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33 Cards in this Set

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ABG ?
Arterial Blood Gas
Is the patient in respiratory failure, and will they need intubation/mechanical ventilation?
?
TEST QUESTION

Clinical signs of Respiratory Failure
Tachypnea
Bradypnea
*Accessory Muscle use*
Poor Tidal Volume
TEST QUESTION

Tachypnea defined
Respiratory rate 30 or more per minute
TEST QUESTION

Bradypnea defined
Respiratory rate below 8 per minute
pO2 + Hgb(SaO2) = ?
Oxygen carrying capacity
Cyanosis correlates with pO2 < __?
50
pulse oximetry measures what?
% hemoglobin oxygen saturation
How do you measure pO2?
arterial blood analysis
Things that complicate pulse ox readings
fingernail polish

poor perfusion of the finger

long fingernail
Arterial blood gas gives what values
pH
pCO2
pO2
HCO3
O2 sat
Acidosis defined
pH < 7.35
Alkalosis defined:
pH > 7.45
normal pCO2
40
normal pO2
80 - 100
normal HCO3
24
what Blood gas value is under respiratory control and changes fast
pCO2
What Blood gas value is under metabolic (kidney) control and changes slowly
HCO3
What blood gas value is "the acid"
pCO2
What blood gas value is "the base"
HCO3
TEST QUESTION

ABG progression in Asthma
1) Hypoxia
2) Hyperventilation leads to hypocapnea
3) pH drops to normal
4) pCO2 raises due to FATIGUE
5) pH becomes acidotic
Why does pH return to normal after respiratory alkalosis?
metabolic acidosis develops

(anerobic metabolism leads to lactic acid)
What are ABG values in step 2: hyperventilation?
pH hi,
pCO2 low,
pO2 low,
HCO3 nl,
O2 sat low
What are ABG values during the pH back-to-normal (bad) phase?
pH nl,
pCO2 low,
pO2 low,
HCO3 low,
O2 sat low
What are ABG values during the fatigue phase?
low pH,
Normal pCO2,
Low pO2
HCO3 low,
O2 sat low
TEST QUESTION

Indications to Intubate
Fatigue – Tachypnea, Accessory muscles

Inability to protect airway
Assessment: Loss of gag reflex

“50/50 Club” on ABG
TEST QUESTION

“50/50 Club” on ABG

(3 things)
Acidotic pH (<7.35)
pCO2 greater than 50
pO2 less than 50
Endotracheal (E.T.) tube size for Adult:
8
Why apply Cricoid pressure during intubation?
Allows for easier passage of E.T. tube through vocal cords
Closes off esophagus, reducing chance of vomiting and aspiration
TEST QUESTION

2 narcotics that suppress respiratory drive
Morphine
Meperidine (Demerol)
TEST QUESTION

Narcotics Reversal agent:
Naloxolone (Narcan)
0.4mg or 1 mg I.V.

"it only does good"
Non-asthma causes of wheezing
1) Pulmonary edema as in Congestive Heart Failure (CHF): Cardiac Asthma
2) Airway obstruction
Foreign body
Epiglotitis
Anyphylaxis
Obstructive sleep apnea (snoring)
Why would Not all Asthmatics Wheeze
Tidal volume is so low, cannot generate enough air flow to produce a wheeze
“Too tight”
Wheezing begins after treatment, a good sign