RESPIRATORY

Question 1

Best objective measurement for asthma

Answer 1

Peak flow

Question 2

Chronic, reversible, triggers, children can have apenic periods/decreased HR

Answer 2

Asthma

Question 3

What is the problem with asthma? What phase is prolonged? When does wheezing occur?

Answer 3

Problem with air getting out due to vasoconstriction. Expiratory phase is prolonged. Wheezing initially on exhalation and then worsens to inhalation.

Question 4

What is a big risk for patients with bronchiolitis?

Answer 4

Dehydration due to increased RR and poor feeding - give humidified oxygen

Question 5

Intermediate step b/t O2 and intubation

Answer 5

CPAP/BiPAP

Question 6

What kind of CXR infiltrate typically is seen with PNA? TB?

Answer 6

PNA = middle/LL

TB = upper lobe

Question 7

When do antibiotics need to be given for strep PNA?

Answer 7

Within 4 hours

Question 8

cramping hands/feet d/t hyperventilation

Answer 8

carpopedal spasms

Question 9

What 6 things are risk factors for a pneumothorax?

Answer 9

-Marfans
-Ehlers Danlos
-Smoking
-Drugs
-Meds
-Prior PTX

Question 10

When do we get a CXR for PTX patients with a chest tube?

Answer 10

Immediately after insertion and at 4 hours

Question 11

What lung sounds do we hear in pts with a PTX?

Answer 11

absent or markedly decreased

Question 12

How much blood in a patient with a hemothorax needs OR/open thoracotomy?

Answer 12

> 1000 mL

Question 13

What kind of shock does a tension PTX cause?

Answer 13

Obstructive due to pressure on the mediastinum

Question 14

How do we treat a tension pneumo?

Answer 14

Immediately with a 14g/3.25” or larger needle @ 2nd ICS MCL affected side, reassess, will need chest tube and OR

Question 15

What symptom does a PE cause? What kind of shock can a large PE lead to?

Answer 15

Progressive and unexplained SOB
Obstructive shock

Question 16

Diffuse inflammatory response in lungs; sudden, progressive, severe; diffuse b/l infiltrates; commonly assoc with pulm contusion

Answer 16

ARDS

Question 17

What are the 7 Ps in RSI?

Answer 17

-Prepare
-Pre-oxygenate (also “do-nitrogenation” - 100% O2 x 3 minutes with NRB)
-Pre-treat (sedate, consider lido for ICP protection and atropine in peds to prevent bradycardia)
-Paralyze
-Placement (Sellick = crich pressure)
-Proof (observe, listen, ETCO2, CXR)
-Post-intubation

Question 18

What kind of pressure do we typically have? What kind of pressure does a vent use?

Answer 18

We use negative pressure; vent uses positive

Question 19

What are 4 causes of vent alarms?

Answer 19

DOPE
Dislodged
Obstruction
Pneumothorax
Equipment

Question 20

What is normal with a chest tube?

Answer 20

Water seal with intermittent bubbling and mild fluctuations with patients respirations

Question 21

What usually means a leak in a chest tube? Where do we normally see a leak?

Answer 21

continuous bubbling = leak
leak is usually at insertion site

Question 22

What is the maximum amount of time we can clamp a chest tube?

Answer 22

1 minute

Question 23

How do we ventilate with a combitube/dual lumen? What do we do with the other lumen?

Answer 23

Ventilate using whatever port makes chest go up and down, clamp off the other tube

Question 24

What does acidity (pH <7.35) cause? (3)

Answer 24

-decreased cardiac contraction force
-decreased vascular response to catecholamines
-decreased action of some meds

Question 25

What does alkalosis (pH >7.45) interfere with? (3)

Answer 25

-tissue oxygenation -neuro function -muscular function

Question 26

Partial pressure of CO2 dissolved in the bloodstream

Answer 26

PaCO2

Question 27

What is a normal PaCO2?

Answer 27

35-45

Question 28

This is the amount of excess or insufficient amount of bicard in the system

Answer 28

Base excess

Question 29

What is a normal base excess?

Answer 29

-2 to +2, with a negative BE meaning HCO3 deficit in the blood

Question 30

What buffers pH rapid but crude? What buffers pH slow but precise?

Answer 30

Lungs / respiratory Kidneys / metabolic

Question 31

What is caused by any condition that causes hypoventilation?

Answer 31

Respiratory Acidosis

Question 32

What is caused by any condition that causes hyperventilation?

Answer 32

Respiratory Alkalosis

Question 33

pH <7.35, PaCO2 >45

Answer 33

Respiratory Acidosis

Question 34

pH >7.45, PaCO2 <35

Answer 34

Respiratory Alkalosis

Question 35

What 6 things might cause a metabolic acidosis?

Answer 35

-DKA -renal failure -starvation -ASA OD -shock -sepsis

Question 36

What 3 things might cause a metabolic alkalosis?

Answer 36

this is RARE -antacid OD -excess use of bicarb -acid loss through vomiting

Question 37

pH <7.35, HCO3 <22

Answer 37

Metabolic Acidosis

Question 38

pH >7.45, HCO3 >26

Answer 38

Metabolic Alkalosis

Question 39

ABGs: uncompensated Problem system ? Functioning system ? pH ?

Answer 39

Problem system abnormal Functioning system WNL pH abnormal

Question 40

ABGs: partially compensated Problem system ? Functioning system ? pH ?

Answer 40

Problem system abnormal Functioning system abnormal pH abnormal

Question 41

ABGs: compensated Problem system ? Functioning system ? pH ?

Answer 41

Problem system abnormal Functioning system abnormal pH WNL

Question 42

pH: 7.30 PaCO2: 36 HCO3: 14 PaO2: 70

Answer 42

pH: 7.30 = acidosis PaCO2: 36 = normal HCO3: 14 = acidosis PaO2: 70 = low Uncompensated Metabolic Acidosis

Question 43

pH: 7.47 PaCO2: 30 HCO3: 18 PaO2: 81

Answer 43

pH: 7.47 = alkalosis PaCO2: 30 = alkalosis HCO3: 18 = acidosis PaO2: 81 = normal Partially Compensated Respiratory Alkalosis

Question 44

pH: 7.52 PaCO2: 50 BE: +3 PaO2: 81

Answer 44

pH: 7.52 = alkalosis PaCO2: 50 = acidosis BE: +3 = alkalosis PaO2: 81 = normal Partially Compensated Metabolic Alkalosis

Question 45

pH: 7.38 PaCO2: 27 HCO3: 17 PaO2: 80

Answer 45

pH: 7.38 = WNL (more acid) PaCO2: 27 = alkalosis HCO3: 17 = acidosis PaO2: 80 = normal Compensated Metabolic Acidosis

Question 46

pH: 7.37 PaCO2: 58 BE: +14

Answer 46

pH: 7.37 = WNL (more acid) PaCO2: 58 = acidosis BE: +14 = alkalosis Compensated Respiratory Acidosis