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Pre-clinical review > wards > Flashcards

wards Flashcards

1
Q

When to do home oxygen assessment

A

72 hrs prior to discharge

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2
Q

Funding for oxygen at rest

A

Pt rested for min 10 minutes on RA and shows ABG PaO2 < 55mmHg OR if they have CHF or pulm HTN + PaO2 < 60mmHg OR if palliative or cannot do ABG, shows SpO2 < 88% for 6 mins continuously

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3
Q

Funding for oxygen with ambulation

A

SpO2 < 88% for > 1 minute on RA during 6 minute walk test

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4
Q

Funding for nocturnal home O2

A

OSA must be absent or maximally treated, SpO2 < 88% for >30% of 4hr night sleep OR if CHF or pulm HTN, for >20% of night.

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5
Q

indications tracheostomy suctioning

A

(open in wards)

  • coarse br/s or decreased br/s
  • desat/compromised oxygenation
  • unable to clear secretions on their own with cough
  • seeing secretions at end of T-piece or trach tube
  • changing inner cannula
  • assessing patency of the tube
  • resp distress
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6
Q

complications of trach suctioning

A
  • bleeding/hemorrhage
  • vomiting
  • bronchospasm
  • infection
  • hyper or hypotension
  • resp arrest
  • increased ICP
  • hypoxemia
  • dysrhythmias/bradycardia
  • mechanical trauma
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7
Q

safety equipment for tracheostomies

A

(must be at bedside AND transport)

  • trach emergency equip bag: syringe, scissors, dilator, lube, 5 cuffed proximal XLT
  • spare inner cannula
  • obturator
  • resusc bag and mask
  • OPA
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8
Q

codes

A

Full: do everything
DNR-5: everything including intubation but no compression
DNR-4: everything but no intubation or compression
DNR-3: everything but no intubation, compression or BiPAP
DNR-1: palliative
**dont do ABGs on DNR-3s bc you can use other oxygenation parameters (e.g. venous samples)

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9
Q

PvO2

A

35-40mmHg

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10
Q

PvCO2

A

40-50mmHg

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11
Q

indications for deep suctioning

A
  • unable to clear secretions
  • less invasive methods do not work
  • retained secretions compromising Pt resp status (increased WOB & O2 requirements)
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12
Q

deep suctioning complications

A
  • mechanical trauma
  • mucosal hemorrhage
  • hyper/hypotension
  • bradycardia
  • resp distress
  • hypoxemia
  • atelectasis
  • infection
  • increased ICP
  • vomit/gag
  • dysrhythmia
  • laryngospasm
  • bronchospasm
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13
Q

deep suctioning contraindications

A
  • INR >1.3 or PTT < 50,000
  • epiglottitis, croup
  • bleeding around mouth/nares
  • laryngospasm
  • irritable airway
  • gastric surgery with high anastomosis
  • head/neck/facial injury (basal skull fracture, battle signs, raccoon eyes)
  • occluded nasal passages
  • loose teeth
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14
Q

heliox indications

A

low density gas, short term support to reduce airway resistance and WOB in Pts with airway narrowing secondary to inflammation, bronchoconstriction, or partial mechanical obstruction

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15
Q

what is the lowest helium mixture possible and why

A

below 50% helium, no benefit due to inadequate difference in density compared to conventional gas mixture

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16
Q

when should intubation/alternative therapy be considered for a Pt on Heliox

A

if they need NP > 6LPM

17
Q

determine flowrate to set on the oxygen flowmeter for heliox cylinder

A

80: 20 desired flow = 1.8 x (flowmeter reading)
70: 30 desired flow = 1.6 x flowmeter
60: 40 = 1.4 x flowmeter

18
Q

calculate tank duration using heliox

A

[(tank - safety (500 = E, 300 = H)) x conversion(3.14 H, 0.28 E)] / flow x heliox conversion

19
Q

compare procedure for heliox if SpO2 >92% vs. if SpO2 <92%

A

SpO2 > 92% = no supplemental O2 needed, attach NRB to heliox and flowrate of 8-10LPM, auscultate and note SpO2 pre-therapy.
SpO2 < 92% = use NP 1-6LPM to maintain sats and place NRB attached to heliox on top

20
Q

CSA vs. OSA

A 
CSA = central sleep apnea; apnea/no airflow for 10 seconds AND no effort; AHI >5
OSA = obstructive sleep apnea; apnea/reduced airflow for 10 seconds WITH resp effort; AHI<5 = mild, AHI >15 = moderate, AHI >30 = severe
21
Q

Level 1 vs. Level 3 sleep study

A

Level 1 = can tell if you are actually sleeping or are awake; additionally monitors chin movement/tension, leg movement, eye movement + what L3 monitors; best Dx for CSA and other complex SDB
Level 3 = monitors body position, effort, airflow, RR, SpO2, HR and helps distinguish between CSA and OSA

22
Q

OSA diagnosis

A

1)sleepiness/daytime fatigue OR 2 of: choking/gasping, impaired concentration, daytime fatigue, unrefreshing sleep, recurrent awakening
and
2) sleep study AHI>5

23
Q

MAP formula

A

(2xdiastolic + systolic) / 3

24
Q

ABMP normal asleep dip

A

BP should normally drop >15% when asleep; if not, could be hypertension

Pre-clinical review (19 decks)

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