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PCM III > Respiratory Procedures > Flashcards

Respiratory Procedures Flashcards

1
Q

5th vital sign

A

pulse ox

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2
Q

messed up pulse ox

A

fingernail polish
hypothermia - decreased periph circulation
carboxy-hemoglobin

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3
Q

carboxyhemoglobin

A

pulse ox doesn’t discriminate oxyhemoglobin vs. carboxyhemoglobin

carbon monoxide - may give false high pulse ox

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4
Q

CXR

A

typically P-A and left lateral studies**

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5
Q

correct CXR

A

9-10 ribs posteriorly

5-6 anteriorly

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6
Q

when to order CXR

A

disease of lung, mediastinum, heart, chest wall

systemic disease with chest involvement

monitor life support devices** ensure correct placement

pneumoperitoneum - gas in abdominal cavity

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7
Q

reading a CXR

A

technical quality of film

RIP - rotation, inspiration, penetration

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8
Q

white on Xray

A

opacity - more dense tissue

black - air

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9
Q

heart size on CXR**

A

transverse size of heart divided by transverse diameter of hemi-thorax should be <0.5

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10
Q

hemi-diaphragm

A

on CXR

right usually higher (due to liver)

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11
Q

AP CXR?**

A

with AP - heart will be enlarged

so PA - will show not falsely enlarged heart

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12
Q

limits of CXR

A

patient cooperation

technician skill

normal CXR can correlate poorly with actual disease**

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13
Q

early pneumonia

A

may not show infiltrate on CXR

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14
Q

pulmonary embolus

A

normal CXR

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15
Q

COPD, chronic bronchitis, asthma

A

increased PA diameter

increase retrosternal air space

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16
Q

ABG

A

arterial blood gas
-acid-base and oxygen status of patient

pH
PaO2
PaCO2
HCO3
O2 sat
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17
Q

common sites of arterial blood

A

radial artery
brachial artery
femoral artery

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18
Q

ABG indications

A 
assess for hypoxia
acid-base disorders
home O2 use
measure carboxyhemoglobin**
calculate O2 sat
blood sample - difficult draw patients - very obese patients**
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19
Q

calculating arterial O2 sat with CO poisoning

A

O2 sat - CO Hg

ABG machine - cannot differentiate O2 and CO hemoglobin

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20
Q

ABG machine

A

cannot differentiate between O2 and CO

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21
Q

allens test

A

severe PAD with poor collaterals

contraindication for ABG

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22
Q

ABG collection

A
  • sterile gloves
  • put it on ice
  • lidocaine - maybe - you’re just sticking patient 2x
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23
Q

allens test

A

radial and ulnar - occlude

squeeze hands until pale

release ulnar - to make sure it works

24
Q

ABG collection

A
  • palpate artery
  • allens test
  • 45 degree to skin bevel up**
  • blood will fill syringe
  • apply firm pressure with gauze - up to 5 minutes**
  • put sample on ice
25
Q

ET/NT tube intubation indications

A 
resp failure
airway protection
maintain airway
faciitate pulmonary tx and meds
positiv pressure ventilation
maintain oxygenation
26
Q

ET/NT tube intubation CIs

A

unskilled operator

facial trauma

inability to extend head and neck for endotracheal**

27
Q

only way to give 100% oxygen

A

through intubation

28
Q

C spine injury

A

use a nasotracheal

29
Q

prep for ET tube placement

A
  • determine method
  • make sure equipment works
  • ensure IV access**
  • remove foreign bodies
  • hyperventilate
  • monitor
  • have appropriate staff
30
Q

before ET tube placement

A

ensure IV access

31
Q

rule of pinky finger

A

for size of ET tube

32
Q

contemplate sedation

A

for conscious patient

33
Q

rapid sequence intubation

A

to sedate - rapid sedative - propofol, thiopental, midazolam

risk is sudden drop of BP

34
Q

sellick maneurver

A

cricoid pressure

to assist intubation

35
Q

intubation position

A

sniffing position

36
Q

curved blade insertion

A

into vallecula - over epiglottis

with cords in view - insert tip - to 21cm mark women or 23 mark men

tip should be 4cm above carina

37
Q

straight blade insertion

A

just below epiglottis

lift scope up and forward

insert tip with cords in view

38
Q

verify ET tube placement

A

look for asymmetric chest wall

listen for equal breath sounds b/l and over epigastrium

do a CXR

39
Q

chest tube placement

A

5th and 6th ICS MCL - least amout of muscle

don’t go below - risk of injury to diaphragm/liver

patient - lateral decubitus

40
Q

pneumothorax

A

22-24 french straight

41
Q

hemothorax or pleural effusion

A

32-36 french straight or right angled

42
Q

chest tube procedure

A

anesthetize subQ tissue

avoid neurovascular bundle - inferior aspect of rib

incision just superior to lower rib of interspace

43
Q

pneumothorax tube direction

A

posteriorly toward apex

44
Q

fluid tube direction

A

posteriorly keeping in dependent position

45
Q

water seal

A

at 20cm of water suction

petroleum gauze

46
Q

once chest tube in place

A
  • water seal it
  • have pt cough
  • sterile gauze
  • CXR to confirm placement**
47
Q

spirometry

A

quantitative measure of lung function based on air flow rates and lug volumes

simple graph plot - volume as function of time

PFT - flow-volume loop

48
Q

spirometry limitations

A

pt debilitation

severe resp distress

not motivated

meds affecting resp cycle

49
Q

FEV1

A

forced exp volume in 1 second

50
Q

FVC

A

total exhaled volme

51
Q

average flow of rate during middle 50% of FVC

A

FEF 25-75

52
Q

V-Q scan

A

evaluate presence of blood clots or other abnormalities in ventilation/circulation

53
Q

CI VQ scan

A

kidney failure

54
Q

two step scan

A

VQ

ventilation - gas xenon or technetium

perfusion - IV technetium

gamma camera

55
Q

VQ results

A

normal

low probability 80%

56
Q

multiple segmental perfusion deficits with normal ventilation

A

high probability

PCM III (17 decks)

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