?
1 = Insert large bore needle to relieve pressure 2 = Insert chest tube with drainage system
What are the two times we use Hyperventilation?
1 = Patient just got into ER 2 = In unit on ventilator and random spike of ICP (Temporarily decreases PaCO2 because CO2 is a Cerebral Vasodilator, so we blow more off to constrict it)
What are the 5 main Pulmonary Rehabilitation techniques taught?
1 = Pursed-lip breathing 2 = Diaphragmatic breathing training 3 = Cough control techniques (Huff cough) 4 = Exercise conditioning 5 = Nutritional balance (Increase protein and fat, decrease carbohydrates)
What is the best order to see if a patient has a Pulmonary Embolism?
1 = Spiral CT with Contrast 2 = VQ scan 3 = Pulmonary Angiogram
What is the first and second choice for best test to see if a patient has Bronchiectasis?
1 = Spiral CT with contrast 2 = Bronchogram
When using an Arterial Line on an infant, what is the process?
1 = withdraw approximately 3-5 mL of fluid from catheter (waste solution) 2 = Attach ABG syringe to sampling port to collect sample 3 = Return waste solution to patient 4 = Close stopcock and flush catheter and tubing
1 Hz is equal to how many cycles per minute?
1 Hz = 60 cycles per minute (1 cycle per second)
What is the best rule to determine Liter flow on a nasal cannula?
1 L = 24% 2L = 28% 3L - 32% 4L = 36% 5L = 40% 6L = 44%
1 millivolt is _______ mm on an ECG?
1 millivolt = 10 mm (Ten boxes vertically Y-axis)
Straight blade vs curved blade for a laryngoscope?
Straight = Miller = Under epiglottis (Directly) Curved = Macintosh = In Vallecula (Indirectly) (Drink miller straight) (Macintosh logo (Apple) is missing a bite out of it, so it is curved)
What is the preferred Laryngoscope for infants?
Straight/Miller blade
What is the most common pressure transducer used?
Strain-gauge transducer
What patient shows Crepitus?
Subcutaneous emphysema
If a patient has coarse crackles, what should we do?
Suction them
What is the duration of flow equation?
Tank Factor X PSI/Lpm Example: E cylinder = 0.28 PSI = 2200 Flow = 10 0.28 X 2200 = 616 616/10 = 61.6 61.6 = 1 hour and 1 minute (Could also divide 61.6/60 to get the answer in minutes)
Air leaks will affect electrodes how?
TcPO2 to read higher than PaO2 (Because it is not monitoring oxygen in the body now, it would be using room air)
What is the advance of using an Isolette (Incubator)
Temperature control will maintain a neutrothermal environment (Constant temperature maintained)
What is the absolute contraindication for chest percussion?
Tension pneumothorax
Normal Blood pressure for term and preterm infants?
Term = 60/40 mmHg Preterm = 50/30 mmHg
Blood glucose is important to monitor in infants, what is the normal for term and Pre-term infants?
Term = > 30 mg/dL Pre-Term = 20mg/dL
Nasal Cannula can deliver how much flow and at what % FiO2?
Flow = 1-6 Lpm FiO2 = 0.24-0.45
Simple Mask can deliver how much flow and at what % FiO2?
Flow = 6-10 Lpm FiO2 = 0.40-0.55 (Flow must be at least 6Lpm to flush out exhaled CO2)
Partial Rebreather Mask can deliver how much flow and at what % FiO2?
Flow = 6-10 Lpm FiO2 = 0.60-0.65 (Has no one way flap valves)
Which is preferred, Pressure or Flow triggering?
Flow is preferred
Bronchoalveolar Lavage (BAL) is used why?
For obtaining specimen from the lung at the alveolar level
If there is High PaCO2 during HFOV, how should you change the following: - Frequency - Amplitude - I-time
Frequency = Decrease Amplitude = Increase I-time = Increase
What is another name for the Oxygen Analzyers?
Galvanic Fuel Cell Polargraphic Clark
How is Indirect calorimetry performed?
Gas exchange measurements are obtained over 15-30 minutes and extrapolated to 24 hours
The bird Mark 7 ventilator is pneumatically powered which means?
Gas powered (Usually air is the gas)
What does Cheyne-Stokes breathing pattern show?
Gradually increasing then decreasing rate and depth in a cycle lasting 30-180 seconds with periods of apnea lasting up to 60 seconds
Gram + vs Gram - Stain color and what drugs to use?
Gram + = Purple - Use "cyllin" - Usually ends in Occocus Gram - = Red - Use "Mycin" - Usually hard to spell or pronounce
Green sputum usually shows what kind of infection?
Gram - Bacteria
Nodule means?
Growth or abnormal Tissue
Most of the CO2 in the blood is carried as HCO3- so that changes in total CO2 content can reflect how?
HCO3 = TCO2 = 22-26 mEq/L H+ = CO2
How much dead space does a Heat Moisture exchanger humidifier/Hydroscopic Condenser Humidifier/Artificial Nose make?
HME = around 40 mL of dead
How are the current values affect by a Stress test: - Heart Rate - Blood Pressure - Respiratory Rate - Tidal Volume - CO2 Production - O2 Consumption - Deadspace (VD/VT)
HR = ↑ BP = ↑ RR = ↑ TV = ↑ CO2 Production = ↑ O2 Consumption = ↑ Deadspace (VD/VT) = ↓ (Because TV increases during exercise but VT/VD should ↓ because VD always stays the same) Example: TV = 500 before Exercise VD = 250 TV = during exercise 525 500-250 = 250 Resting 525-250 = 275 exercising
What is the values for FeCO: Heavy Smokers Moderate Smokers Light Smokers Non-Smokers
Heavy Smokers = > 20 ppm Moderate Smokers = 11-20 ppm Light Smokers = 7-10 ppm Non-Smokers = < 7 ppm (Normal Value)
What is the best way to measure SaO2?
Hemoximeter
What is another name for External Percussive devices?
High Frequency Chest Wall Compression Devices (HFCWCD) (The vest)
What do you set the following Ventilator alarms at: High Pressure Minimum Exhaled Volume Low pressure
High Pressure = Set 10 cmH2O above PIP Minimum Exhaled Volume = Set 100 mL below exhaled TV Low Pressure = Set 10 cmH2O below PIP
What does HPI stand for?
History of Present illness
What do you clean the inner cannula with?
Hydrogen peroxide and sterile water
What should you do before with drawing Nitric Oxide?
Hyperoxygenate the patient
What are the two factors that affect electrical impulse/axis?
Hypertrophy = increased electrical activity, Axis will shift toward hypertrophy (Toward) Infarction = Dead tissue, no electrical activity, axis will shift away from the infarction (Away)
What is the most common hazard of IPPB?
Hyperventilation
Decreased cardiac stress indicates poor perfusion, which causes?
Hypovolemia
Increased blood pressure indicates cardiac stress, which causes?
Hypoxemia
What is the most serious complications of suctioning a patient?
Hypoxemia (leads to Tachycardia)
How are nosocomial infections spread?
Inadequate handwashing techniques and nasal discharge
What is the best method of treating contaminated disposable items and supplies?
Incineration
What does Auto PEEP mean?
Incomplete exhalation and air is trapped in the lungs (Insufficient Expiratory time)
How do you fix a Ventilation problem on BiPAP?
Increase IPAP
How do you fix an Oxygenation issue on BiPAP?
Increase IPAP and EPAP
If a patient has High ICP and we need to help them oxygenate more what can we do?
Increase the FiO2, but increasing the PEEP would worsen the problem because of more pressure
If the bag collapses on a Non-Rebreather, what should you do?
Increase the flow
What is the purpose of a Wick Humdifier?
Increase the surface area of the gas-water interface, therefore increasing the humidifiers efficency
Increased vs Decreased White blood cell (WBC)?
Increased = Bacterial infection (Recommend Antibiotics) Decreased = Viral (Antiviral Agent if possible)
Increase vs Decrease in PETCO2% shows?
Increased = Decrease in Ventilation (Ventilatory Failure) Decrease = Increase in Ventilation or Decrease in Perfusion (Pulmonary Embolism/Hypovolemia)
Barrel Chest shows what?
Increased Anterior Posterior Diameter (Puffed up like a balloon)
When adjusting TV or PIP in an attempt to improve alveolar ventilation, this will cause?
Increased Bronchopleural leak (From the chest tube)
What does Kussmauls breathing pattern show?
Increased Respiratory Rate, increased depth, irregular rhythm, breathing sounds labored
What does Biot's breathing pattern show?
Increased respiratory rate and depth with irregular periods of apnea
How can you tell the difference between Increasing Airway Resistance (RAW) vs Decreasing Lung Compliance?
Increasing RAW: PIP = ↑ PLP = Constant Decreasing Compliance: PIP = ↑ PLP = ↑
What is the purpose of a Double-Lumen endotracheal tube (DLT)/Endobronchial tube/Carlens tube?
Independent unilateral lung ventilation
What is the main purpose/advantage a PET scan has over MRI/CT?
It detects diseases earlier
What suction catheter is used that allows patients to still receive ventilation and oxygenation during suctioning?
Inline suction catheter (Ballard)
How do you insert an Oropharyngeal airway?
Inserted opposite of its anatomical shape (Upside down) to back of throat then rotate into correct position
How is a Nasopharyngeal Airway inserted?
Inserted the way it is anatomically shaped with lubricant
How to tell which way the trachea will deviate?
Inside the lung = Toward Outside the lung = Away Examples: Inside: - Atelectasis - Pneumonia Outside: - Pneumothorax - Pleural effusion - Tumor or mass
What is the biggest disadvantage of any equipment that contains water?
It can transmit infectious agents such as Pseudomonas Aeruginosa and Serratia (Especially aerosol devices)
Why is Emphysema the only obstructive disease to have Decreased DLCO?
It causes loss of surface area of the alveoli (Less surface area = Less space to diffuse)
Which primary variable creates a plateau?
Limit Variable
When calibrating a Helium Analyzer you should use a multi-point precise gas concertation to establish?
Linearity (Straight line of dots plotted)
What is the equation for the respiratory Quotient?
RQ = VCO2/VO2 CO2 consumed to Oxygen consumed (Normal is usually 200mL/250 mL = 0.8)
Termination of a SBT for should occur when, for the following: - Respiratory Rate increase - Heart rate increase - Cardiac Arrhythmia - Change in blood pressure - Agitation or anxiety - Oxygen saturation - pH
RR = > 35 bpm for 5 minutes or more HR = > 130 bpm or 20% over baseline Cardiac arrhythmia develop Systolic = > 180 mmHg Diastolic = < 90 mmHg Excessive agitation or anxiety Oxygen saturation = < 90% or decreased 4% or more from baseline pH = < 7.30
What are the appropriate acceptable values for weaning for the following: - Rapid Shallow Breathing Index (RSBI) - Respiratory Rate (RR) - Vital Capacity (VC) - Minute Ventilation (VE) - Spontaneous Tidal Volume (TV) - Maximum Inspiratory Pressure (MIP/NIF) - Maximum Expiratory Pressure (MEP)
RSBI = < 100 RR = 8-20 bpm VC = > 10 mL/kg MV = < 10 L/min Spontaneous TV = ≥ 5 mL/kg MIP = ≥ -20 cmH2O MEP = ≥ 40 cmH2O
What is the equation for Rapid Shallow Breathing Index (RSBI) and what is normal?
RSBI normal = ≤ 100 RSBI = RR/TV (L) Example: Respiratory Rate = 25 bpm TV = 250 mL 25/0.25 = 100 (Have to convert 250 mL to 0.25 L then divide)
What does decreased lung compliance mean?
Stiffer lungs due to alveoli being harder to fill with air
What does Vascular Markings mean and what is shown on an Xray?
Lymphatics, Vessels, Lung tissue (↑ with CHF, Absent with Pneumothorax)
What is the equation for Mean Arterial Pressure?
MAP = (Diastolic x 2) + Systolic / 3 (This is because of 2/3 of the blood is free falling during the rapid filling phase of the ventricles)
What is the most efficient way to administer aerosolized medications to avoid cross contamination of a drug?
MDI
Always change from SVN to ____ and _____ if possible?
MDI or DPI
When a patient is an organ donor how do we treat their body?
Maintain: PaCO2 = 35-45 mmHg PaO2 > 100 mmHg SaO2 > 95% (Mainly all normal values with increased PaO2)
If a flow is 40% then you need to do what?
Make a Tandem system (Dual Bottle system)
Intubation distance for Male vs Female?
Male = 23-25 cm Female = 21-23 cm
What score is used to visualize the soft palate, uvula, and fauces?
Mallampati Score
What test is used to determine if a patient has Tuberculosis?
Mantoux test/PPD (PPD = Purified protein derivative)
Insufflation/Exsufflation devices are also known as?
Manually Assisted Coughing (MAC)
What is indirect Calorimetry?
Method of calculating resting energy expenditure (REE) by measuring the whole body VO2 and VCO2
Is a CO2/CO/CH4 (Methane) analyzer affected by partial pressure in altitude?
No
What changes and what remains constant during Increasing Airway Resistance (RAW)?
PIP = ↑ PLP = Constant
How can you estimate Airway Resistance (RAW)?
PIP-PLP
How do you estimate where to set pressure support (PEEP) initially?
PIP-PLP = PEEP to set
What is the equation used for Airway Resistance (RAW)?
PIP-PLP/Flow/(Lps)
Prone positioning a patient may increase PaO2 by how much, and decrease shunting by how much?
PaO2 increased by 10-50 torr Shunting decreased by 12-25%
If FeNO is decreased it shows?
Decrease in airway inflammation and that the corticosteroids are working as a control drug
How does a Foam cuff (Kamen-Wilkinson, Bivona) Trach tube work?
Pilot tube is left open to the atmosphere and foam expands to seal trachea
Pulmonary artery catheter position and wave forms?
RA = I RV = II Pulmonary Artery (PAP) = III Pulmonary Capillary Bed (PCWP) = IV (Purpose is to see where the tip of the PAC is)
Instead of increasing TV or PIP when a patient has a chest tube, what is another viable option?
Decrease the TV, but Increase the RR (Will still possibly maintain Minute Ventilation, if other options are not available)
Don vs Doff order for personal protective equipment (PPE)?
Don (Put on): - Hand hygiene - Gown - Face mask - Goggles/Face shield - Gloves Doff (Take off): - Gloves - Goggles/Face shield - Gown - Mask - Hand hygiene
For lavage of an entire lung, what must be used?
Double-Lumen Carlen's endobronchial tube is inserted to ventilate one lung while the other lung is filled with saline and a complete lavage is performed
If someone is persistently bleeding during surgery, what tube would we use?
Double-Lumen endotracheal tube (DLT)/Endobronchial tube/Carlens tube
What is the normal impulse/axis of electrical flow?
Down and to the left
How do you treat water/condensation in the tubing?
Drain and then add heated circuit (↑ Temperature = ↓ Condensation)
If an asthmatic is not well controlled, what is a good indicator?
Dry non-productive cough
When should the HME always have to be removed?
During Aerosol therapy as it blocks the pathway for the medication to be delivered
What is the number one indicator for a Barium Swallow?
Dysphagia (Difficulty Swallowing)
When should you recommend ECMO for infants based on Oxygen Index (OI) values?
ECMO recommended for newborns with OI > 40
When is the best time to collect a specimen using sputum induction?
Early in the morning
ECG stands for? It measures what?
Electrocardiogram Measures cardiac performance (Overall Cardiac Function and Left Ventricular volume and Ejection Fraction)
EEG stands for? It measures what?
Electroencephalogram Measures Brain waves
Severe, Marked, or Profound indicate what type of issue?
Emergency
You can NOT replace a Laryngectomy tube with a Trachea tube, you must use what?
Endotracheal Tube
What does Macroglossia mean?
Enlarged Tongue
What is another name for a Barium Swallow?
Esophagram
New Ballard score is used when and why?
Estimates gestational age in low birth weight infants SGA = Small gestational age
When using an Aerosol Mask, Trach Collar, and Face tent, room air will not enter the devices exhalation ports as long as the devices flow _______ the patients inspiratory flow?
Exceeds (> 40L/min)
Peripheral Edema shows what?
Excessive fluid in the tissue
How is Exhaled Tidal Volume calculated?
Exhaled Tidal Volume = TV = VE/RR
Capnography measures what?
Exhaled carbon dioxide (CO2) content using infrared absorption
On a flow volume loop the inspiratory vs expiratory flow goes in which direction?
Expiratory is above base line Inspiratory is below base line
What does Hyperlucency mean and what is shown on an Xray?
Extra pulmonary Air (COPD, Asthma attack, Pneumothorax)
What does Crepitus mean?
Extra pulmonary air under the skin
What does Cachexia mean?
Extreme muscle atrophy (Muscle Wasting)
Pre and Post bronchodilator therapy should have an increase in FEV1 by _____% or ______mL to show obstruction is reversible?
FEV1 = 12% increase or increase of 200 mL
FEV1/FVC vs FVC determines?
FEV1/FVC = Obstructive FVC = Restrictive
Nitrogen Wash Out (Open method) is used to determine?
FRC
Thoracic gas volume is another term that also means?
FRC (Functional Residual Capacity)
What does Mean Airway Pressure (PAW) mean?
The average pressure transmitted to the airway from the beginning of one breath to the beginning of the next
Exudate is defined how?
pH = < 7.30 Pleural fluid protein to serum protein = > 0.5 Loculated/Very thick
If there is continuous bubbling in a suction control bottle this shows?
The suction pressure is set properly
What is the parameter that starts the inspiratory phase?
Trigger Variable
What is a normal Troponin level?
Troponin normal = 0.01 ng/mL (If increases places patient at higher risk for death from a myocardial infarction)
Autocycling means you need to turn down what?
Too sensitive (Turn down the sensitivity)
What is administered during a Bronchoscopy to control cough/gag reflex?
Topical Anesthetic: - Lidocaine - Benzocaine - Cetacaine - Novocaine "Caines" = numbing agent
What is the Total Flow equation?
Total Flow = 100-FiO2/FiO2-21 Example: FiO2 = 28% Flow = 5 Lpm 100-28/28-21 = 72/7 72/7 = 10.2 10/1 = Air to O2 ratio (For every 10 parts air, there is 1 part O2) 10/1 = 11 11 x Flow 11 x 5 = 55 Lpm
What patient usually has Diaphoresis during the night?
Tuberculosis (Night Sweats)
What are the 2 types of ABG results that a patient can have?
Type 1 = ABG looks good/Patient looks and feels bad Type 2 = ABG looks bad/Patient looks and feels fine
Give an example of Type 1 vs Type 2 ABG results patients can have?
Type 1: - CO poisoning - Anemia - Pulmonary Embolism Type 2: - COPD
If a patient has a 20 pound weight gain or loss since starting CPAP/BiPAP, what must be done?
Update the pressures needed currently (If they weigh less it could require less pressure)
Stridor indicates?
Upper airway obstruction (high pitched or crowing inspiratory sound)
What is the largest advantages of using a Reservoir cannula in the home setting?
Used commonly in the home to reduce costs and increase duration of cylinder flow
What is the purpose of a Ultrasonic Nebulizer?
Used for Sputum Induction
What is the purpose of a pressure transducer?
Used in hemodynamics to convert pressures (Analog signal) into electrical signals (digital signals) that can be displayed
What does Intravenous infusion mean?
Used to administer medications or blood products or supplemental nutrition and fluids continuously to patients
Dubowitz or Ballard Score is measured how and is used to do what?
Used to assess gestational age Normal = 40 corresponding to 40 weeks > 40 = Post-term (Suction + ETT) < 40 = Pre-term (Surfactant)
Activated Partial Thromboplastin Time (APTT) vs Prothrombin Time (PT) and purpose?
Used to measure time it takes to clot APTT = Heparin Therapy PT = Warfarin (coumadin)
What is Exhaled Carbon Monoxide (FeCO) testing used for?
Used to monitor whether or not a patient has been smoking (Carbon monoxide increases from smoking)
Purpose of a Electromagnetic Navigational Bronchoscopy (ENB)?
Useful for obtaining biopsy samples from peripheral pulmonary nodules
If a sudden drop in HR is observed during a bronchoscopy, that means?
Vagal nerve stimulation, too close to the carina
Spirometer are used to measure?
Volumes
What does Eupnea mean?
Normal breathing pattern
How long does it take to disinfect vs sterilize?
Disinfect = 20 minutes Sterilize = 10 hours (Cidex for bronchoscope)
Disinfections vs Sterlization?
Disinfect = process of destroying vegetative pathogenic microorganisms Sterilization = complete destruction of all microorganisms (Sterilization is also disinfection, but not the other way around)
Insufficient flow will show how?
Normal graphic then random decrease and back to normal
What does Epistaxis mean?
Nose bleed
What are some common troubleshooting issue associated with a Large Volume Nebulizer?
Not misting enough: - Clogged capillary tube - Insufficient flow - Decrease in temperature causes more condensation - Insufficient water level Changes in FiO2: - Increase in resistance (Such as water collecting in the tubing) will cause less air to be entrained causing the FiO2 to increase (Venturi principle)
If a pneumothorax is < 10% do we need to fix it?
Not until 20% or greater, because it could fix itself
A patient requires a total flow of 45Lpm, What flowrate should the therapist select if the dilution control is set to deliver 40% Oxygen?
O2 flow = Total flow/Factor O2 Flow = 45/4 = 11.25 Lpm
What is a normal value for Oxygen index
OI = < 10
When is a Automated External Defibrillator (AED) indicated?
ONLY when a patient has the following: - No response - No breathing - No pulse
What is the best way to verify adequate aerosol flow?
Observe the aerosol coming out of the end of the tubing during inspiration
If FVC is smaller than SVC it indicates?
Obstructive Disease
What is the best way to remember whether something leaving the body causes acidosis vs alkalosis?
Out the ass = Acidosis Out the mouth = Alkalosis (Because out the mouth you lose stomach acid, making it more alkalotic)
What does cardiac output measure?
Output of the left ventricle to the systemic arterial circulation
Bronchial breath sounds are normal and are heard where?
Over the trachea and bronchi
What device uses a molecular sieve that removes nitrogen and other gases from room air to concentrate the oxygen?
Oxygen concentrator
If a liquid or oxygen concentrator are not working, what can be used as a backup system in the home care setting?
Oxygen cylinder
A patient can not _______ through a Gum Elastic Bougie?
Oxygenate or Ventilate (Only used to change damaged ET tubes)
Out of the four life functions, which one is the most common problem?
Oxygenation
P wave, QRS complex, and T wave show what?
P wave = Atrial Depolarization QRS = Ventricular Depolarization T wave = Ventricular Repolarization
What is boyles law?
P1V1 = P2V2 (Temperature is always constant) (Boyle = Temperature his name sounds like boiling, which is a great way to remember temperature is always constant)
What is the Alveolar Air equation?
PAO2 = ( Pb - pH20 ) FiO2 - PaCO2/RQ
What is the formula for the A-a Gradient?
PAO2-PaO2
What has the largest influence on Mean Airway Pressure (PAW)?
PEEP
What are the interpretation values for PF ratio vs A-a gradient?
PF ratio: > 380 = normal 200-380 = VQ < 200 = Shunting A-a gradient: 25-65 = Normal 66-300 = VQ > 300 = Shunting
If no dicrotic knotch is present that shows?
Pressure dampened (Obstructed catheter)
Preterm, Term, Post-Term age for infants?
Preterm = < 38 weeks Term = 38-42 weeks Post-Term = > 42 weeks
What are the primary and secondary controls used during HFOV for: PaCO2 PaO2
Primary PaCO2: - Amplitude (Power, ΔP) Secondary PaCO2: - Frequency in Hz (Also affects I-time) (Lower the frequency the Higher the TV) Primary PaO2: - Mean Airway Pressure (PAW)
How do you take an MDI treatment?
Prime MDI Hold MDI 1-2 inches in front of mouth Deep inhale and hold breath for 10 seconds (If quick relief medication (SABA/Rescue Meds) wait one minute between puffs)
If a patient is extubated then has Marked inspiratory stridor or Severe Respiratory distress, what should you do?
Reintubate the patient ASAP
What fluid is used to help when collecting sputum specimen samples for cytology?
Saline
Water/condensation in the tubing shows what on a graphic?
Scalloped pattern/Shark tooth
Why is Minimal Leak technique (MLT) bad?
Secretions can go down throat causing VAPS
Give some examples of PCWP being high?
- Left Heart Failure - Mitral valve Stenosis (BCV) - CHF
Epiglottis shows what sign and what Xray is used?
- Left Lateral - Thumb sign
How are CvO2 and SvO2 affected when Cardiac Output is Decrease?
CvO2 ↓ = CO ↓ SvO2 ↓ = CO ↓
What is the Desired Minute Volume equation?
(Current VE x Current PaCO2) = (Desired VE x Desired PaCO2) Example: MV = 8 L/min PaCO2 = 50 torr Desired PaCO2 = 40 torr (8 x 50 ) = (VE x 40) 400 = (VE x 40) VE = 400/40 = 10 L/min
What causes Autocycling?
- Leak - Trigger too sensitive - Condensation in circuit
How do you perform an apnea test for brain death determination?
- Disconnect patient from ventilator while administering 100% O2 and monitoring SpO2 - Observe patient for any chest/abdominal movement to produce adequate TV - Absence of respiratory effort supports diagnosis - Diagnosis is completely confirmed by cerebral perfusion scan (Cerebral angiogram)
When administering medication down the ET tube, you must?
- Double the normal IV dose - Flush with 10mL of saline - Hyperventilate for 30 seconds
What are some other names for Capnography devices?
- EZ cap - Colormetric devices
What type of patient can show Exudate?
- Emphyema/pyothorax - Bloody effusions (Hemothorax) - Purulent (Pus) - Chyle (Lymphatic exudative fluid)
What are the routes for suctioning?
- Endotracheal - Nasotracheal - Oropharyngeal
What is the purpose of Maximum voluntary Ventilation (MVV)?
- Evaluate respiratory muscle reserve - Endurance - Fatigue
Maximum voluntary Ventilation (MVV) should be?
- Fast and Deep - 10-15 seconds then calculated to 1 minute
Why is a Tracheostomy used compared to a ET tube for long term ventilation?
- Fewer hazards - Less RAW (Airway resistance)
What are the 3 ways to measure Cardiac output?
- Fick equation = CO = VO2/C(a-v)O2 x 10 - Stroke Volume = CO = SV x HR - Thermal Dilution
What Xray sign is shown with Pulmonary Edema?
- Fluffy infiltrates - Batwing - Butterfly
What are some names for PEP therapy devices?
- Flutter valve - Acapella - Quake (Great for post op patients)
What Xray sign is shown with ARDS?
- Groundglass appearance - Honeycomb pattern - Diffuse bilateral radiopacity
When is Inverse Ratio Ventilation (IRV) recommended for patients?
- High FiO2 (>60%) - PEEP (>15 cmH2O) - High PIP (>50 cmH2O) - Low PaO2 with decreased compliance - PLP > 30 cmH2O
What are some usual causes of irreversible ventilator dependence?
- High spinal cord injury - ALS (Lou Gehrig Disease)
How do we treat stridor?
- Humidified O2 - Racemic Epinephrine - Corticosteroid - Heliox
What are some signs to look for when determining a Pulmonary Embolism?
- Hyperpnea (Increased rate and depth) - Blood gas reveals normal PaCO2 (No hyperventilation)
When is an Infant Apnea Monitor indicated?
- If an infant may be at risk of periods of apnea > 20 seconds - One or more ALTE - SIDS (Sudden infant death syndrome) - Preterm infants with significant apnea periods - Snoring in infants
What is the best ways to treat Auto PEEP?
- Increase Flow - Increase E-time - Decrease I-time
What are the two ways to treat Decreased Lung Compliance?
- Increase PEEP - Treat the underlying cause
If aerosol disappears while using a T-piece, what can you do?
- Increase the flow - Add more reservoir tubing - Setup a device to provide more flow (Blender, Tandem setup, change flowmeter)
What can be used to correct Insufficient flow?
- Increase the flow - Decrease I-time - Increase E-time
What is the most common setup for a Recruitment Maneuver?
- Increase to high level of PEEP for short period of time - Increase PEEP to 40 cmH2O for 40 seconds - Increase CPAP o 20 cmH2O for 20 seconds (if not intubated)
What patients show Cheyne-Stokes?
- Increased ICP levels - Brainstem Injury - Drug overdose
What parameters are monitored during a sleep study?
- Inductive Plethysmography - Nasal Air flow - Pulse oximetry - Number of Apnea (Cessation of breathing) - Number of Hypopneas (Shallow or slow breathing)
What are some late (After 24hrs) complications from a Tracheostomy?
- Infection - Hemorrhage (Tracheoinnominate artery fistula) - Obstruction - Tracheo-Esophageal (T-E) fistula
Localized hemorrhage is common after tissue biopsy, but if serious bleeding occurs what can be done?
- Instill Epinephrine (Vasoconstrictor) - Compress the site with the scope - Insert Fogarty Catheter (Bigger surface area to compress more)
What are the accessory muscles of ventilation?
- Internal intercostals - Scalene - Sternocleidomastoid - Pectoralis Major - Obliques - Rectus abdominis
What are other terms also known as Auto PEEP?
- Intrinsic PEEP - Occult PEEP - Dynamic Hyperinflation
If there is loss of pressure when using an IPPB what is the issue?
- Leak - Insufficient flow
When using a nebulizer how should the patient breathe?
1-3 second hold is important to enhance medication delivery
What is a normal PEFR?
10 L/sec or 600 L/min
What is a normal respiratory rate in Hz for HFOV?
3-15 Hz
What is a normal ETCO2 %?
3-5 %
What is a normal shunt value?
3-5 %
What should CPAP therapy be started at?
3-5 cmH2O
What are the Blade sizes for Adult, Pediatric, Term, and Pre-term infants?
Adult = Size 3 Pediatric = Size 2 Term infant = Size 1 Pre-Term = Size 0
What are the normal Endotracheal tube sizes?
Adult Male = 8.0-8.5 mm Adult Female = 7.0-7.5 mm Full term infant = 3.0-3.5 mm Pre-term infant = 2.5-3.0 mm
What does Ascites mean?
Accumulation of fluid in the abdomen (Usually caused by Liver failure)
What is the advantage vs disadvantage of a DPI?
Advantage: Medications are in powdered form and do not require propellant Disadvantage: Have to be able to suck in hard enough for it to work properly
How do you calculate actual flow?
Actual flow = Indicated flow X Factor Example: Indicated flow = 10 Lpm Factor = 1.8 10 x 1.8 = 18 Lpm
What are the vacuum pressures to suction for Adults, Children, and Infants?
Adult = 120-150 mmHg Children = 100-120 mmHg Infant = 80-100 mmHg
What should the bronchoscope be put in after a procedure?
Alkaline glutaraldehyde (Cidex)
If all values are high or low when monitoring hemodynamics is shows what two things?
All increased = Hypervolemia All decreased = Hypovolemia
What does a Tonometer device do?
Allows precise gas mixtures to be equilibrated with whole blood or a buffer solution
How do you determine if a patient needs, Ambulance, Helicopter, Fixed Wing Aircraft?
Ambulance = 0-80 miles Helicopter = 81-150 miles Fixed Wing Aircraft = > 150 miles
What is the mechanism behind Aerosol therapy?
An aerosol is particulate matter suspended in a gas (produces a spray)
What is the purpose of a Coude tip catheter?
Angles to help suction the LEFT main stem bronchus
Vitamin C is known as?
Ascorbic Acid
Where can Intravenous infusion be performed?
Any central Vein: - Femoral - Jugular - Subclavian Vessel - Peripheral Vessels
If a patient has a indwelling dialysis shunt, where should you do an ABG?
Any of the other sites that the shunt is not present in
What does Point of care testing mean?
Any type of lab testing done at the bedside
What are the drugs we use to make sure a patient does not move when sedation is needed?
Anything that ends in "lam" or "pam" Examples: - Midazolam (Versed) - Alprazolam (Xanax) - Lorazepam (Ativan) - Diazepam (Valium)
When is a bubble humidifier most commonly used?
Anytime flow greater than 4 L/min (Low flow device)
Apical Lordotic Xray is used to detect?
Apices of the lungs
What is the absolute indication for mechanical ventilation?
Apnea
How do you calculate the Apnea Hypopnea Index (AHI)?
Apneas + Hypopneas / Hours of sleep
ALTE stands for?
Apparent Life-Threatening Event
Crowding of ribs together is a sign of?
Atelectasis
What drug is used to treat bradycardia?
Atropine
How does a Manually Assisted Coughing (MAC) device work?
Attach to mask/ET tube/Trach Deliver deep inspiration by positive pressure followed by 1-2 second breath hold then negative pressure exsufflation to create a cough
When using a Manual resuscitation bag (Self-inflating), where does the PEEP valve go?
Attach to the expiratory side of patient valve
Not enough sensitivity will show how?
Attempts under the baseline
Affinity means?
Attraction More affinity = Less O2 because Hb is more attracted to something else
What does axis mean when talking about electrophysiology of the heart?
Average direction of impulse (electrical flow)
Neutrophils are divided into what two categories?
Bands = Immature cells (4%) Increased in Bacterial Infections Segs = Mature cells (60%) decreased in Bacterial Infections (Immature are increased in bacterial because the mature cells need help so they go and help earlier than becoming mature to try to fight the infection faster) (Segs are decreased because they have to fight the infection, while the body is using more than it can produce, because the immatures die too young before they are turned into segs)
What test is used to diagnose abnormalities in the hypopharynx, esophagus, or stomach?
Barium Swallow (Esophogram)
Over distention looks like what on a graphic loop?
Bird beak
White vs Black on Xray?
Black = Radiolucent (Air filled) White = Radiopaque/Radiodense (Solid/Fluid)
Bottle 1 vs 2 vs 3 in a Three bottle water-seal suction drainage system?
Bottle 1 = Collection bottle Bottle 2 = Water seal Bottle 3 = Suction Control
A Body Box (Plethysmography) uses what law?
Boyles Law
What is Autogenic Drainage?
Breathing exercises utilized to improve mucus clearance
What is the main indication to perform a Bronchogram?
Bronchiectasis
To detect foreign body aspirations we use inspiratory/expiratory radiographs, these allow us to use what device to help remove them?
Bronchoscope
What device do we use to suction infants?
Bulb syringe
What is the equation for Arterial-Venous Oxygen Content Difference?
C(a-v)O2 = CaO2 - CvO2
If Vascular marking are increased it shows?
CHF
Pectus excavatum is usually seen with what kind of patients?
CHF
Venous Distention is usually seen in what patients and when should you look for it?
CHF (Seen during exhalation in obstructive air trapping patients)
What is the Cardiac Index equation?
CI = CO/BSA (Usually 1/2 the Cardiac Output)
What is the modified Fick Equation?
CO = VO2/C(a-v)O2 x10
Erythema is usually a sign on what type of patients?
CO poisoning (Carbon monoxide)
How do we calculate Cerebral Perfusion pressure to see if a patient is oxygenating enough?
CPP = MAP - ICP Example: CPP = 80 mmHg - 15 mmHg CPP = 65 mmHg
When an infant is sent home while needing an apnea monitor, the parents must know?
CPR
Central Sleep Apnea vs Obstructive Sleep Apnea?
CSA = No Effort with decreased Nasal Flow OSA = Effort with decreased Nasal Flow
If a number is high it shows the problem in that location, what values are used to see Right heart, Left heart, and Lung issues?
CVP = Right Heart PAP = lungs PCWP = Left Heart
Difference between CVP Swan Ganz catheter and Central line?
CVP Swan Ganz = 2-6 mmHg CVP Central Line = 4-12 cmH20
What is the Arterial Oxygen Content Equation?
CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003)
What is the purpose of the Alveolar Air equation?
Calculates the partial pressure of oxygen (PO2) in the alveoli
Nitrogen Analyzer is calibrated how?
Calibrate to 0 with 100% Oxygen (0% N2) and a known concentration
CO2/CO/CH4 (Methane) analyzers are calibrated how?
Calibrate to room air (0%) and known concentration (0.3% CO) then re-zero
Advantage of IPV?
Can be administered to patients who are unconscious or cannot follow directions (Use Mask on the patient)
Alkaline glutaraldehyde (Cidex) vs Acid glutaraldehyde (Sonacide) time frames for disinfection or sterilization process?
Cidex = 10 hour soak Sonacide = 1 hour soak
How do Carbohydrates, Fats, and Proteins affect the Respiratory Quotient?
Carbohydrates = 1.00 Fats = 0.71 Proteins = 0.82 (In general, molecules that are more oxidized (e.g., glucose) require less oxygen to be fully metabolized and, therefore, have higher respiratory quotients. Conversely, molecules that are less oxidized (e.g., fatty acids) require more oxygen for their complete metabolism and have lower respiratory quotients.) (The ratio of carbon dioxide output to oxygen usage is called the respiratory quotient, so the respiratory quotient for carbohydrates is 1.0.) (Diet high in carbohydrates would produce excess CO2 which would Increase the Work of breathing)
Co-oximeter/hemoximeter are used to diagnose?
Carbon Monoxide poisoning (CO)
Cardioversion is delivered at: - Joules - Synchronized Switch - Delivered when
Cardioversion: - 50-100, then 200 if unsuccessful J (Monophasic) - Synchronized to R wave (ON) (Usually atrial issues)
Cardiovert vs Defibrillation?
Cardiovert (Atrial) 50-200J (Synchronized to the R wave) Pulse V-tach Defibrillation (Ventricular) 360J (Unsynchronized) Pulseless V-tach V-flutter/fib
What is the formula to determine Suction Catheter size?
Catheter size = ID size/2 x 3 Example: 8.0 mm ID ETT Half of 8.0 mm = 4.0mm 8.0/2 = 4.0mm 4.0mm x 3 = 12 French Suction catheter
How is Ventilator associated Pneumonia (VAP) usually aquired?
Caused by aspiration of bacteria that have colonized the upper GI tract or oropharynx (secretions that pool above the airway cuff aspirated through small folds in the cuff)
Why would you not perform a Head-tilt/Chin-lift?
Cervical Injury (Use modified Jaw thrust)
How is work of breathing calculated?
Change in Pressure X change in Volume (ΔP x ΔV)
If a patient has a change in prognosis, what should you look for?
Change in orders (To start new methods of treatment)
Cuff pressures and Volume vary with?
Changes in altitude
Inductive plethysmography is also known as?
Chest motion (Bands that go on chest to detect movement)
What does Retractions mean?
Chest moves inward during inspiratory efforts instead of outward
If a pregnant woman needs help with a Severe Airway Obstruction, how do you perform the Heimlich?
Chest thrusts by sternum
Clubbing of fingers is caused by?
Chronic Hypoxemia
How does IPV work?
Combination of high frequency pulse delivery (100-250 cycles/min) of a sub-tidal volume and a dense aerosol (percussive effect of gas delivery improves ventilation past obstructions in the airway)
Palliative care means?
Comfort measurement to control pain and other symptoms (Terminally ill Patients)
Hospice care means?
Comfort measurements to control pain or other symptoms without curative intent
Transudate fluid is associated with what patient?
Congestive Heart Failure (CHF)
Nasopharyngeal airway is for?
Conscious Patients
What are the 4 Inspiratory Flow patterns and what are they associated with?
Constant (Square) (Volume) Decelerating (Pressure) Accelerating Sinusoidal (Spontaneous)
Kyphosis shows what?
Convex curvature of the spine (Forward lean)
What is the purpose of the inflection point?
Critical opening pressure to inflate alveoli (Set PEEP here)
Difference between Croup and Epiglottis?
Croup - Viral Epiglottis - Bacterial - Medical Emergency
When using a speaking valve for a trach patient, what must always be done?
Cuff MUST be deflated
Defibrillation is delivered at: - Joules - Synchronized Switch - Delivered when
Defibrillation: - 360J - Ventricular Problems - Unsynchronized (OFF)
Pectus Excavatum shows what?
Depression of the sternum (Excavate = to dig, so it digs down into the chest)
Purpose of Extended Tracheostomy tubes?
Designed to accommodate variation in the distance from the skin to the trachea
What patient show Kussmauls?
Diabetics
Bronchoscopy Diagnostic vs Therapeutic use?
Diagnostic = Flexible Therapeutic = Rigid
If there is no light on the left side while using a Transilluminator on a infant, there could be?
Diaphragmatic hernia
If Failure of arterial waveform to return after an Arterial Line ABG is given, what does this indicate?
Failure of arterial waveform to return indicates the stopcock was not turn to the correct position
If a patient can not tolerate a Passy Meir, what tube can be used?
Fenestrated tube
What does not affect Mean Airway Resistance at all?
FiO2
Prone positioning a patient should be considered for ARDS/ALI when?
FiO2 60% and PEEP > 15 cmH2O or if Recruitment Maneuver has failed
If a Mallampati score is III or IV, what device do we need to use to intubate?
Fiberoptic bronchoscope
Which is worse, Atrial Flutter or Atrial Fibrillation?
Fibrillation because the blood is just laying in the ventricles clotting up
When looking at the Lecithin/Sphingomyelin (L/S) ratio which number should always be higher in the ratio?
First number should always be higher Example: 2:1
Postural Drainage Positions: - Flat - Down 15° - Down 30° What is being drained?
Flat = Upper lobes Down 15° = Middle lobes Down 30° = Lower lobes
Not enough PEEP looks like what on a graphic loop?
Flat line across bottom of oval on pressure line (Point should just touch pressure line to make an oval)
Rigid vs Flexible location performed?
Flexible = Bed side or Office Rigid = Operating Room
For a diagnostic lavage, what bronchoscope is used?
Flexible bronchoscope is used to instill and then aspirate small volumes of saline (Fluid then analyzed in a laboratory)
What position is the Dicrotic knotch seen on a Pulmonary artery catheter?
III = Pulmonary Artery (PAP)
What are the initial settings for BiPAP?
IPAP = 8-12 cmH2O EPAP = 4-6 cmH2O 10/5 = average
IPAP vs EPAP?
IPAP = Ventilation EPAP = Oxygenation
For an oxygen concentrator the purity of the oxygen is 88%, but it can drop below 88% when?
If Flow is greater than > 2 L/min
Low PETCO2 readings after intubation indicate the ET tube is where?
In the esophagus
Where is the most commonly used Intravenous infusion performed?
In the peripheral vessels of the hand or arm
When would you instill medication down an Intubation tube?
If no IV access is avaliable
What is a huge disadvantage and is the reason why when performing a DLCO it must be done correctly the first 2 tests?
If performed more than 2 times it can give a patient COHb poisoning
Transtracheal Oxygen catheters (TTO2) should be removed and cleaned when? How should it be performed?
If the patient complains of shortness of breath you should remove the catheter and clean it as there could be an obstruction (When removing you should put a nasal cannula on the patient to help oxygenate in the mean time)
When should you change an ET tube?
If the suction catheter can not be passed through it or a punctured cuff is present
The strain-gauge transducer should be at the same level as the tip of the catheter, if not what happens?
If too high = Reads ↓ If too low = Reads ↑
What does Infiltrate mean and what is shown on an Xray?
Ill defined radiodensity (Atelectasis)
How does a Illuminated stylet/light wand (Bonfils) work?
Illuminates path of airway
What is the purpose of Bronchial Hygiene Therapy?
Improve mobilization of secretions (Prevent accumulation of secretions)
What is the purpose of a Spacer/Holding Chamber?
Improves the efficacy of MDI by allowing larger particles to attach to the walls of the device and decrease oral deposition (less large particles left in the mouth)
In hypermetabolic patients the _____ can be up to _____% higher than extrapolated _____?
In hypermetabolic patients the TEE can be up to 40% higher than extrapolated REE?
Phosphatidylglycerol (PG), Phosphatidylcholine (PC), or Dipalmitoylphosphatidylcholine (DPPC) are all used to evaluate?
Indicator for lung maturity in infants and will increase as lungs mature (If present this is good)
When is Nasal CPAP mostly used?
Infants because they are obligatory nose breathers
What does Pleurisy mean?
Inflammation of the lining of the lungs
Laryngectomy tubes do NOT have what?
Inflatable cuff
How does Capnography work?
Infrared absorption
If a Manual resuscitation bag (Self-inflating) fills rapidly and collapses easily on minimal pressure, where should you check?
Inlet Valve
If bronchial breath sounds are heard over the periphery, this would indicate?
Lung consolidation = Pneumonia
Intra-Hospital transport vs Inter-Hospital Transport?
Intra-Hospital = In the hospital Inter-Hospital = Between Hospitals (For different levels of care/Different types of equipment at certain hospitals)
What is the major intracellular cation, extracellular cation, and Major extracellular anion?
Intracellular Cation = K+ Extracellular Cation = Na+ Extracellular Anion = Cl-
What does IPV stand for?
Intrapulmonary percussive ventilation
Frequency and I-time are _______ related?
Inversely
Frequency and volume are ________ related?
Inversely
Ischemia, Injury, and Infarction show?
Ischemia = ST Depression/T wave inversion Injury = ST elevation Infarction = Significant Q wave
How is quality control performed for a Body box?
Isothermal Lung model used with the following items: - Glass bottle - Rubber stopper - Mouthpiece connection - Rubber squeeze bulb
Why is it important to make sure we use humidity when either a patient complains of dry nose or over 4Lpm?
It can cause Epistaxis (Nose bleeds)
What is Lecithin/Sphingomyelin (L/S) ratio? Why is it important?
It indicates if an infant is at higher risk of developing Hyaline membrane disease (HMD) or Infant Respiratory Distress Syndrome (IRDS)
Fenestrated tubing means?
It is a hole in tube in case of obstruction
Why is a bronchogram the second choice and not first when comparing to CT scan?
It is dangerous because you are injecting a radiopaque contrast into the tracheobronchial tree, which could cause impairment of ventilation or allergic reaction
Why would a patient have a less effective cough with an ET tube in?
It is holding the glottis open (glottis needs to close and contract when we cough)
Why is Brain Natriuretic Peptide (BNP) important?
It is secreted by the cardiac muscle when heart failure develops or worsens
What is the advantages of using a Wick humidifier?
It support Water vapor content (44mg/L) at 100% body humidity Low risk of cross-contamination (nosocomial infections) because no particles are being produced
What is the advantage the Mini-BAL procedure has?
It utilizes a protected catheter to prevent specimen contamination
How will oxygen partial pressure be affected even if an aircraft has a pressurized or non-pressurized cabin?
It will decrease
Pulse oximeter has no affect on what patients/problems?
Jaundice, Anemia, Dark skin = No effect Blue, green, black nail polish = Poor signal
What must be used with a Nasopharyngeal Airway?
KY jelly or water soluble lubricant (To prevent Trauma to the mucosa)
What does LGA, SGA, and AGA mean?
LGA = Large for gestational Age SGA = Small for gestational Age AGA = Appropriate for gestational Age
If a baby is LGA vs SGA it shows?
LGA = Large for gestational Age (Diabetic mother) SGA = Small for gestational Age (Drug using mother)
Path of blood flow through the body and pressures?
LV = 120/0 mmHg Systemic Arteries = 120/80 (90) MAP Systemic Arterioles = 30 mmHg Systemic Capillary Bed = 20 mmHg Systemic Venules = 10 mmHg RA = 2-6 mmHg / 4-12 cmH20 = CVP/RAP RV = 25/0 mmHg Pulmonary Artery = 25/8 mmHg MPAP Pulmonary Capillary Bed = 4-12 mmHg PCWP Pulmonary Veins = 8 mmHg LA = 2-6 mmHg
What are the 4 chambers of the heart and what do they do for ciruclation?
LV = Systemic arteries RA = Systemic veins RV = Pulmonary Arteries LA = Pulmonary Veins
Forced Expiratory flow 200-1200 FEF shows?
Large airway obstructions - Tumors - Vocal cord paralysis
Coarse crackles (rhonchi that clear with a cough) show what?
Large airway secretions
For therapeutic lavage, what is the biggest difference?
Larger volume of saline used and aspirated
What is the most serious complication of Intubation with an ET tube?
Laryngospasm
When is High Frequency Oscillatory Ventilation (HFOV) chosen or used?
Last chance option
Scoliosis shows what?
Lateral "S" shape curvature of the spine (Lean side to side)
Good lung is always placed down unless?
Lateral Decubitus is performed
Normal QRS deflection comparing Lead I, II, III, AVR, AVL, AVF?
Lead I = + Lead II = + Lead III = + AVR = - AVL = + AVF = +
What are the limb leads for Lead I, Lead II, and Lead III?
Lead I: Right arm - Left Arm + Lead II: Right arm - Left leg + Lead III: Left arm - Left leg +
If there is ever a break in a graphic is always shows?
Leak (Need to bag the patient and fix)
If a capnograph measure 0 mmHg, what is the problem?
Leak or disconnect (CO2 in the atmosphere is 1% so the reading is 0 mmHg because it is such a low %)
Impervious also means?
Leak proof
How will a leak affect the circuit of a Mark 7?
Leak will prevent normal cycling into exhalation
Left vs Right shift for Oxyhemoglobin disassociation curve?
Left = Less O2 to the tissues Right = more O2 to the tissues
What affects the left and right shift of the Oxyhemoglobin disassociation curve?
Left: ↑ Affinity ↓ PaCO2 (↑ pH) ↓ Temperature ↓ 2-3 DPG
Oblique Xray is used to detect?
Lesions
Pulmonary Embolus can be caused by fat emboli from what?
Long bone trauma or injury
What should you do first when interpreting Xrays?
Look for the ET tube first
Anemia means?
Low Hemoglobin
What is the largest advantage of a Vibrating Mesh Nebulizer?
Low residual drug volume so patient may receive more of the drug compared to small volume nebulizer - Additional flow is not added to the patients airway or ventilator circuit
The lower graphic on a graphic loop vs the higher?
Lower = Low compliance Higher = Higher compliance
What device is used to collect a sputum specimen?
Lukens trap/sterile suction trap
What is the biggest disadvantage of Volume cycled ventilation?
Lung compliance or airway resistance worsen (PIP and PLP ↑) (May result in Barotrauma)
MIP/MEP devices are used to measure?
Maximum pressures (Readiness to wean in ventilator patients)
What is the limit variable?
Maximum value that a variable can reach during inspiration
If there is Low PaO2 during HFOV, how should you change the following: - Mean Airway Pressure
Mean Airway Pressure (PAW) = Increase
What does a Spirometer do?
Measure volume and flow rates
ABG measures what? What is Calculated?
Measured: - pH - PaCO2 - PaO2 Estimated: - HCO3
Gas Diffusing Capacity (DLCO, DCO) works how?
Measures all the factors that affect the diffusion of Carbon monoxide across the alveolar capillary membrane (Where gas exchange occurs)
What does a Pneumotachometer do?
Measures flow and converts to a volume
How does a Pneumotachometer measure?
Measures flow and converts to a volume (We mainly just use volume ones now)
What is the purpose of chest percussion?
Mechanically dislodge secretions
Jackson trach tube is made of?
Metal (Silver)
What drugs are used to treat MetHb Poisoning?
Methylene Blue Vitamin C (Ascorbic Acid)
What are the values for Mild, Moderate, and Severe for the Apnea Hypopnea Index (AHI)?
Mild = 5-15 Moderate = 16-30 Severe = > 30
How do you tell the difference between a mild/severe airway obstruction?
Mild = Can Vocalize Severe = Can Not Vocalize
If cuff pressure can not be measured, what technique can we use?
Minimal Leak Technique (MLT)
What is the minimum and maximum amount of time for Spontaneous Breathing trial (SBT)?
Minimum = 30 minutes Maximum = 2 Hours
What is the biggest advantage of Volume cycled ventilation?
Minute volume will remain constant to provide stable blood gases
What test is used to assess the collateral circulation in the hand prior to drawing a radial ABG?
Modified Allen's test
What do we give for analgesic problems?
Morphine (analgesic = Pain medications)
What is the most important factor when assessing prenatal history?
Mothers history: - Pregnancies before - Age - Smoking - Drug abuse
What is the most common complication of a Bronchoscopy?
Nasal Epistaxis
Silver is used because it is a?
Natural Anti microbial (Microbes have a hard time forming on it)
A Flow-Inflating Resuscitation (Anesthesia) bag is used on what type of patients?
Neonates
When should a stoma be close?
Never, it will either shut by itself or not (NEVER SUTURE A STOMA)
What is the biggest advantage to an MRI?
No radiation is used
What does Stertor sound like?
Noisy breathing during inhalation (Low pitched snoring type of sound arises from vibration of fluid)
What is a normal, acceptable, and unacceptable Respiratory rate?
Normal = 12-20 bpm Acceptable = 8-20 bpm Unacceptable = > 20 bpm or < 8 bpm
What is a normal, acceptable, and unacceptable MEP?
Normal = 160 cmH2O Acceptable = 40 cmH2O Unacceptable = < 40 cmH2O
What is a normal, acceptable, and unacceptable VD/VT (Deadspace)?
Normal = 20-40% Acceptable = ≤ 60% Unacceptable = > 60%
When using the PF ratio, what values define Normal, ALI, ARDS?
Normal = 380 ALI = < 300 ARDS = < 200
What is a normal, acceptable, and unacceptable Qs/QT (Shunting)?
Normal = 5% Acceptable = < 20% Unacceptable = > 20%
What is a normal, acceptable, and unacceptable Minute Ventilation (VE)?
Normal = 5-6 L/min Acceptable = < 10 L/min Unacceptable = > 10 L/min
What is a normal, acceptable, and unacceptable Spontaneous Tidal Volume (TV)?
Normal = 5-8 mL/kg Acceptable = ≥ 5 mL/kg Unacceptable = < 5 mL/kg
What is a normal, acceptable, and unacceptable Cst (mL/cmH2O) (Static Compliance)?
Normal = 60-100 mL/cmH2O Acceptable = > 25 mL/cmH2O Unacceptable = < 25 mL/cmH2O
What is a normal, acceptable, and unacceptable MIP?
Normal = 80 cmH2O Acceptable = 20 cmH2O Unacceptable = < 20 cmH2O
What are the hypoxemia ranges for ABG interpretation?
Normal = 80-100 mmHg Mild Hypoxemia = 60-79 mmHg Moderate = 40-59 mmHg Severe = < 40 mmHg
What does Vesicular mean?
Normal breath sounds
When is Vibration performed?
On Exhalation ONLY
How does a Positive expiratory pressure (PEP) therapy work?
One way inspiratory valve and a one way expiratory flow resistor are used Expiratory flow resistor prevents end-expiratory pressures from falling to zero
Advantage of Nitric Oxide?
Only affects pulmonary Blood pressure and not systemic
When is a stylet used?
Only for Oral intubation
When are Magill Forceps used?
Only for nasal intubation
Before attaching a regulator, what should you do to the cylinder valve?
Open the cylinder valve slowly to discharge gas then close (This cracking of the tank valve prevents debris from entering the regulator)
Oral intubation vs Nasal intubation tube distance markings?
Oral intubation = 21-25 cm at patients lip ( ≤ 25 = Oral) Nasal intubation = 26-29 cm at patients nare
What is the equation for Pulmonary Vascular Resistance (PVR)?
PVR = MPAP - PCWP / CO x 80
Normally Capnography (PETCO2) is usually lower than arterial PCO2 by how much?
PaCO2 = 40 Torr PETCO2 = 35 Torr USually 5 less
If air bubbles are present in an ABG, how does it affect the following: - PaCO2 - PaO2 - pH
PaCO2 = ↓ toward 0 torr PaO2 = ↑ or ↓ toward 150 torr pH = Increases (PaCO2 decreases because 1% CO2 in atmosphere)
How can you evaluate normal values for a room air ABG?
PaO2 + PaCO2 = between 110-140 normal (To see if arterial or venous stick)
What is the PF ratio equation?
PaO2/FiO2
If the pre-ductal (right radial artery) PaO2 is 15 mmHg higher than the post-ductal (umbilical artery) PaO2 then this shows?
Patent Ductal Arteriosus suspected get an ECG
Fremitus shows?
Patient has secretions
What does Egophony mean?
Patient is instructed to say "E" but it sounds like "A" this indicates consolidation of the lung
How do you remove a chest tube?
Patient takes a deep breath and exhales while performing a Valsalva maneuver
When is an Ultrasonic Nebulizer recommended?
Patients with Thick Tenacious Secretions
When would you use a Insufflation/Exsufflation device?
Patients with neurological problems or muscles weakness to force them to cough
What are normal Mean Airway Pressures for the following: - Patients with normal compliance and resistance - Patients with Obstructive Disease - Patients with ARDS
Patients with normal compliance and resistance = 5-10 cmH2O Patients with Obstructive Disease = 10-20 cmH2O Patients with ARDS = 15-30 cmH2O
What is the equation for Oxygen index?
Paw x FiO2/PaO2 x 100 Example: Mean airway pressure = 35 cmH20 FiO2 = 70% Goal PaO2 = 80 torr 35 x .70/80 x 100 = 0.31 x 100 = 31
What is the purpose of SaO2?
Percentage of hemoglobin that is bound by oxygen
What Xray sign is shown with Pulmonary Embolus?
Peripheral Wedge-shaped infiltrate
What are the 3 phases for Mechanical Ventilation?
Phase 1: - Recommend/initiate Mechanical Ventilation - Recommend/initiate initial ventilator settings Phase 2: - Monitor the patient receiving mechanical ventilation - Recommend/initiate changes to the ventilator settings - Identify and correct problems with patient/ventilator Phase 3: - Assess patient's readiness for weaning - Implement weaning procedures - Monitor the patient during weaning
Lateral Decubitus Xray is used to detect?
Pleural Effusion
What is the most common pleural disorder that requires a thoracentesis?
Pleural Effusion
Incentive Spirometry (ICS) is also known as what device?
Pneumotachometer
Wright respirometer is a form of a what device?
Pneumotachometer
Transillumination is used to see what in infants?
Pneumothorax
If Vascular Marking are decreased it shows?
Pnuemothorax
Dry non-productive cough can indicate?
Possible tumor in lungs
What is the most important Electrolyte to monitor?
Potassium (K+)
When Prone positioning a patient you should do this before and after due to transient oxygen desaturation and hemodynamic instability for a short time?
Pre and Post hyperoxygenation
What is the purpose of an Esophageal Tracheal Combitube?
Pre-hospital emergency airway management (If one port is blocked or you do not hear breath sounds, use the other port)
How will an obstruction/coughing affect a Mark 7?
Prematurely end inspiration (Because the extra pressure would cause it to hit the pressure limit early)
What is Splinting?
Press pillow over incised area to enhance better cough (Used for Post op patients mostly)
A water manometer or barometer is used to measure?
Pressure (Atmospheric)
What is the cycling variable used during IPPB?
Pressure Cycled
What does Apneustic mean?
Prolonged gasping inspiration followed by extremely short, insufficient expiration (Fish/Guppy breathing)
The following patient positions help with what problems/diseases: - Prone - Fowlers position - Lateral Fowlers - Good lung down
Prone = ARDS Fowlers = CHF Lateral Fowlers = Obese Good lung down = unilateral lung disease
What is the purpose of Troponin?
Protein found in myocardial cells and indicates damage to the heart muscle
When troubleshooting a ventilator, you should always do what first?
Provide manual ventilation then troubleshoot (Also start at the patient then go towards the machine)
Proximal vs Distal port on Pulmonary Artery Catheter?
Proximal = CVP Distal deflated = PAP Distal inflated = PCWP
Deadspace disease is also known as?
Pulmonary Embolism
Pulmonary Angiogram is used to test for?
Pulmonary Embolism
A normal ventilation with abnormal perfusion scan indicates?
Pulmonary Embolism (They are ventilating fine, but the blood flow is blocked by a clot)
What is the shunt equation?
Qs/Qt = (A-aDO2)(0.003) / C(a-v)O2 + (A-aDO2)(0.003)
Nitric Oxide is used as a?
Pulmonary Vasodilator
What does Paradoxical pulse/pulsus paradoxus mean?
Pulse/blood pressure varies with respiration > 10mmHg drop in systolic blood pressure during inspiration
What is another name for the Automated Medication Dispensing Systems?
Pyxis Medstation
Max inspiration followed by max exhalation without force is known as?
Slow Vital Capacity
Purpose of a Endobronchial Ultrasound (EBUS)?
Real time ultrasound guidance for transbronchial needle aspiration (Allows to examine mediastinal and hilar lymph nodes, avoiding surgical mediastinal exploration.)
Recommended diet for COPD patient?
Recommended Diet: ↑ Proteins ↑ Fats ↓ Carbohydrates
What does Erythema mean?
Redness of the skin
If a tracheostomy is obstructed what should you do first?
Remove the inner cannula
If pressure increased on the ventilator and there is an HME attached, what should we do?
Replace the HME as it can cause increased delivery pressure
What do each of these breath sounds mean: - Resonant - Flat - Dull - Tympanic - Hyperressonant
Resonant = Normal air filled lungs (Hollow sound) Flat = Fluid filled or bone Dull = Fluid filled Tympanic = Air filled stomach (Increased volumes) Hyperresonant = Extra air filled
What is another term for Respiratory Quotient?
Respiratory Exchange Ratio
Total daily energy expenditure (TEE) is equivalent to?
Resting energy expenditure (REE) in normal patients
Decreased Vital capacity is the best indicator for?
Restrictive lung disease
Kyphoscoliosis is a combination of Kyphosis and Scoliosis and shows what kind of lung pattern?
Restrictive pattern (Reduced lung volumes) ↓ Vital Capacity
What drug is used to treat RSV?
Ribavirin (Virazole)
Right cardiac border vs Left Cardiac Border?
Right Cardiac Border = 2 bulges - Superior Vena Cava - Right Atrium Left Cardiac Broder = 3 bulges - Aorta - Pulmonary Artery - Left Ventricle
Pacemakers are usually placed where?
Right Ventricle
Flow calibration is calibrated using a?
Rotameter
How long should Pneumotachometers be able to measure SVC, FVC, FEV1? (Flows)
SVC = 30 seconds FVC = 14 seconds FEV1 = 1 second
Systemic Vascular Resistance (SVR) and Pulmonary Vascular Resistance (PVR) represent what?
SVR = LV PVR = RV
What is the equation for Systemic Vascular Resistance (SVR) ?
SVR = MAP - CVP / CO x 80
What is another name for transudate fluid?
Serous fluid
Paradoixcal pulse/Pulsus paradoxus may indicate?
Severe air trapping
When using an ABG analyzer, which electrode represents which value: - Severinghaus - Clark - Sanz
Severinghaus electrode = PCO2 Clark electrode = PO2 Sanz electrode = pH
Esophageal Tracheal Combitube is only used for what?
Short term emergencies (Want to pull and put in Et tube ASAP)
What is the main purpose of the Laryngeal Mask Airway (LMA)?
Short term ventilation for face or nasal trauma
What should a post op patients goal be for hyperinflation?
Should be one-half of the pre-operative inspiratory capacity Example: Pre op = 2600 mL so post op should be = 1300 mL
What is the pace maker of the heart?
Sinoatrial Node (SA Node)
Venous stasis means?
Sitting for long periods of time (Causes Pulmonary Embolism)
What size Suction catheter is never picked according to the NBRC?
Size 14 french
By looking at the shape of a flow volume loop what can be determine by these: - Skinny - Concave - Egg shaped
Skinny = Restrictive Concave = Obstructive Egg shaped = Obstruction
Small box vs Large box on ECG?
Small = 0.04 seconds Large = 0.20 seconds
What device is used to deliver Ribavirin (Virazole) to treat RSV?
Small Particle Aerosol Generator (SPAG)
End Expiratory Xray is used to detect?
Small Pneumothoraxes on exhalation
If an MDI or DPI can not be used, what should the patient be switched to?
Small Volume Nebulizer
Forced Expiratory Flow 25%-75% FEF shows?
Small airway obstructions - Asthma - COPD
Oxygen cylinders are usually used for patient in the home care setting when?
Small amounts of oxygen used intermittently
How does a Guide channel work?
Small screen on handle allows visualization of Larynx, it also holds the ET tube
COHb is elevated in what type of patient and to what range usually?
Smokers = 2-12 COHb
Why do we bend a stylet on one end when using it for Oral intubation?
So it does not go further than the ET tube
How do many patients clean home equipment that is reusable?
Soak in white distilled vinegar (acetic acid) for 20 minutes
What does Consolidation mean and what is shown on an Xray?
Solid white area (Fluid or Solid) (Pneumonia/Pleural effusion)
What is a Laryngospasm?
Spasm of the Larynx (Vocal cords)
What device do we use to measure cuff pressures?
Sphygmomanometer
APRV must always be?
Spontaneous
How can you tell the difference for spontaneous, Assisted, and Mandatory breathes with a graphic loop?
Spontaneous = Oval shape on both sides of volume line Assisted = Jesus fish Mandatory = Oval shape all above 0 on pressure line
When a patient is breathing spontaneously vs on a Ventilator for a Chest tube system, when does the bubbling occur?
Spontaneously = Bubblers during exhalation Positive Pressure Ventilation = Bubbles during Inhalation (We breathe by negative pressure, so exhalation would be positive)
What does Diffuse mean and what is shown on an Xray?
Spread throughout (Pneumonia/Atelectasis)
What are the benefits/disadvantages of the following: Sputum Culture Sensitivity Gram Stain Acid Fast Stain
Sputum Culture: - 48-72 hours - Identifies Bacteria present Sensitivity: - 48-72 hours - Identifies what antibiotics kill bacteria Gram Stain: - 1 hour - Identifies whether + or - bacteria Acid fast: -Only identifies Tuberculosis
Stable Ventricular Tachycardia vs Unstable Ventricular tachycardia?
Stable = Pulse present Unstable = Pulseless (No pulse)
What are the 3 stages to checking skin integrity?
Stage 1 = Redness/warm to touch Stage 2 = Skin is broken Stage 3 = Crevice (Can go past the fatty tissue)
King LT is another type of what tube?
Supraglottic Airway (Want to pull ASAP and insert ET tube)
If WBC increase when a patient has a line in, what should you check for?
Suspected infection
Pulse pressure equation?
Systolic - Diastolic = Pulse Pressure
What are the normal ranges for Systolic and Diastolic?
Systolic = 90-140 mmHg Diastolic = 90-60 mmHg
If the jabber (Spike in the plastic spin on top) does not pierce or make a hole in the plastic, what can happen?
The pop off alarm would not sound properly (Clogged inlet)
What is the purpose of a Large Volume Nebulizer?
To deliver bland aerosol to the upper airway to reduce chances of edema or humidity deficit
What is the purpose of the Arterial-Venous Oxygen Content Difference (C(a-v)O2)?
To measure oxygen consumption of the tissues
What is the purpose of the Oxygen Index?
To measure the amount of ventilatory support required to support the level of oxygenation
What is the purpose of Vibration for patients?
To move secretions to larger airways
What is the Mini-BAL procedure used for?
To obtain a distal lung specimen for diagnosis of ventilator acquired pneumonia (VAP)
What is the purpose of a Continuous Aspiration of Subglottic Secretions (CASS) tube?
To prevent VAPS Continuous suction is provided via separate tube connected to a vacuum pressure of 20 mmHg
Purpose of the Sellick Maneuver/Cricoid Pressure?
To prevent aspiration with extra pressure or to move adams apple on males
What is the main purpose of the one way valve/personal sampling chambers on a wright respirometer?
To prevent cross infection when using on multiple patients
What is the purpose of Hyperinflation?
To prevent or treat atelectasis
What is the purpose of the Mallampati score and how is it measured?
To see if a patient will be difficult to intubate or not Measure from I-IV (The higher the number the harder the intubation)
What is MEP used for?
To see if patient has the ability to maintain an airway and clear secretions (Ability to cough effectively)
What is Exhaled Nitric Oxide (FeNO) testing used for?
To see if there is airway inflammation and whether or not a patient has been taking their anti-inflammatory corticosteroids (Asthmatics)
What is the purpose of a bronchoscopy?
To visualize the trachea and bronchi
What Nebulizer has the highest output range of all Nebulizer without heating?
Ultrasonic Nebulizer
Oropharyngeal airways should only be used on?
Unconscious patients
Disadvantage of tracheal button?
Uncuffed = can NOT use for resuscitation (Need to use ET tube)
Under exposed vs Over exposed CXray?
Under exposed = White out Over exposed = Black out (Black in over exposed because Xray penetrates matter, so there is too much penetration)
Unilateral vs Bilateral wheeze?
Unilateral = Indicates Aspiration/foreign body obstruction Bilateral = SABA needed
Hyperresonant can indicate unilateral or bilateral lung issues, what is shown with each?
Unilateral = Pneumothorax Bilateral = Emphysema
What does the V/Q mean in VQ scan?
V = Ventilation Q = Perfusion
Normal QRS deflection in precordial leads?
V1 = - V2 = - V3 = Isoelectric V4 = Isoelectric V5 = + V6 = +
What are the V-leads/Precordial Leads? What is the proper placement for V1-V6?
V1 = 4th ICS RSB V2 = 4th ICS LSB V3 = Between V2 and V4 V4 = 5th ICS MCL V5 = 5th ICS AAL V6 = 5th ICS MAL
What is the equation for the Respiratory Quotient (RQ)?
VCO2/VO2 Usually 200/250 = 0.8 CO2 vs O2 consumption
What is the formula for Deadspace to Tidal Volume Ratio?
VD/VT = PaCO2-PECO2/PaCO2 x 100
How is Minute Ventilation Calculated?
VE = TV x RR
How can the modified Fick equation be rearranged to find O2 consumption?
VO2 = CO x C(a-v)O2 x 10
Just a general rule of thumb for O2 given, at what % can you determine it is VQ vs shunt?
VQ = < 60% O2 Shunt = > 60% O2 (Oxygen needed)
How do we treat VQ mismatch vs Shunting?
VQ = Give O2 Shunting = PEEP
What is Tactile fremitus?
Vibrations that are felt by the hand on the chest wall
Warning vs Out of control situation when calibrating an ABG analyzer?
Warning: - One control exceeds the mean +/- 2 SD Out of control: - One control excess the mean +/- 3 SD - Two consecutive control observations exceed the mean +/- 2 SD - The differences between consecutive runs exceeds 4 SD (SD = Standard Deviation)
The Helium Analyzer uses what device inside of it?
Wheatstone bridge
What is the most common breath sounds heard from a bronchospasm?
Wheeze
When is Sputum induction used?
When a patient does not have a productive cough
When should a PICC line be used?
When an IV is expected to be in a patient for more than 2-3 days (IV is used for short term access)
When is Ethylene Oxide sterilization used?
When something can not be soaked in a liquid
What suction device is used to clear out the mouth and throat?
Yankauer
Capnograph should show what color if good or bad? What is the rule to remember it?
Yellow = Mellow Purple = Poor (ETT in esophogus)
If the heart rate increases less than 20 beats per minute, can you continue to wean?
Yes, but need to monitor and may increase the FiO2
What is the location called where a flow meter is inserted?
Zone Valve
What does Apnea mean?
absence of breathing
Cufflator is calibrated in?
cmH2O
What is Huff coughing?
coughing with an open glottis ( More effective in patients with COPD or head trauma to prevent increased intracranial Pressures (ICP))
Jaundice is caused by?
increased bilirubin levels in the blood and tissue (Usually alcoholics)
What is Ethylene Oxide used for?
sterilizes equipment by alkylation of enzymes