Not ventilating You use to correct it - Ippb - mechanical ventilation - manual resuscitation (bag) - bipap - mouth to mouth - pressure support ventilation (PSV)

Patient Data Flashcards by Chris Lewis

(7.35-7.45)

Important to diagnose diabetes and may be a indication for sodium administration

Determine CO2 retainer (COPD) if pH is normal when PaCO2 is high = COPD

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PaCO2^45 (35-45)

Not ventilating

You use to correct it

Ippb
mechanical ventilation
manual resuscitation (bag)
bipap
mouth to mouth
pressure support ventilation (PSV)

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Below PaO2< 80. (80-100)

Means the patient is not oxygenating

Intervention is needed

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Low HCO3 (22-26)

Clear indication for sodium bicarbonate administration

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Hb (12-16)

Difference between low Hb and high Hb

If Hb is low the patient is hypoxic regardless of PaO2 and SaO2 so give blood

High Hb above 16 is called polycythemia found in COPD pt’s

Hemorrhaging is a indication of blood loss and indicates supplemental blood should be given!

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VD/VT (20-40%)

Acceptable up to 60% if on a ventilator

The only calculation that relates to ventilation

Represents the percentage of the tidal volume that is unavailable for gas exchange

VD/VT=(PaCo2- PECo2)/ PaCo2 x100

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High dead space VD/VT

Relates to pulmonary embolus

PaC02 value comes from blood gas

PECO2 comes from end-tidal CO2 monitor (infrared device or capnography) or the Douglas bag

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Tube position

Tube position should always be

2cm - 1 inch above the carina or at the aortic knob/notch

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Instillation of medication

Navel

 Narcan.-          Narcotic overdose 
Atropine-         Bradycardia 
Valium/versed- Sedative 
Epinephrine-     Asystole
Lidocaine-         PVC

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Sinus Arrhythmia

Sinus rhythm with irregular rate

Treatment- treat any other symptoms

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Sinus tachycardia

Sinus rhythm with a rate above 100

Treatment- give oxygen

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Sinus bradycardia

Sinus rhythm with a rate below 60

Treatment- oxygen, atropine

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PVC

Premature ventricular contractions

Treatment- oxygen lidocaine

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MPVC

Multifocal premature ventricular contractions

Treatment- oxygen, lidocaine

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V-tach

Ventricular tachycardia rhythm with a rate above 100

Treatment- defibrillate (if no pulse), lidocaine & (cardiovert if pulse is present)

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V-fib

Ventricular fibrillation is a completely irregular ventricular rhythm

Treatment- defibrillate

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Asystole

Treatment-Confirm in 2 leads first, epinephrine, atropine, CPR

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1st degree heart AV block

PR interval above .20 (measured from the beginning of P wave to the beginning of the QRS

Maybe due to ischemia or digitalis

Treatment-atropine

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2nd degree AV block

Irregular rhythm normal P waves but the QRS complex is missing

Treatment- atropine, electrical pacemaker

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3rd degree AV block

Atrial rate above 60…. ventricular rate below 40/minute
PR interval cannot be determined; QRS complex will be widened

Treatment- electrical pacemaker

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Ischemia

Reduced blood flow to tissue

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Inverted T waves

Can also be caused by digitalis toxicity and hypokalemia

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Injury indication

Injury is indicated by an elevated S-T segment

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Infarction diagnosis

Infarction diagnosed by significant Q waves

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Hyperkalemia

Will cause elevated or spike T waves

Secretions in lower lobes part of the lunges

put pt head down Secretions in higher

Indications: Coughing helps us get the gunk up and out

``` Impaired mucociliary transport Excessive pulmonary secretions *(pts who have Chronic Bronchitis & Cystic Fibrosis) Ineffective cough Absent cough ```

CaO2

(17-20%) Oxygen molecules in the atrial blood Can be reduced by low Hb anemia or CO CaO2 has the best relationship to tissues oxygenation CaO2=(Hb x 1.34)

CvO2

(14-16%) Oxygen retuning to the right side of the heart Best place to obtain mixed venous blood is from the pulmonary artery Decreasing values relate to decreasing cardiac output Mixed venous oxygen content CvO2=Hb

C(a-v)O2 | Arterial-venous oxygen content difference from

(4-5 vol%) C(a-v)O2= CaO2 - CvO2 Value increases as C.O decrease. (Inverse relationship) CvO2 is dropping, cardiac output is decreasing. If the SVO2 or PVO2 is dropping while the arterial counterparts (SaO2 & PaO2) remain steady reduction of cardiac output can be assumed Measure the oxygen consumption of the tissue

PAO2 | Alveolar oxygen tension

PAO2=((PB-PH2O)FIO2)- PaCO2/0.8 The alveolar air equation is the method for calculating partial pressure of alveolar gas (PAO2). The equation is used in assessing if the lungs are properly transferring oxygen into the blood. Shortcut: PAO2=(O2%x7)-(PaCO2+10)

A-a Gradient

A-aDO2= PAO2- PaO2 (25-65 mm Hg) Above 65 but less than 300 mm Hg= V/Q mismatch Above 300 mm Hg= shunt (venous admixture) Get value on 100% FIO2 Hypoxemia - cause interpretation

P/F Ratio

(PaO2/FIO2) Normal is 380 or greater 300 or less signifies Acute lung Injury (ALI) 200 or less signifies Acute Respiratory Distress Syndrome (ARDS)

Oxygen Index (OI)

(Mean airway pressure x %oxygen) / PaO2

Fluffy infiltrates

Pulmonary edema

Tracheal shift from midline

Pneumothorax, hemothorax, significant atelectasis

Obliterated costophrenic angles

Pleural effusion

Flattened diaphragm

COPD, significant air trapping

Wedge shaped infiltrates

Pulmonary embolism

Butterfly or bat wing

Pulmonary edema

Plate like or patchy infiltrates

ARDS, or atelectasis

Scattered patchy infiltrates

ARDS

Ground glass or honeycomb pattern

ARDS or IRDS

Reticulogranular or granular pattern

ARDS or IRDS

Concave superior border or interface

Pleural effusion

Consolidation or haziness

Pneumonia

Sudden onset of shortness of breath

Pulmonary embolus

Steeple sign lateral neck x-ray

Croup (laryngotracheobronchitis)

Tachycardia

Hypoxemia

(Thumb sign) lateral neck x-ray

Acute epiglottitis

Flat to percussion

Atelectasis

Cold clammy skin

Myocardial infarction

Fine rales

CHF & pulmonary edema Diurese the patient, cardiac medications, positive pressure ventilation

Venous distension

CHF

Decreased flows FEV1/FVC% FEV1, FEF25-75 FEF 200-1200

Obstructive pulmonary disorder

Pt | Prothrombin time

Warfarin (Coumadin) Therapy Heparin therapy

3 layer Sputum

Bronchiectasis

Retraction

Infant respiratory distress

PTT | Partial Thromblastin time

Heparin therapy

Sudden onset tachypnea

Pneumothorax

Hyperresonant to percussion

Pneumothorax

Medium rales

Secretions in mid-size airways Any therapy to mobilize secretions (IPPB, SMI, PEP, CPT)

Chest movement without nasal flow

Obstructive sleep apnea

Double lumen endotracheal tube

Independent lung ventilation After lung surgery, transplant, or with lung cancer

Hypernatremia

Dehydration

Angry, irritable combative

Electrolyte imbalance

Pitting edema

cHF

Hyperlucency

Excess pulmonary air COPD, Asthma, Pneumothorax

Dull to percussion

Fluid filled Pneumonia or pleural effusion

Pulses paradoxus

Severe air trapping As seen in status asthmaticus

Consolidation | Chest x ray

Heavy collection of infiltrates

Ashen or pallor

Anemia or acute blood loss

Diaphoresis

Heart failure

Opaque | Chest x ray

Fluid filled lungs

No chest movement without nasal flow

Central sleep apnea

Pleural friction rub

Tuberculosis, lung cancer, | Pulmonary infarction

General malaise

Electrolyte imbalance

Pronounced Q waves

Previous myocardial infarction | With tissue death

Struporous confused

Drug overdose

Weakness in legs | Lower extremities

Gullain Barre | Syndrome

Bronchogram

Bronchiectasis

Minimum spontaneous tidal volume (to sustain life)

5 mL/kg

Minimum vital capacity (to sustain life)

10 mL/kg

Unilateral wheezing

Lung mass or foreign body in lungs

Elevated eosinophil count

Asthma

Reticulgranular pattern on x ray

ARDS, IRDS

Lethargic sleepy, somnolent

CO2 overdose

Marked or severe

Emergent condition

Flattened t waves

Hypokalemia

Vascular markings

Increased with CHF absent with pneumonia

Spiked t waves

Hyperkalemia

H cylinder tank factory

3.14

Drooping eyelids double vision dysphagia

Myasthenia gravis

Purulent sputum

Chronic bronchitis

Tree in winter pattern chest x ray

Bronchiectasis

Paradoxical chest movement

Fail chest | Ribs broken in multiple places

Kussmaul's breathing

Metabolic acidosis, diabetes, renal failure

Mucoid sputum

Chronic bronchitis

E cylinder tank factor

0.28

Radiolucent

Normal lungs

Rhonchi (course rales)

Mucus in large airways | Suctioning, cough coaching and anything to mobilize secretions

Night sweets

Tuberculosis

Spag unit | Small particle aerosol generator

Deliver Ribavirin for RSV

5 obstructive diseases

``` Chronic bronchitis Emphysema Bronchiectasis Asthma cystic fibrosis ```

Minimum MIP (to sustain breathing)

20 cmH2O

Myasthenia gravis

Descending (mind to ground) Positive tensilon test Monitor VC/MIP (serial testing) Drugs: neostigmine, pyridostigmine Intubation/ mech vent- short term

Gullain barre syndrome

Ascending (ground to the brain) Spinal tap- protein in spinal fluid Monitor VC/MIP Drugs: steroids, prophylactic, antibiotics Mech vent/ trach- long term Plasmapheresis

Patient Data Flashcards

(107 cards)