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142 Cards in this Set
- Front
- Back
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Pack Years |
#packs/day x # of years smoked Ex: 4 packs a day × 10 years = 40 pack years |
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Nml Urine Output |
1 liter per day or 40 ml per/h |
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Nml CVP = ? |
2-6 mmhg Decreased CVP (<2 ) = hypovolemia (give fluids) Increased CVP (> 6) = hypervolemia (Diuretics) |
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Orthopnea |
Difficulty breathing when laying down except when sitting upright (CHF) |
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Nml RR |
12-20 bpm |
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Nml HR Tachycardia Bradycardia |
Nml 100-60 Tachycardia >100 Bradycardia < 60 |
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Tracheal Deviation: Pulled to abnormal side (toward pathology) |
Atelectasis Pulmonary fibrosis Pnemonectomy Diaphragm paralysis |
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Tracheal Deviation: Pushed towards nml side (away from pathology) |
Huge pleural effusion Tension pneumo Neck/thyroid tumor Large mediastinal mass |
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Stridor Marked/severe VS. Mild - Moderate |
Marked/severe = need an airway, intubate Mild - Moderate = they are ventilating |
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BS: Course Rhonchi/Rales Description/Cause: ? Treatment: ? |
secretions / fluid in the large airways treat by suctioning or coach to cough |
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BS: Medium Rales Description/Cause: ? Treatment: ? |
Middle airway Secretions treat with bronchial hygiene |
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BS: Fine Rales/ Crackles Description/Cause: ? Treatment: ? |
Alveoli fluid, pulmonary edema, atelectasis, CHF Treat with O2 Positive pressure therapy, + inotropic agents, diuretics |
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BS: Wheeze Description/Cause: ? Treatment: ? |
Caused by bronchospasm, musical tone Treat with bronchodilators |
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BS: Stridor Description/Cause: ? Treatment: ? |
Supraglottic (epiglotitis) Subglotic ( Croup) Swelling, and post extubation treatment depends on severity |
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BS: Pleural Friction Rub Description/Cause: ? Treatment: ? |
Inflamed surface of viceral and parietal pleura rubbing together.Caused by pleurisy, TB, PNE, Pulmonary infarction, Cancer, etc. Treat with steroids and antibiotics |
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Pco2 Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 40 Range = 35 - 45 Nml V = 46 |
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Po2
Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 97
Range = 80 -10p
Nml V = 40 |
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Ph
Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 7.40
Range = 7.35 - 7.45
Nml V = 7.35 |
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SO2
Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 98%
Range = 95 -100%
Nml V = 70 - 75% |
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Hco3
Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 24
Range = 22 - 26
Nml V = 24
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Hb
Normal Arterial = ? Range = ? Normal Venous = ? |
Nml = 14g
Range = 12 -16
Nml V = 14g |
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CaO2 Normal Arterial = ? Range = ? |
Nml = 20% Range = 17 -20% |
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CvO2 Normal Venous = ? Range = ? |
Nml V = 15% Range = 12-16% |
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Relating ABG values to life functions: PaCO2 : 35 - 45 |
Nml ventilation Don't change vent settings Don't put pt on a vent |
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Relating ABG values to life functions:PaCO2 : ABOVE 45 |
Pt is NOT ventilating Initiate ventilation or Remove/decrease mechanical deadspace or Increase current ventilation |
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Relating ABG values to life functions:PaCO2 : BELOW 35 |
Pt is ventilating but, too much Do not put on mechanical ventilation Decrease ventilation if pao2 is high Consider other causes of hyperventilation |
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Peak flow meter |
Green - 80% highest value Yellow - may need Meds Red - ER Nml for healthy adult is 10 L/sec or 600 L/min |
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Maximum Inspiratory Pressure (MIP) |
Measurements of < 20 indicate inspiratory muscle weakness |
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Classification of spirometry results: Nml PFT = ? Mild disorder = ? Moderate disorder = ? Severe = ? |
Nml PFT = 80 - 100% Mild disorder = 60 - 79% Moderate disorder = 59 - 40% Severe = <40% |
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Fev/fvc or FEVt % is ______? |
Best predictor odd obstructive disease Nml = 80 -85% <80% = obstuctive |
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Pre and post bronchodilator results in PFT |
Minimum increase of 12% and 200ml in the FEV1 post study is significant |
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Gas Diffusion capacity (DLco) |
Nml = 25 Decreased DLCO Pulmonary fibrosis Sarcoidosis Ards Pulmonary edema Emphysema (only obstructive) |
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Bronchoscopy Diagnostic indications |
Suspected foreign body Suspected malignancy Bronchial washings Hemoptysis Persistent problems |
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Bronchoscopy Therapeutic indications |
Foreign body obstruction Secretion removal Bronchial lovage Airway stenosis Atelectasis |
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Contraindications to Bronchoscopy |
Refractory hypoxemia Bleeding disorder Cardiovascular instability Status asthmaticus Marked hypercapnea |
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Hazards and complications of bronchoscopy |
Most common is mild epistaxis If serious bleeding occurs 1 epi 2 compress with scope 3 fogarty cath Bronchspasm/laryngospasm Hypoxemia Pneumo |
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When are ventilator circuits changed? |
Circuit is grossly contaminated Malfunctioning |
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Trouble shooting alarms: High pressure |
Always bag first Pt obstruction (ETT, Pneumo, Raw, secretions) Equipment obstruction |
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Trouble shooting alarms: Low pressure |
Bag pt first Pt disconnect Leak Not enough flow ETT leak |
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Indications for mechanical ventilation |
* Apnea * Acute ventilatory/ acute respiratory failure - not enough spontaneous ventilation to maintain PaCo2 and PaO2 * Impending ventilatory failure - trend of rising paco2 or decreasing Vt, VC, MIP * Oxygenation - reduce WOB (If fine paco2 can use cpap) |
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Bedside ventilatory parameters: Vital Capacity (VC) |
Nml 65 - 75 ml/kg (10 x Vt) Acceptable > 10 ml/kg (2 × vt) Unacceptable < 10 ml/kg (< 2 x vt) |
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Bedside ventilatory parameters: MIP/ NIF |
NML 80 cmh20 Acceptable 20 Unacceptable < 20 |
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Bedside ventilatory parameters: RR |
Nml 12 - 20 Acceptable 8 -20 Unacceptable >20 or <8 |
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Bedside ventilatory parameters: Spontaneous VT |
Nml 5 -8 ml/kg Acceptable greater than or equal to 5 Not acceptable < 5 |
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Bedside ventilatory parameters: Minute ventilation Ve |
Nml 5-6 l/min Acceptable < 10 Unacceptable > 10 |
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Physiologic assessment/calculations: Vd/Vt |
Nml 20 - 40% Acceptable <60% Unacceptable > 60% |
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Physiologic assessment/calculations: Cst (static compliance) |
Nml 60-100 ml/cmh20 Acceptable > 25 Unacceptable <25 |
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Initial Vent Settings |
VT: 5-10 ml/kg Pressure: plat from VC <35 RR: 10 - 20 FIO2: set same as prior. Or start 40- 60% Always choose lower option PEEP: 2 - 6 |
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Calculate IBW |
50 kg + (2 × inches over 5ft) |
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Initial setting for infant vent |
Vt: 4- 6 PIP: 20 - 30 RR: 20 - 30 FIO2: 40- 60% PEEP: 2- 4 |
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Calculate static compliance |
Vt/ plat - peep Nml 60 - 100 ml/cmH20 40 - 60 on a vent pt |
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Airway Resistance |
Nml is .6 - 2.4 |
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Problem with Raw |
Increasing PIP Plat constant Pip 30 - 35 - 40 Plat 20 - 20 - 20 |
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Problem with Cl |
PIP increases Plat increases Pip 30 - 35 - 40 Plat 20 - 25 - 30 |
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HFOV |
Improves oxtgenation in pts with severe lung injury like ARDS. Amplitude = 1st control of paco2 Frequency = 2nd control paco2 Mean airway pressure (Paw) = control of pao2 Used for Bronchial pleural Fistula Pulmonary interstitial emphysema Pneumo 1 HZ = 60 Frequency of 5 x 60 = 300 bpm |
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Correcting ABG: Want to normalize high Paco2 |
1. Remove mechanical deadspace 2. Increase Vt or pip 3. Increses rr |
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Correcting ABG: Normalize low paco2 |
1. Find cause 2. Lower RR 3. Lower Vt or PIP |
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Correcting ABG: Increase low pao2 |
FIRST increase FIO2 by 5 -10% (up to 60%) THEN increase PEEP by levels of 2-5 until 1. We good 2. Side effects happen |
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Assessment for Weaning: RSBI |
RR/ Vt Acceptable <100 |
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Assessment for Weaning: RR |
8 - 20 bpm |
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Assessment for Weaning: VC |
>10 ml/kg (2 x vt) |
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Assessment for Weaning: Ve |
<10 L/min |
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Assessment for Weaning: Spontaneous VT |
> 5 ml/kg |
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Assessment for Weaning: MIP |
-20 cmh20 |
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Assessment for Weaning: Clinical measurements |
A - a < 300 Shunt < 20% Vd/Vt < 60% Pulse and BP nml Verify underlying disease process is reversed |
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Wean of SIMV |
Acceptable to exudate on Rate of 4 +5 and 40% |
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Initial NPPV |
IPAP 8 -12 EPAP 4 - 6 |
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Hyperbaric Oxygen Therapy |
Increases po2 by increasing barometric pressure. Used to treat: 1. CO 2. Bends 3. Tissue transplants/grafts 4. Anaerobic infections (gangrene) Therapy is usually 2 - 3 ATA |
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Heliox |
80/20 = 1.8 70/30 = 1.6 Actual flow = flow x factor EX. 10 lpm using 80/20 10 x 1.8 = 18 lpm |
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Inhaled Nitric Oxide (INO) Indications |
Indications 1. Primary pulmonary HTN 2. refractory hypoxemia related to increased PAP 3. Increased PVR 4. Right heart failure/ cor pulmonale |
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Inhaled Nitric Oxide (INO) Dosage |
Standard dose 20 - 40 ppm Should not exceed 80 Doses < 20 can be used for Weaning (Usually 20 - 10 - 5 - done) |
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Inhaled Nitric Oxide (INO) Side effects |
1. MetHb increase 2. Nitrogen Dioxide (NO2) toxic to body at levels > 10ppm 3. Rebound pulmonary HTN from discontinuing INO too fast |
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Thoracentesis |
Inserted through 7th or 8th intercostal space just above rib at site of maximum dullness |
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Sleep Apnea: Apnea Hypopnea Index (AHI) |
Mild 5-15 Moderate 16 - 30 Severe > 30 |
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Chest tube placement |
Air: second intercostal space in the midclavicular line Fluid: 5th to 7th intercostal space in the mid axillary line |
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Troubleshooting Chest Tube |
1. If device breaks or disconnected a) pt breathing spontaneously submerge CT in glass of water b) on vent leave open till new system can be set up 2. Collection bottle full = replace 3. Blood and hypotension = call DR 4. Continuous bubbling in water seal a ) clamp chest tube b) if stops look for severe very pulmonary air leak check pt connection c) if continues replace CT system 5. If no bubbling in suction control increase suction |
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What is cardioversion? |
Therapeutic procedure that administers low voltage current to heart to convert dysrhythmia to NSR SYNCHRONISATION IS ON Sync to R wave |
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When do u cardiovert? |
Unstable a fib Unstable a flutter Stable very tach |
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What is Defibrillation? |
Like cardioversion but used on life threatening dysrhythmia Like Pulse less v tach V fib SYNCHRONISATION IS OFF |
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Blood pressure Nml = ? Range = ? |
Systolic / diastolic Nml = 120/80 Range = Systolic 90 190 Diastolic 60 90 |
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Good XRAY is...? |
Clavicle should be level. Hemidiahragms rounded withe the right slightly higher. Sharpe costophrenic angles. Trachea midline. Bilateral radiolucency. Well penetrated vertebrae just visible behind the heart spaces between vertebrae equal visible and distinct. |
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" CXR with black paranchemya and we'll visible vertebrae... Is this a good or bad CXR?" |
Bad it is overexposed/ over penetrated |
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Vascular markings in CXR |
They are blood vessels, lymph, and lung tissue Lack of vascular markings suggests possible Pneumo |
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Lateral CXR helpful in...? |
Seeing if pneumonia is in front or back of the lung |
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Oblique CXR is helpful in....? |
Localising lesions |
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Lateral Decubitus XRAY is when....? |
Pt lays on effected side, valuable for detecting pleural effusions. See if the fluid moves. If moves = effusions |
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End expiratory xray is useful for...? |
Diagnosing small pneumos |
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Proper position of the ETT |
1. Below the vocal cords 2. Approx 2-6 cm above the carina (2.5 cm = 1" ) 3. At level of aortic knob or aortic arch |
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Visual pulmonary artery catheters in xray |
Seen in right lower lung field |
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Croup (laryngotracheobronchitis) |
Viral infection Lateral xray of neck will reveal tracheal narrowing with subplot tickets swelling and Barking cough. Steeple sign Picket fence Pencil point Hourglass |
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Epiglottitis |
Bacterial - give antibiotics Lateral neck XRAY show supraglotic narrowing with enlarged / inflamed epiglottis Known as thumb sign |
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Xray: pulmonary edema Terms: ? Description: ? Treat: ? |
Terms: fluffy, infiltrates, butterfly/batwing pattern. Large areas of vessel engoregment Description: diffuse whiteness. Infiltrates in shape of butterfly Treat: diuretics. Digitalis. Digoxin |
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Xray: Atelectasis Terms: ?Description: ? Treat: ? |
Terms: Patchy/ plate-like infiltrates. Crowded pulmonary vessels. Air bronch grams Description: scattered densities. Thin layer densities Treat: lung expansion therapy SMI IPPB CPAP PEEP |
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Xray: ARDS/IRDSTerms: ?Description: ? Treat: ? |
Terms: ground glass. Honeycomb. Diffuse bilateral radiopacity Description: reticulogram Treat: O2. low Vt or pip. CPAP. PEEP |
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Xray: pleural effusions Terms: ?Description: ? Treat: ? |
Terms: no costophrenic angles Description: fluid on effected side possibly mediastinal shift Treat: thoracentesis. CT. Antibiotics. Steroids |
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Xray: pneumonia Terms: ?Description: ? Treat: ? |
Terms: air bronchgram Description: increased density from consolidation and atelectasis Treat: antibiotics |
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Xray: Pulmonary Embolism Terms: ?Description: ? Treat: ? |
Terms: peripheral wedge shaped infiltrate Description: may be normal Treat: heparin. Streptokinase |
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Xray: tuberculosis Terms: ?Description: ? Treat: ? |
Terms: cavity formation Description: often in Upper lobes Treat: antitubercular agents |
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Steps in diagnosing a PE |
CXR - wedge shaped pattern Spiral CT V/Q scan Pulmonary angiogram |
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Nml ICP Therapy to reduce ICP Drug? |
Nml = 5 - 10 mmhg Hyperventilation to reduce ICP paco2 of 25-35 Mannitol- pulls fluid out of tissues into the blood osmotic agent |
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RBC |
Nml 4 - 6 mill/mm3 |
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Hb |
Nml 12- 16 g/100ml |
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Hct |
Nml 40-50% |
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RBC x 3 = Hb HB X 3 = Hct |
RBC x 3 = HbHB X 3 = Hct |
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WBC |
Nml 5000 - 10000 per mm3 INCREASE = Bacterial infection DECREASE = Viral |
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What WBC is associated with asthma and allergic reactions? |
Eosinophils |
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Potassium (K) |
Nml = 4 Range = 3.5 - 4.5 |
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Hypokalemia does what to T waves? |
Flattened T waves |
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Hyperkalemia does what to T waves ? |
Spiked T waves |
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Sodium (Na) |
Nml 140 Range = 135 - 145 |
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Chloride (Cl) |
Nml = 90 Range = 80 - 100 |
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Bicarbonate (HCO3) |
Nml = 24 Range = 22 - 26 |
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Creatinine |
More specific to kidneys then BUN Nml = .7 - 1.3 Waste product of kidney that should be excreted if high sign of kidney failure |
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BUN |
Nml 8- 25 Waste product of kidney that should be excreted if high sign of kidney failure Increased BUN = KF |
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Platelet count |
Nml 150000 - 400000 |
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Activated partial Thromboplastin Time (APPT) |
Uses for monitoring heparin therapy Nml 24 - 32 secs |
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Prothrombin Time (PT) |
12 - 15 secs Monitor warfarin therapy |
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Troponin |
Protien found in myocardial cells Pts with MI have elevated troponin > 0.1 are high risk for death Give o2. Morphine. Asprin. Nitro |
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Brain Naturiuertic Peptide (BNP) |
Secret by cardiac muscle when in HF develops or worsens Nml = < 100 Increase = CHF |
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What is the name for the skin TB test? |
Mantoux |
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Pathway of signal in heart |
SA node AV node Bundle of his Right and left bundle branches Purkinje fibers |
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Ishemia Injury Infarction |
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Term infant |
38 - 42 weeks 40 weeks |
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Preterm infant |
<38 |
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Apgar |
Color Grimace Muscle tone Cry Pulse 0-2 score |
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Apgar of 7- 10 what do you do? |
Monitor is nml routine care |
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Apgar of 4 - 6 what do you do? |
Support Stimulate warm o2 |
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Apgar of 0 - 3 what do you do? |
Resuscitation |
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Translumination |
Recommended for possible Pneumo Nml is halo appearance |
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Capnography |
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Carbon monoxide poisoning |
Nml 0 - 1% COHB SMOKERS 2- 12% CO Poisoning >20% |
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Temp for transcutaneous monitor |
43 - 45 degrees c |
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PAP |
25/8 (14) |
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PCWP |
4 -12 Left side of heart = PCWP |
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CVP |
2-6 mm 4 - 12 cm Right = CVP |
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Right Ventricle |
25/0 |
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Mean Arterial pressure |
( 2x diastolic) + systolic/ 3 Nml 40 |
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Cardiac output |
Nml 4 -8 |
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Stroke volume |
Hr x stroke volume = Qt |
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Cardiac index |
Qt/BSA Nml 2.5 - 4 |
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Systemic vascular resistance SVR |
Map - CVP/ QT x80 Nml <20 or 1600 dynes |
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Pulmonary vascular resistance PVR |
MPAP- PCWP / QT X 80 NML = < 2.5 or 200 dynes |
