resp procedure

Question 1

_______ can decrease peripheral circulation and cause a falsely lowered O2 saturation

Answer 1

hypothermia

Question 2

fingernail polish cannot penetrate though it, what is the alternate site for O2 measurement?

Answer 2

ear lobe

Question 3

which CXR view is typically done?

Answer 3

PA and lateral studies

Question 4

which CXR view for bed bound patients?

Answer 4

AP view

Question 5

when to order CXR

Answer 5

1. suspecting disease of the lungs, mediastinum, heart, or chest wall
2. suspecting systemic disease and suspicion of chest involvement
3. monitor life-support devices to make sure it is inserted correctly
4. pneumoperitoneum (gase in abdominal cavity)

Question 6

on AP CXR view, which structure is falsely enlarged?

Answer 6

heart

Question 7

ABG is used to determine

Answer 7

1. pH of blood
2. PaO2
3. PaCO2
4. HCO3
5. O2 sat

Question 8

most common sites to do ABG

Answer 8

1. radial artery
2. brachial arter
3. femoral artery (used in ICU patients)

Question 9

indications for ABG

Answer 9

1. asses for hypoxia and severity
2. evaluation of acid-base disorders
3. assess need for home O2 use (chronic patients)
4. measure CO-Hb levels in patients suffering from smoke inhalation or other exposures
5. calculate arterial O2 saturation content
6. blood sample in difficult draw patients (obese)

Question 10

calculating arterial O2 saturation

Answer 10

ABG cannot differentiate between O2 and CO, so subtract O2 sat and CO-Hb to get actual O2 saturation

Question 11

relative contraindications to ABG

Answer 11

1. invasive procedure
2. coagulopathy
3. severe PAD with poor collaterals (Allen’s test)
4. trauma or infection at draw site
5. difficult to standarize d/t factors such as hyperventilation, breath holding, altitude, obesity

Question 12

what degree should bevel be when inserting syringe for ABG?

Answer 12

45 degrees

Question 13

equipments for ABG

Answer 13

1. sterile gloves
2. rolled towel to support wrist or elbow
3. ice for transport to lab to slow down blood metabolism
4. ABG kit

Question 14

ET/NT tube intubate indications

Answer 14

1. resp failure
2. airway protection
3. maintaince of airway
4. help facilitate pulm tx and meds
5. use pos pressure ventilation
6. maintain adequate oxygenation

Question 15

ET/NT tube intubation contraindications

Answer 15

1. operator unskilled
2. excessive trauma to face, neck, c-spine (relative)
3. inability to extend the head and neck (ET)

Question 16

risk when sedating conscious patients for ET intubation

Answer 16

1. rapid IV admin of sedative can cause sudden drop of BP

2. fast acting mm relaxant might cause arrhythmias and post-op myalgias

Question 17

blades used for ET intubation and location of insertion

Answer 17

1. curved blade - into the vallecula

2. straight blade - below epiglottis

Question 18

verification of ET tube placement

Answer 18

1. look for symmetrical rise of the chest wall
2. listen for equal breath sounds b/l and over the epigastrium
3. Do CXR to confirm placement is correct

Question 19

chest tubes indication

Answer 19

1. pneumothorax causing resp distress
2. hemothorax
3. large pleural effusions causing resp distress
4. empyema
5. post thoracotomy

Question 20

chest tubes contraindication

Answer 20

1. small pneumothorax not causing resp distress
2. pleura adherent to the chest wall
3. coagulopathy (relative)
4. previous chest tube in the same site

Question 21

patient position for doing chest tube

Answer 21

lateral decubitous position with affected side up

Question 22

where to place the chest tube and why

Answer 22

5th and 6th intercostal space in MAL because are below this will risk injury to diaphragm or liver

Question 23

appropriate size chest tube for pneumothorax and hemothorax

Answer 23

pneumothorax - 22-24 French straight

hemothorax - 32-36 French straight of right angled

Question 24

where to anesthetize for chest tube

Answer 24

top edge of rib to avoid neurovascular bundle

Question 25

where to direct the tube after chest tube insertion

Answer 25

pneumothorax - posteriorly and toward apex | fluid - posteriorly

Question 26

what do you place around the tube exit site for airtight seal after placing chest tube?

Answer 26

petroleum gauze

Question 27

how to confirm placement of chest tube

Answer 27

CXR

Question 28

indications for spirometry/PFT

Answer 28

1. screening 2. diagnostic 3. evaluate efficacy of tx 4. tracking the course of disease 5. disability determinations

Question 29

spirometry limitations and contraindications

Answer 29

1. results very patient dependent 2. severe debilitation and excessive tiring 3. severe or moderately severe respiratory distress 4. patient not motivated or desired to take the test 5. medications affecting the resp cycle or function of the chest mm

Question 30

V/Q scan indications

Answer 30

1. evaluate for presence of blood clots or other abnormalities in V and Q 2. evaluate COPD or pneumonia 3. detect PE

Question 31

V/Q scan contraindications

Answer 31

1. kidney failure | 2. allergy to radioactive materials

Question 32

V/Q scan risk

Answer 32

1. radiation exposure | 2. renal toxicity

Question 33

how do we use the results of PFT

Answer 33

1. good correlation between FEV1 and ADL/work status 2. FEV1 correlates better with exercise capacity than ABG 3. FEV1/FVC