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Year 2- Cardio respiratory > Station 1- CXR or ABG > Flashcards

Station 1- CXR or ABG Flashcards

1
Q

Normal value of pH

A

7.35-7.45

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2
Q

Normal value of PaO2

A

10.7-13.3 KPa

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3
Q

Normal value of PaCO2

A

4.7-6.0 KPa

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4
Q

Normal value of HCO3- (bicarbonate)

A

22-26mmol/l

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5
Q

Normal value of base excess

A

-2 —> +2

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6
Q

What is type 1 respiratory failure? And how do you recognize it?

A
  • Occurs when the respiratory system cannot adequately provide oxygen to the body
  • Caused by pneumonia, pneumothorax, COPD, pulmonary embolism
  • PaO2 is less than 8 KPa
  • 1 THING WRONG= low O2
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7
Q

What is type 2 respiratory failure? And how do you recognise it?

A
  • When the respiratory system cannot adequately remove carbon dioxide from the body
  • Caused by COPD, neuromusclar disorders (reduced strength of expiratory muscles), fatigue, reduced compliance of lung wall/ tissue (rib fracture, pneumonia)
  • 2 THINGS WRONG: PaO2 is less than 8 KPa AND increased PaCO2
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8
Q

What are the 5 outcomes from an ABG?

A

Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Respiratory failure (1 or 2)

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9
Q

Steps for analysing ABGs

A
  1. Check PO2 - hypoxemia (low) or hyperoxia (high)
  2. pH - Acidosis or alkalosis
  3. PCO2- hypercapnia (high) or hypocapnia (low)
  4. HCO3- helps mop up acids. Raised = high pH, Low = low pH.
  5. Base excess- how much buffering is needed to normalise the blood. Raised = higher than normal HCO3 (alkalosis), Low = lower than normal HCO3 (acidosis)
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10
Q

What is hypercapnia?

A

Increase in CO2 in the blood.
Caused by hypoventilation leading to respiratory acidosis or compensated metabolic alkalosis

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11
Q

What is hypoxemia?

A

Low level of O2 in the blood
- Due to a V/Q mismatch

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12
Q

Tips for exam

A
  • Give some examples of pathophysiology which may be causing this issue and what treatment would help
  • Put into clinical context of patients condition
  • Use arrows and labels
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13
Q

What is a posterior-anterior (PA) CXR? And how can you tell?

A
  • Patient standing and holding the X-ray detector on their chest
  • X-ray source behind to take an x-ray from their back so no major organs are in the way
  • You can tell by= scapula position (retraction), larger air space, clear spinous processes
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14
Q

What is an anterior-posterior CXR? How can you tell?

A
  • When the patient is too poorly to go to the x-ray department so done in bed
  • x-ray detector board is placed behind the patient and a portable x-ray machine is wheeled to the end of the bed
  • You can tell by = smaller air space, position of scapulas, heart might look larger
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15
Q

How does bone appear on CXR?

A

White = high absorption

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16
Q

How does tissues appear on CXR?

A

Grey = moderate absorption

17
Q

How does air appear on CXR?

A

Black = low absorption

18
Q

Checking for a normal CXR. Which features are we looking to identify?

A
  • Clavicle
  • Ribs
  • Heart boarder
  • Aortic arch
  • Vertebral bodies
  • Diaphragm
  • Trachea
  • Costo cardiac angles and costo phrenic angles
19
Q

A-H for identifying an abnormal x-ray

A

Airway
Bones
Cardiac silhouette
Diaphragm
Effusions
Fields (lung fields)
Gadgets
Hidden areas

20
Q

Airway in A-H

A

Is the trachea central?
Does it deviate?
Does it narrow?
Does it contain any foreign objects?

21
Q

Bones in A-H

A

Can you see any rib fractures?
Can you see the abnormalities?

22
Q

Cardiac silhouette in A-H

A

Have they got an enlarged heart (cardiomegaly)?
Can you see the heart outline?
Is there any mediastinal shift

23
Q

Diaphragm in A-H

A

Is the diaphragm domed?
Is it flat?
Look at the position

24
Q

Effusions in A-H

A

Can you see a water line?
Can you see the costophrenic angle?

25
Q

Fields (lung fields) in A-H

A

Lung volumes- do lungs expand to the pleura (pneumothorax?)
Visible costophrenic and costocardiac angles?
Are they obscured and why?

26
Q

Gadgets in A-H

A

Are there any attachments?

27
Q

Hidden areas in A-H

A
  • Lung apex
  • Below diaphragm
  • Hilum
  • Retrocardinal zone
28
Q

What does a chest with consolidation look like?

A

Whiteness in alveoli due to fluid
Very opaque white patches
‘Fluffy’
- Could be caused by pneumonia

29
Q

What does a COPD chest look like?

A

Flat diaphragm (can be blurry), horizontal ribs, larger lung volume ‘barrel chest’

30
Q

What does a chest with pneumothorax look like?

A
  • Air in the pleural space ‘pleural edge’
  • Deflated lung
  • Black space
  • No lung markings
  • Deviated trachea away from the pneumothorax
  • Caused by trauma (rib fracture?
31
Q

What does a chest with pleural effusion look like?

A

Build up of fluid
‘Water line’
Obscured lung fields and a ‘meniscus sign’
- Deviated trachea away from the effusion
- Caused by pneumonia, cancer, heart failure, pulmonary embolism

32
Q

What does a chest with pulmonary oedema look like?

A

Fluid in the lung
Patchy white in lung fields ‘bat wings’
Enlarged hila
- Can be caused by heart failure

33
Q

Acronym for quality of x-ray

A

R- rotation: is trachea and spine central or rotated? Clavicals level and symmetrical?
I- inspiration: can you see 6 anterior ribs and 9-10 posterior?
P- projection: AP or PA?
E- exposure: is it over or under exposed? Can you see vertebrae behind the heart?

34
Q

Potential causes for a metabolic alkalosis? Physio and MDT intervention strategies?

A

Loss of acid due to vomiting, NG tube aspiration and diuretics
Interventions: referral to MDT to identify what is causing this loss of acid.
Physios to monitor lung volumes, mobility and chest. Might decrease RR to reduce loss of CO2

35
Q

Metabolic acidosis - causes and interventions

A

Diarrhoea , renal problems/failure, diabetic ketoacidosis (DKA)
Interventions: referral to MDT to check cause.
Physio might increase RR to increase amount of CO2 leaving the blood if not already compensated

36
Q

Respiratory alkalosis: causes and interventions

A

Hyperventilation due to panic attacks, stress, pain, breathlessness, breathing pattern disorder
Interventions: Referral to psychologist is caused by anxiety
Physio to do ACBT, box breathing, deep breathing exercises

37
Q

Respiratory acidosis: causes and interventions

A

Alveolar hyperventilation caused by COPD, neuromuscular disorders (GB or MND) opoids.
Interventions: control oxygen levels for hypoxemia
If related to sputum retention then ACBT, MT. Breathlessness management
Respiratory acidosis could be type 2 resp failure.

Year 2- Cardio respiratory (6 decks)

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