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People in Respiratory CarePriestly = Oxygen, Black = Carbon Dioxide, Beddoes = Father Inhalation Therapy
Organizations of RTAARC = Professional org. , NBRC = Testing, CoARC = Program accreditation
Service Areas of RTGeneral Therapeutics, Critical Care, Emergency Care, Diagnostic, Pulmonary Rehab
General TherapyAerosol, humidity therapy, Bronchial hygiene, IS, IPPB
Critical CareMechanical Vent, CPAP, pt transport, Airway care
Emergency CareCPR, pt transport, Intubation
DiagnosticSputum collection, ABG, PFT, bedside monitoring
Pressure Conversion Formulaeither multipy or divide by 1.36(from cm to mm, divide)(mm to cm, multiply)…mm to lbs = x14.7….mm to g/cm3 = x 1034
Boyle’s LawP1V1 = P2V2 (Temp is Constant) Think “boil” water by temp
Charlie’s LawV1/T1 = V2/T2 (Pressure is Constant) Think Charlie lives in VT
Gay’s LawP1/T1 = P2/T2 (Volume is Constant)
Graham’s LawInversely proportional to sq. root
Henry’s LawMore P = more gas dissolves in Liquid
Combined Gas Law(P1V1)/T1 = (P2V2)/T2, if BTPS, remember to take out 47 from P2
Nasal AnatomyVestibular(entry), Olfactory(smell), Respiratory
Vestibular Region of NoseAlae(wings), Vibrissae(hairs), Septum(seperator)
Respiratory RegionWhere the warming occurs, Superior, Middle and Inferior Concha
Pharyngeal RegionNaso, Oro, and Hypo/Laryngo pharyngeals
Laryngeal RegionEpiglottis, Thyroid(adams apple), Cricoid. Glottis is space between vocal chords
Trachea16-20 “C” shaped cartliages. Seperates about 21-23 cm from mouth at Carina into mainstream R and L Bronchi
Lobar BronchiRight has 3 that branch into 10 segmental. Left has 2 that branch into 8 segmental.
BronchiolesThousands. the Terminal Bronchioles are the last of the Conducting Airways
Pulmonary LobuleGas exchange area. Alveolar ducts, sacs, alveoli
DiaphragmTwo muscles L and R hemidiaphragms innervated by the Phrenic Nerve
Accessory Inspiration MusclesThink Neck/Chest. Scalenes, Sterno, Pectoralis Major
Accessory Expiration MusclesStomach muscles
Minute VentilationTidal V x Frequency. Normal values are 500ml x 12 = 6L/M
Alveolar VentilationTake (Tidal V – body wt) x f or if given VD/VT, take Tidal V x (1 – VD/VT) x f
Pulmonary ShuntAlveolar deadspace. Perfusion w/o ventilation. No gas exchange. Noted in pneumonia
DeadspaceConduction Airways. Ventilation w/o perfusion
ABG normal valuespH 7.35-7.45, CO2 40, HCO3 24
ECGP wave = atrial depolorization, QRS wave = ventricular depolorization, T wave = Ventrical repolorization
Cardiac AnatomyBlood in RA thru Tricuspid to RV to Pulmonary Art return Pulm veins to LA thru Bi(Mi)to LV out Aorta
Oxygen Content Calculation1.34 x g/Hb x SaO2(sat). Then add (PaO2 x .003)to the total
ApneaStop Breathing
DyspneaSOB
EupneaNormal Breathing
Hyperventblowing off CO2 <35
HypoventCO2 level up >45
Orthopneabreath only in upright position
HyperneaVT >10L/M
HypopneaVT <5L/M
Bradypneaf <10/M
Tachypneaf >20/M
Causes of Resp. AcidosisHypovent(hang on to CO2), Narc drugs, anestesia, sedative drugs, obesity
Causes of Resp. AlkalosisFaster breathing, anxiety, Acute Asthma, Pulm. Vasc. disease, Hypobarism
Causes of Met. AcidosisLoss BiCarb, Diarrhea, Diabetic ketoacidosis, lactic acidosis
Causes of Met. AlkalosisIncrease in Base, Diuretic therapy, Vomitting
Gas Cylinder VolumesE= 22, G= 187, H= 244, K= 275
Cylinder FactorsE= .28, G= 2.41, H= 3.14
Cylinder Calculation/Duration of Flow(PSIG x Factor)/Flow
Liquid to Gas Conversion1LB of Liquid O2 = 344L Gaseous O2
Cubic Feet to Liters1Cu foot of Gaseous O2 = 28.3L of Gas
NFPARegulates storage and Handling of cylinders as well as central supply gas and piping
DOTRegulates cylinder construction, testing and transport
CGASets all safety standards…ASSS, PISS, DISS
FDASets medical gas purity standards
Thorpes Tubes FlowmeterCOMPENSATED, will jump, needle distal to valve, reads accurately in back pressure
Oxygen ConcentratorsElectrically powered, use molecular sieves containing ZEOLITE to absorb N2 as well as H2O and CO2 from air. <6L/M = 92-96% delivered
Alveolar Air EquationQuick and dirty 7 x FiO2 – CO2 from Bl. gas
Clinical Manifestations of HypoxemiaTachycardia, Tachypnea, Cyanosis, Pulmonary Hypertention, Restlessness/Confusion
Refractory HypoxemiaMinimal response w/ increase FiO2. Due to Shunting. Use PEEP or CPAP
Responsive HypoxiaSignificant increase in PaO2 w/increase in FiO2. Due to V/Q mismatch or diffusion defect. Use Hi or Low flow device
Total FlowRemember Magic Box from Clinicals100 Percent20Then cross substact, add then x flow
AARC CPGs for HypoxemiaDocumented = PaO2 < 60mmHg, SaO2 <90%. Suspected = Acute M/I, Severe Trauma
Low Flow Systems Under 15LNC= 2-4L, Transtracheal O2 Cath, Simple= 6-10L, Partial and Non-Rebreathing Masks= 12-15L
High Flow SystemsWill meet pts peak Insp. needs. AEM <.40/Venti, AE Nebs – High Flow <.40
Oxygen AnalyzersPolargraphic and Galvanic Fuel Cell
PolargraphicUsed in Bl. Gas machines, Clark electrode, vent circuits, O2 analyzers. Fast because of Battery. Under 30 secs. Silver Anode, Platinum Cathode KCl solution
Galvanic Fuel CellNo Voltage. Found Vent circuits O2 analyzers. Lead Anode, Gold Cathode, teflon membrane, SLOWER
HeOx TherapyDecrease turbulence and WOB, Stidor(post extubation), Croup, Foreign body aspiration, Upper airway masses, Diffuses faster than O2 or air
Pulse OxSpectro= light, S= spectrum.Photo= Pulse
Hyperinflation Calculation`VC= ml/kg. If VC >10-15 and clear= ISVC >10-15 w/secrections PEP, VC <10-15 and clear= IPPB
Bronchial Hygiene DevicesOscillation, HFCC(Hi Freq Closed Chest), HFO(Flutter Valve)= CHEAP, IPV(used for tx w/hygiene therapy), MIE(mechanical couch), HUFF(Forced Ex. Techniques), Autogenic Drainage(AD) uses series of steps
Categories of NebsPneumatic(powered by gas) include Jet,SVN, LVN(SPAG for Ribavirin and HEART for continuous Broncho Di), MDI, DPI. Electric- ultrasonic
Percent Drug Solutiondivide mg/ml/10 for % solution or % solution x 10= mg/ml
What are Adrenergics?Sympathetic. Receptor sensitive to norepinephrine. Increase HR and contraction, bronchodilate, Vasoconstriction
Adrenergic DrugsCatecholamines – Racemic(All receptors), Noncatecholamines – Alupent, Albuterol, Levalbuterol, Salmeterol, Formoterol, Brovana, Tornalate, Maxair
What are Anticholinergics?Block Parasympathetic receptor sensitive to acetylcholine. Broncho Di, Increase HR, Dry secretions. Atrovent and Spiriva(Tiotropium BR) DPI
What are Asthma Maintenance Drugs?Glucocorticosteroids= Prednisone(Tab) and Pulmicort(MDI/DPI. Also Mast cell stabilizers Intal and Tilade. And Leukotriene blockers Accolate, Zyflo and Singulair. Fight all inflammation.
Proteolytic AgentDornase Alpha(Pulmozyme) NEB, infectious secretions, digest DNA
Wetting AgentsUse Ultrasonic Neb, Iso and Hypo both Thin secretions and Hyper induces sputum
Biological IndicatorsSpore strips used to determine sterilization
Chemical IndicatorsETO exposure
DisinfectantsLow-level in Home Acetic Acid(Vinegar), Glutaraldehyde (sterilizing agent for vent tubes, scopes, bags), Auto- claving(true sterilization process in central supply, damages rubber and plastic), Ionizing(High cost, long time), Ethylene(heat sensitive),