Question Answer
People in Respiratory Care Priestly = Oxygen, Black = Carbon Dioxide, Beddoes = Father Inhalation Therapy
Organizations of RT AARC = Professional org. , NBRC = Testing, CoARC = Program accreditation
Service Areas of RT General Therapeutics, Critical Care, Emergency Care, Diagnostic, Pulmonary Rehab
General Therapy Aerosol, humidity therapy, Bronchial hygiene, IS, IPPB
Critical Care Mechanical Vent, CPAP, pt transport, Airway care
Emergency Care CPR, pt transport, Intubation
Diagnostic Sputum collection, ABG, PFT, bedside monitoring
Pressure Conversion Formula either 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 Law P1V1 = P2V2 (Temp is Constant) Think “boil” water by temp
Charlie’s Law V1/T1 = V2/T2 (Pressure is Constant) Think Charlie lives in VT
Gay’s Law P1/T1 = P2/T2 (Volume is Constant)
Graham’s Law Inversely proportional to sq. root
Henry’s Law More P = more gas dissolves in Liquid
Combined Gas Law (P1V1)/T1 = (P2V2)/T2, if BTPS, remember to take out 47 from P2
Nasal Anatomy Vestibular(entry), Olfactory(smell), Respiratory
Vestibular Region of Nose Alae(wings), Vibrissae(hairs), Septum(seperator)
Respiratory Region Where the warming occurs, Superior, Middle and Inferior Concha
Pharyngeal Region Naso, Oro, and Hypo/Laryngo pharyngeals
Laryngeal Region Epiglottis, Thyroid(adams apple), Cricoid. Glottis is space between vocal chords
Trachea 16-20 “C” shaped cartliages. Seperates about 21-23 cm from mouth at Carina into mainstream R and L Bronchi
Lobar Bronchi Right has 3 that branch into 10 segmental. Left has 2 that branch into 8 segmental.
Bronchioles Thousands. the Terminal Bronchioles are the last of the Conducting Airways
Pulmonary Lobule Gas exchange area. Alveolar ducts, sacs, alveoli
Diaphragm Two muscles L and R hemidiaphragms innervated by the Phrenic Nerve
Accessory Inspiration Muscles Think Neck/Chest. Scalenes, Sterno, Pectoralis Major
Accessory Expiration Muscles Stomach muscles
Minute Ventilation Tidal V x Frequency. Normal values are 500ml x 12 = 6L/M
Alveolar Ventilation Take (Tidal V – body wt) x f or if given VD/VT, take Tidal V x (1 – VD/VT) x f
Pulmonary Shunt Alveolar deadspace. Perfusion w/o ventilation. No gas exchange. Noted in pneumonia
Deadspace Conduction Airways. Ventilation w/o perfusion
ABG normal values pH 7.35-7.45, CO2 40, HCO3 24
ECG P wave = atrial depolorization, QRS wave = ventricular depolorization, T wave = Ventrical repolorization
Cardiac Anatomy Blood in RA thru Tricuspid to RV to Pulmonary Art return Pulm veins to LA thru Bi(Mi)to LV out Aorta
Oxygen Content Calculation 1.34 x g/Hb x SaO2(sat). Then add (PaO2 x .003)to the total
Apnea Stop Breathing
Dyspnea SOB
Eupnea Normal Breathing
Hypervent blowing off CO2 <35
Hypovent CO2 level up >45
Orthopnea breath only in upright position
Hypernea VT >10L/M
Hypopnea VT <5L/M
Bradypnea f <10/M
Tachypnea f >20/M
Causes of Resp. Acidosis Hypovent(hang on to CO2), Narc drugs, anestesia, sedative drugs, obesity
Causes of Resp. Alkalosis Faster breathing, anxiety, Acute Asthma, Pulm. Vasc. disease, Hypobarism
Causes of Met. Acidosis Loss BiCarb, Diarrhea, Diabetic ketoacidosis, lactic acidosis
Causes of Met. Alkalosis Increase in Base, Diuretic therapy, Vomitting
Gas Cylinder Volumes E= 22, G= 187, H= 244, K= 275
Cylinder Factors E= .28, G= 2.41, H= 3.14
Cylinder Calculation/Duration of Flow (PSIG x Factor)/Flow
Liquid to Gas Conversion 1LB of Liquid O2 = 344L Gaseous O2
Cubic Feet to Liters 1Cu foot of Gaseous O2 = 28.3L of Gas
NFPA Regulates storage and Handling of cylinders as well as central supply gas and piping
DOT Regulates cylinder construction, testing and transport
CGA Sets all safety standards…ASSS, PISS, DISS
FDA Sets medical gas purity standards
Thorpes Tubes Flowmeter COMPENSATED, will jump, needle distal to valve, reads accurately in back pressure
Oxygen Concentrators Electrically powered, use molecular sieves containing ZEOLITE to absorb N2 as well as H2O and CO2 from air. <6L/M = 92-96% delivered
Alveolar Air Equation Quick and dirty 7 x FiO2 – CO2 from Bl. gas
Clinical Manifestations of Hypoxemia Tachycardia, Tachypnea, Cyanosis, Pulmonary Hypertention, Restlessness/Confusion
Refractory Hypoxemia Minimal response w/ increase FiO2. Due to Shunting. Use PEEP or CPAP
Responsive Hypoxia Significant increase in PaO2 w/increase in FiO2. Due to V/Q mismatch or diffusion defect. Use Hi or Low flow device
Total Flow Remember Magic Box from Clinicals100 Percent20Then cross substact, add then x flow
AARC CPGs for Hypoxemia Documented = PaO2 < 60mmHg, SaO2 <90%. Suspected = Acute M/I, Severe Trauma
Low Flow Systems Under 15L NC= 2-4L, Transtracheal O2 Cath, Simple= 6-10L, Partial and Non-Rebreathing Masks= 12-15L
High Flow Systems Will meet pts peak Insp. needs. AEM <.40/Venti, AE Nebs – High Flow <.40
Oxygen Analyzers Polargraphic and Galvanic Fuel Cell
Polargraphic Used 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 Cell No Voltage. Found Vent circuits O2 analyzers. Lead Anode, Gold Cathode, teflon membrane, SLOWER
HeOx Therapy Decrease turbulence and WOB, Stidor(post extubation), Croup, Foreign body aspiration, Upper airway masses, Diffuses faster than O2 or air
Pulse Ox Spectro= 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 Devices Oscillation, 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 Nebs Pneumatic(powered by gas) include Jet,SVN, LVN(SPAG for Ribavirin and HEART for continuous Broncho Di), MDI, DPI. Electric- ultrasonic
Percent Drug Solution divide 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 Drugs Catecholamines – 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 Agent Dornase Alpha(Pulmozyme) NEB, infectious secretions, digest DNA
Wetting Agents Use Ultrasonic Neb, Iso and Hypo both Thin secretions and Hyper induces sputum
Biological Indicators Spore strips used to determine sterilization
Chemical Indicators ETO exposure
Disinfectants Low-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),