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Year 2 PCM III > Respiratory Procedures- Stasio > Flashcards

Respiratory Procedures- Stasio Flashcards

(65 cards)

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1
Q

What can make pulse oximetry readings less accurate

A

hypothermia- decreased peripheral circulation
fingernail polish
cannot discriminate between oxyhemoglobin and carboxyhemoglobin

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2
Q

If dont correctly what will a CXR show you

A

9-10 ribs posteriorly and 5-6 anteriorly

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3
Q

When do you order a CXR

A

suspect disease in that area
suspect systemic disease with chest involvement
monitor life-support devices
pneumoperitoneum (gas in abcdominal cavity)

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4
Q

What is RIP when reading CXR

A

rotation, inspiration and penetration

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5
Q

normal heart size on CXR is what

A

transverse size of heart divided by transverese diameter of thorax shoul dbe <.5

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6
Q

What side of diaphragm is higher on CXR

A

the right is higher from liver

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7
Q

What does penetration refer to on CXR

A

under or over penetrated

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8
Q

what does inspiration of CXR refer to

A

ddiaphragm to the 9-10 rib

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9
Q

on PA view the heart looks enlarged, why?

A

divergence of x ray beams

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10
Q

What is seen on CXR of early COPD/chornic bronchitis/asthma

A

hyperinflation, loss of vascular markings, flattened hemidiaphragms, inc PA diamteres, inc retrosternal air space

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11
Q

ABG is used to determine what

A 
pH of blood
pp O2 in blood
pp CO2 in blood
HCO3 level
O2 sat Hb
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12
Q

Where are the common sites to pull ABG from

A

radial a, brachial a and femoral

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13
Q

what are indications for ABG

A

assess for hypoxia
evaluate acid base
need for home O2?
measure carboxyHb levels in smoke inhalation patients or exposure (CO)
calculate arterial O2 sat
blood sample in dificult draw patients (obese)

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14
Q

How do you calculate actual O2 sat in ABG

A

O2 sat- CO Hb = actual O2 sat

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15
Q

What are the absolute contraindications to ABG

A

none

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16
Q

what are the relative contraindications to ABG

A

invasive procedure
coagulopathy
severe PAD with poor collaterals (allens test)
trauma of infection at draw site
difficult to standarize from factors: hyperventilation, breath holding, altitude, obesity

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17
Q

What is equipment for ABG collection

A 
sterile gloves
rolled towel
ice for transport
ABG kit
and lidocaine if desired
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18
Q

What is in ABG kit

A

2 ml heparinized syringe with 25 gauge needle, iodophor and alcohol pads, 2x2 sterile gauze and band-aid

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19
Q

describe cleaning process before arterial draw

A

cleab with iodophor then wipe once with alcohol pad

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20
Q

at what angle do you insetrt needle for ABC

A

45 to skin, bevel up and slowly advance till artery is puntured

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21
Q

how much blood do you collect for ABG

A

2-3mL

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22
Q

how long do you apply pressure after stick

A

5 minutes or until no bleeding occurs

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23
Q

describe traction on skin for ABG draw

A

locate a with index and middle finger and speard apart

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24
Q

What are indications for ET/NT intubation

A 
respiratory failure
airway protection
maintenance of airway
facilitate pulm Tx and medication
use + P ventilation
maintain adequate oxygenation
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25
what are contraindications to ET/NT intubation
operator unskilled to administer tube excessive trauma to face, neck and c spine inability to extend head and neck
26
What is key for reparing ET tube placement
``` most appropriate method all equipment must be functioning have adequate IV access! removed any foreign bodies hyperventialte monitor BP, pulse ox and cardiac status ```
27
What is equipemnt for ET tube
``` bag-valve-mask and O2 source laryngoscop handles and blades (2)- one curved and one straight(adult size 3) severeal ET tubes oral and nasal airways available stylet (lubricated) forceps and suction tape or strap to secure tube 10 mL syringe to inflate cuff ```
28
what are the ET tube sizing for males and females
7-8mm females | 8-9 mm males
29
If sedating patient for ED tube (conscious) what do you use
rapid IB admin of sedative :propofol thiopental, midazolam | fast aciting muscle reacanat too (succinnylcholine)
30
What is risk for sedation of ET tube placement patient
risk if sudden drop BP
31
What is intubation sequence for ET tube
recheck all equipment is functiong hyperventilate patiend cricoid pressure by assistant position patient in sniffing position place laryngoscop in right side mouth and sweep blade to left displacing tongur curved blade tup inserted into vallevula and lift scope up and forward then insert tip between vocal cords 2-3 cm below and removed scope and inflate cuff
32
what is sniffing position
extending head at OA joing, jaw thurst or chin lift if needed
33
Correct placement of ET tube is at what level in females and adults
21 cm mark on tube- women | 23 mark on tube- men
34
you want the tip of ET tube where in body
3-4 cm above carina
35
Where is the tip for a straight blade laryngoscope
just below epilottis
36
What do you do tog verifty ET tube placement
look for symmetrical rise and equal breath sounds b/l over epigastrum secure tube to skin do CXR to confirm correct placement monitor rep valuse and confirm proper function
37
what are indications for chest tubes
``` pneumo casing resp distress hemothorax large pleural effusions empyema pos thoracotomy ```
38
What are contraindiciations for chest tubes
small pneumonthorax not causing resp distress pleura adherent to chest wall coagulopathy previous chest tube in same site
39
describe prep for chest tube plcaement
written consent lateral decubitus with affected side up prep and drape steril, 5th-6th ICS MAL ***Do not go below because risk of injuring the diaphragm
40
What is on equipment list for chest tube
skin prep(betadine) steril gloves, mask, gogles, fenestrated draope lidocaine, 10 mL syringe 22 gauge-1.5 in needle scalpel blad with hangle curved clamp appropriate size chest tube multi chamber water seal needle holder, suture, scissors, gauze with petroleum jelly on it sterile sponges and elastic adhesive
41
what is appropriate size chest tube for pneumo? | hemotthorax or pleural effusion?
pneumothorax- # 22-24 french straigh | hemothorax or pleural effusion- #32-36 french straight or right angled
42
describe chest tube procedure
anesthetize subcut tissues along top edge of rib slowly advance while infiltratin along costa periosteum until air of fluis is aspirated in pleural space make small incision throught fact and mm superior to lower rib enlarge incision with curved clamp and perforate into pleural space
43
where do you direct tube for pneumothorax
posteriorly and toward apex
44
where do you direct tube for fluid
posteriolry and dependent position
45
how do you prevent lung injury with chest tube
grip th clamp with other hand so that the distance from hand to tip is just greater than chest wall thickeness
46
What do you do once you verify! chest tube is in place
attach opp end of tube to multi chamber water seal with suction at 20 cm water have patient cough (should have bubble appear) suture through skin and tie tube down place petroleum gauze around tube exit apply sterile gauze and secure with tape CXR to confirm placement continue to monitor for resolution of problem
47
What is on a simple spirometry graph plot
volume as function of time
48
what is on a pulm function test plot
flow-volume loops expiratory against volumes expiratory and inspiratory flow rates against volumes diffusion rates of gases
49
what are indications for spirometry/PFT
screening(smoker, toxic exposures, asthma, COPD) Dx testing: obstrutive lung disease and restrictive lung disease evaluate efficacy of treatments tracking course of disease disability determinations
50
What are spirometry limitations and contraindications
results bery patient dependent severe debilitation and excessive tiring severe or moderately severe resp distress patient not motivated or desiring to take test medication affecting resp cycle of function of chest mm
51
What is FEV1
forced expiratory volume in 1 sec
52
what is FVC
forced vital capacity (total exhaled volume)
53
when does average flow of expiration occur
during middle 50% of FEF forced xpiratory flow
54
diminished FVC is a reliable and valid index of what
significant impairement in patients with interstitial lung disease
55
FEV1/FVC ratio is <40% what does this correlate with
shortened life span
56
What is a better correlation of exercise capacity: FEV1 or ppO2 ABG
FEV1
57
What are indications for V/Q scan
presence of blood clots or other abnormalities in ventilation and circulation evaluate COPD or pneumonia
58
What are contraindicaitons to V/Q scans
kdiney failure, allergy to radioactive materials
59
what are risks with v/Q scans
radiation exposure, renal toxicity
60
What gase is used for ventialtion component of v/q scan
xenon or technetium
61
what is used for perfusoin part of VQ scan
IV technectium
62
What type camera is for vq scan
gamm camera
63
What are the possible results of a vq scan
normal | low probability 80%
64
describe interpretation of intermediate probability vq scan
perfusoin deficit that corresponds to parenchymal abnormality on CXR
65
describe high probability of vq scan
multiple segmental perfusion deficits with normal ventilation

Year 2 PCM III (5 decks)

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