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65 Cards in this Set
- Front
- Back
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Hypercapnia
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Too much CO2 in the blood
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Coagulopathy
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Condition in which the bloods ability to clot is impaired
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Atropine
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a naturally occuring tropane alkaloid extracted from Datura, Jimson Weed and deadly nightshade
In general, atropine counters the "rest and digest" activity of all muscles and glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system). Atropine dilates the pupils, increases heart rate, and reduces salivation and other secretions. |
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Bronchoscopy
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term used to describe the insertion of a visualization instrument (endoscope) into the bronchi.
The purpose: inspect airway remove objects collect samples |
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Types of Bronchoscopes
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rigid - Removal of foreign body from large airway
Fiberoptic |
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Bronchoscopes - Indications
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Diagnostic biopsy
Obtain lower airway samples Investigate hemoptysis, unexplained cough, wheeze or stridor Assess inhalation /aspiration injury/upper airway Suction secretions & mucus plugs- mucolytic - Acetylcysteine & bronchodilator normal saline - Difficult intubations Retrieve foreign body |
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absorption atelectasis
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If a large volume of nitrogen in the lungs is replaced with oxygen, the oxygen may subsequently be absorbed into the blood, reducing the volume of the alveoli, resulting in a form of alveolar collapse known as absorption atelectasis
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Bronchoscopes - Contraindications
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Absolute
No consent No experienced bronchoscopist No adequate facilities Code cart Personnel Oxygen / equipment Hold: If Risk > Benefit Uncorrected coagulopathy Severe obstructive disease Refractory hypoxemia Unstable hemodynamics (HR, BP) |
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Bronchoscopes - Relative Contraindications
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Uncooperative patient
RTs prepare the patient Moderate/Severe hypoxemia Hypercapnia (too much CO2) Lung abscess Recent MI (<6 wks) |
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BAL Indications
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Diagnose Ventilator Associated Pneumonia (VAP)
Nonresolving pneumonia Unexplained lung infiltrates |
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Patient monitoring
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During procedure
Continuous oxygen - Before/after procedure Vital signs Cardiac monitor pulse oximeter Automatic regular BP readings Respiratory rate / depth |
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Lidocaine
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a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.
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Bronchoscopy Complications
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Hemoptysis: Can lead to hemorrhage/death
Vasoconstrictors: stop/prevent bleeding Epinephrine solution Racemic epinephrine (NBRC only - not real world) ****** Hypercapnia Hypoxemia Cardiac arrhythmias - Atropine for bradycardia Pneumothorax - From biopsy Laryngospasm/mucosal edema - Racemic Epinephrine Bronchospasm - Bronchodilator available |
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Bronchoalveolar Lavage: BAL
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Scope wedged into bronchus. RT instills 40-60 ml aliquots NS into port. NS sample suctioned into collection jar
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Brochoscopy - High Level Disinfection
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#1: Leak test scope
#2 Enzymatic cleaning process: 5 min. removes blood, mucus, etc #3 20 min minimum: high level disinfection Cold process (glutaraldehyde) Kills micro-organisms Sterilization not needed (which kills spores) (3 hours to sterilize) Optional automatic endoscope reprocessor Rinse & dry |
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Cardioversion
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a medical procedure by which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs.
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defibrillation
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a common treatment for life-threatening cardiac dysrhythmias, ventricular fibrillation, and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. This depolarizes a critical mass of the heart muscle, terminates the dysrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart. Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed.
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ectopic beat
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Ectopic beat (or cardiac ectopy) is a disturbance of the cardiac rhythm frequently related to the electrical conduction system of the heart, in which beats arise from fiber or group of fibers outside the region in the heart muscle ordinarily responsible for impulse formation, i.e., the Sinoatrial node
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Bigeminy
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every other beat
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Couplet
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2 PVCs together
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Electrocardiograms - Definition
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Graphic tracing of heart's electrical activity
Does not show mechanical activity Evaluation tool Inexpensive, noninvasive Sometimes performed by RTs |
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Automaticity
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Cardiac cells' ability to depolarize without nerve stimulation
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Ectopic
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Rhythm originates outside SA node
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P Wave
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Atrial depolarize
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QRS Complex
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Depolarization over the ventricles
Normal - maximum 3 mm wide (.12 seconds: narrow) |
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T Wave
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Repolarization of the ventricles
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ST Segment
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Elevated in MI or depressed in myocardial ischemia
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EKG paper:
Each square is |
1mm = .04 seconds
Darker lines divide paper every 5gh square = .20 seconds Short outer vertical lines designate 3 sec intervals - Help calculate HR |
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12 Lead EKG
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12 Lead switches thru 12 different views
Different angles of the electrical conduction Acute usage: Not for long-term ECG monitoring Include: standard Limb Leads precordial Leads: Horizontal views - helpful for diagnosing MI |
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Normal Sinus Rhythm
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HR 60 - 100 BPM
Regular rhythm P wave before each QRS P Waves identical QRS identical = < .12 sec Narrow |
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Sinus Bradycardia
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HR < 60 BPM
Same as Normal Sinus Rhythm, but too slow Acute tx? Atropine |
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Premature Atrial Contractions
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HR, Rhythm usually regular, except for PAC
Premature P wave different shape & size |
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Sinus Tachycardia
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HR > 100 BPM
Differentiate if > 160 P wave before each QRS QRS identical Narrow: =.12 sec |
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Supraventricular Tachycardia
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Paroxysmal SVT (PSVT): Sudden Onset
Atrial ectopic focus overrides SA node - paces heart Can resemble Sinus Tachycardia - differentiate by HR Sinus Tach max at 160 BPM PSVT can go to 250 BPM So fast that P waves often hidden in previous T waves |
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Atrial Flutter
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Saw tooth pattern between QRS
Atrial rate 250-350 BPM AV node blocks impulses |
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Atrial Fibrillation
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Multiple ectopic blitzes from atria hit AV node
Some impulses allowed through to ventricles Rhythm irregular No P waves Can form blood clots in the atrium |
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Premature Ventricular Contractions
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Basic rhythm starts in atrium
Ectopic conduction starts in ventricles occurs early Ectopic QRS is >0.12 Usually followed by compensatory pause |
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Conscious sedation
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Versed - midazolam
Valium - diazapam Narcan - Noloxone - reversal |
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EKG Artifact
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patient movement
bad ground Bad leads Bad placement bad equipment |
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3 main components of Pulmonary Function Testing
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measure lung volumes & capacities
measure airway mechanics Think "flows" - airspeed Measure diffusing capacity (DlCO) - Diffusion in the lung of Carbon Dioxide |
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Contraindications for PFT
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Absolute: MI withi 1 month prior
Relative: negatively affects results Chest/abdominal pain Oral/facial pain Stress incontinence Confused states |
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Spirometry
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Direct measurement of volume (L) & speed (L/sec) of air
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How do we measure indirect volumes / capacities?
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Helium dilution
Nitrogen washout body plethysmography |
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Nitrogen Wash-out:
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Open Circuit (NBRC) ***************
Patient breathes 100% O2 Exhales Nitrogen N2 level: 79%; decreases with each breath Tracing / % trends down Sudden increase = system leak results = falsely increased FRC To 1.5% / 7 min. Maximum ******* (NBRC) |
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Body Plethysmography
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(aka body box)
Calculations based on boyle's law: volume inverse to pressure Most accurate: measures total gas in thorax (trapped air) |
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Helium dilution
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Closed circuit test (NBRC) ********
Calibrating the analyzer to room air - should be zero (no helium in lungs) about 20 minutes for COPD patients ***** |
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Tidal Volume
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Vt
Volume of air inhaled or exhaled during a normal breath Practice it: Just rest - breath in, breathe out |
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Inspiratory Reserve Volume
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IRV
Maximum amount of air that can be inhaled after a normal inspiration practice it: Inhale your normal Vt. Now take a breath all the way in - that was your IRV |
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Expiratory Reserve Volume
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ERV
Volume of air exhaled after a normal expiration practice it: Exhale your normal Vt. Now push out all the air you can - that was your ERV |
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Residual Volume
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RV
Volume of air left in the lungs after a maximal expiration. Cannot be measured directly Practice it: Exhale all your air. There is some air that still remains in the lung. That is the RV - You cannot exhale it. |
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Inspiratory Capacity
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Vt + IRV
Maximum amount of air that can be inhaled after a normal expiration Practice it: Exhale your normal Vt. Now inhale as much air as possible - you just inhaled your IC When teaching patients to use an incentive Spirometer they use this breathing pattern |
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Vital Capacity
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Vt + IRV + ERV
Amount of air that can be exhaled following a maximum inspiration Practice it: Breath in as deeply as possible, now exhale all your air - that is your VC |
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FVC
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Forced Vital Capacity
*** Most commonly performed maneuver Used to measure FEVs & flows ***** The amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible. Patient coaching is important! 1st 20-30% effort dependent Next 70-80% effort independent Practice it: Take a deep breath all the way in, then blast out all your air as hard & fast as possible...Keep blowing hard until all the air is out of your lungs. |
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TLC
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Total Lung Capacity
RV + VC or FRC + IC Amount of air in the lungs at the end of a maximal inhalation |
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Functional Residual Capacity
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ERV + RV
Amount of air left in the lung after a normal exhalation Practice it: Exhale your normal Tidal Volume. The amount of air now left in your lungs is the FRC |
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Peak Flow
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During full PFT - measured in liters per second
With peak flow meter Measured in liters per minute Fast assessment Asthma monitoring Normal value 400 to 600 L/min |
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Forced Vital Capacity
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FVC *** most common test *** Used to measure FEVs & flows
Patient coaching is important! 1st 20-30% effort dependent Next 70-80% effort independent Practice it: Take a deep breath all the way in, then blast out all your air as hard & fast as possible...Keep blowing hard until all the air is out of your lungs. |
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Forced Expiratory Volume
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During FVC maneuver
Volume of air exhaled in a specific time measured in liters FEV1 - 1st second of FVC FEV1/FVC ratio compares FEV1 to FVC At least 70% of FVC should exhale in the 1st second FEV1/FVC ratio < 70% = increased airway resistance = obstructive problem |
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Forced Expiratory Flow 25% - 75%
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FEF 25% - 75%
Average flow rate (L/sec.) during middle half of FVC Assess small airways |
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FEV1
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the maximal amount of air you can forcefully exhale in one second.
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FEF200-1200
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Forced Expiratory Flow 200-1200
Average flow rate between 200 ml & 1200 ml of FVC Reflects large airways |
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DLCO
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Diffusing capacity of lung:
single breath method Pt inhales gas mixture: 0.3% CO, 10% helium, + medical air Holds it 10 sec; then full exhale CO diffuses across a-c membrane Affinity for HB: 250-300 x O2 Exhalation analyzed for CO not returned Normal = 25-30 mL/min/mm Hg (**** NBRC normals*****) decreases with obstructive & restrictive disease |
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Maximum Voluntary Ventilation
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MVV
Largest volume of air that can be voluntarily breathed in & out in 1 min Tested for 10, 12 or 15 seconds Reflects ventilatory reserve |
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Bronchial Challenge
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Airway reactivity to methacholine
Physician present Bronchodilators & resuscitation equipment available Procedure: FEV1 tested Sequential methacholine aerosols given If FEV1 decreases by 20% or more from baseline, test terminated Object: find methacholine dosage decrease FEV1 by 20% Methacholine stimulates the parasympathetic system in the lungs. Causes bronchoconstriction. |
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Maximum voluntary ventilation (MVV)
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This measures the greatest amount of air you can breathe in and out during one minute.
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