Question Answer
The efficiency of external respiration is dependant on what (3) factors? 1)Alveolar ventilation, Is it adequate? 2)matching of V/Q 3)membrane diffusion across A.C membrane
3 factors involved in oxygen delivery 1)O2 loading 2)O2 unloading 3)O2 transport
O2 loading “external” respiration gas exchange of 02 and CO2 from the atmosphere to the alveoli at the AC membrane
02 unloading ” internal” respiration gas exchange at systemic capilaries(blood and tissues)
02 transport requires a normal Hgb concentration as well as an adequate cardiac output
Why does V/Q mismatch occur even in the normal lung? There is a normal physiologic shunt of 3% in the normal healthy adult. 2% of cardiac output bypasses the lung,and 1% relative capillary shunting also occurs
what is the normal vd/vt ratio in a spontaneous breathing individual .40 with a somewhat higher ratio being acceptable for patients on mechanical ventilatory support
The distribution of ventilation in the lung depends on regional differences in ———-and ————-. CL and RAW
A vd/vt ratio of .7 means that: 70% of the vt is lost to vd. The patient would need to be placed on mechanical ventilation. Their lungs are not ventilating adequately.
Cardiac output = stroke volume X heartrate
At residual volume most gas entering the lungs would go to the apices or bases? apices
Most gas inhaled during normal breathing from normal FRC enters the apices or bases? bases
Will a change in FRC affect the distribution of ventilation? Yes
A patient’s minute ventilation is 10 lpm, her respirator rate is 22, and her PaCO2 is 55 mmHg. You would expect that she may be experiencing: increased deadspace ventilation,increased work of breathing, and decreased alveolar ventilation
A pulmonary embolus would increase shunt or deadspace in the affected area? Deadspace
A totally atelectatic alveolus would increase shunt or deadspace in the affected area? shunt
Normal anatomic shunt is approximately what percent of cardiac output 2%
What diffuses about 20x faster than O2 across the a-c membrane? CO2
what are the 2 major requirements for successful pulmonary diffusion? 1) adequate time for for gases to equilibrate across the Alveolar capillary membrane2) their needs to be enough surface area to permit gas exchange at the alveolar capillary membrane
Hgb tends to combine 4 oxygen molecules or none, true or false true
what is the normal value range for hemoglobin in males? 15 g/100ml
What is the normal value range for hemoglobin in females? 13-14 g/100ml
physiological deadspace the sum of all alveolar and anatomic deadspace
shunt blood is perfused but not ventilated
anatomic deadspace the quantity of gas remaining in the airway at the end of each breath
anatomic shunting the pleural, bronchial and thebesian largely veins contribute to this form of normal shunting
mechanical deadspace represented by the volume of exhaled gas remaining within a ventilator circuit or an oxygen mask, which is then inspired on the next breath
relative capillary shunting this form of shunting would be represented by an alveolus at which the volume of perfusion exceeds the volume of ventilation to the alveolus
what is the numerical difference between the normal total base in a blood sample and the actual amount of base in the sample? base excess
Question Answer
What is a SPAG nebulizer designed to admin Ribavirn
What nebulizer should RTT where mask gloves gown and goggles when delivering meds with SPAG
What is a USN ultrasonic nebulizer
What is the particle size of a USN fine
How does USN work radio frequency generator produces high frequency vibrations across piezoelectric transducer or crystal, breaks up meds, frequency determines particles size, amplitude determines volume
Best nebulizer of choice for pt with thick retained secretions USN
How does RTT control the volume on a USN amplitude, can go as high as 6 l/m (2x higher than other nebs)
Hazards of USN over hydration, bronchospasm, sudden mobilization of secretions, electrical shock, water in tube from condensation, nosocomial infections, drug dosing changes caused by reconcentrations in nebulizer as treatment continues
Why must RTT be concerned about condensation in the tubing during neb treatment accidental pt lavage, water in tube caused decreased flow and increased FIO2
What kind of mask is most often used with a SPAG tent or hood
You are delivering humidity to pt at 30 percent but when you analyze it, it reads 60 percent, what is the problem condensation in the tube increases FIO2
What is a Passover humidifier non heated low humidity appox 25 percent body humidity
What is a bubble humidifier the most common non heated humidifier, body humidity of 35 to 40 percent, usually for nasal canulla
What is a diffuser humidifier high output aerosol neb often used with CPAP, heated, uses evaporation to produce high humidity at high flow (misty ox)
What is the cascade humidifier heated humidifier most often used with vent pt, water passes over a grid, capable of deliver 100 percent humidity at high flows
What is a wick or concha humidifier heated humidifier, water passes over wick made of paper, cloth or sponge, produces humidity close to 100 percent, best for artificial airway for pt on vent
What is an HME heat moisture exchange, device placed between pt and wye on vent circuit, body humidity is collected and then used to humidify next insp, ideally 70-90 humidity is produced
How often do we change out the humidifier circuit to prevent pseudomonas every 24 hours
Therapeutic range for aerosol meds is .5 to 3 microns
What is an HHN hand held nebulizer aka SVN
What is the volume of an SVN less than 30 ml
What is the particle size of an SVN 1.5 to 7 microns
Respigard II SVN is used for what tamadine or pentamidine medication for treating C Pneumonia in AIDS pts
AeroEclipse is what breath actuated nebulizer used in many hospitals today, saves meds and gives shorter treatment
MDI’s are more effective with what spacer and good pt education
DPI is what dry powder inhaler
What is the downside of DPI pt must have a strong enough inspiratory flow to get meds
What is the upside to DPI’s do not take the same pt coordination as MDI
What is the purpose of large volume nebs provide continuous aerosol therapy, refill every 4 to 8 hours depending on flow and heat
Allegiance health LVN air entrainment prefilled neb for cool or heat 21 to 100 percent
Misty ox hi-fi neb air entrainment 60-90 percent on flows of 42 to 77 L/M
Misty ox gas injection neb or GIN 21 to 100 percent at rates over 100 L/M not an air entrainment device, used with CPAP, requires 2 gas sources if greater that 75percent
Heart neb used if giving continuous aerosolized meds like albuterol for status asthmaticus, 240 ml reservoir
What is humidity water in a gaseous states
What are the advantages of MDI convenient, inexpensive, portable, no drug prep, hard to contaminate
What are the disadvantages of MDI pt coordination and activation, increased pharyngeal deposits, abuse, no high doses, not all meds available, CFC’s
What are the advantages of SVN less pt coordination, high doses, even and continuous, no CFC
What are the disadvantages of svn’s expensive, wasteful, drug prep, contamination, not all drugs available press source required, long treatment time
Hazards of aerosols are wheezing and bronchospasm esp with copd, broncoconstriction with artificial airway, infection, overhydration, pt discomfort, rtt exposure, edema
Contraindications of aerosol are Bronchoconstriction, history of airway hyperresponsive
Indications of aerosol are upper airway edema (cool), LTB, subglottic edema, post extubation edema, post op mgmt of upper airway, sputum specimen or mobilize secretions
Body humidity is 44 mg/L always, regardless of body temp or outside temp
Actual humidity RH x capacity
Aerosol is what liquid particles suspended in gas
Bland aerosol therapy is what sterile hypo, hyper or normal saline in aerosol
What is the primary purpose of humidity therapy humidify dry medical gases to overcome humidity deficit when upper airway is bypassed
What is the secondary purpose of humidity therapy heated to manage hypothermia or treat bronchospasm from cold air
How do you tell if a non heated humidifier has a leak all have pop off at 2 psi, kink the hose if pop off does NOT sound, you have a leak
Where do you monitor temp of humidity insp side at wye
Passover humidifiers are wick-air flows over wick, membrane-gas passes through hydrophobic membrane, USN-prezo electronic crystal
Contraindications of HME thick copious secretions, less than 70 VT, less than 32 body temp, great than 10 min vent
Hazards of HME under hydration, mucus plugging, increased WOB, hypoventilation from increased dead space, ineffective pop off, hypothermia
Contraindications for heated humidifiers there are none
Hazards of heated humidifiers high flow at disconnect will spray contaminated condensation, under hydration, mucus plugging, inc WOB, wrong FIO2 from condensation in tubing, hypothermia, burns, lavage
Relative humidity is actual humidity divided by capacity
Indications for humidity are all vent patients with endotrach or tracheostomy, primary – pt receiving dry gas, upper airway bypassed, secondary – mgmt of hypothermia and bronchospasm from cold air
Which nebulizer administers particles with sizes 0.5-3.0 microns and allows for the greatest deposition of aerosol? Ultrasonic nebulizers
Question Answer
n-acetylcysteine mucolytic,Mucomyst,acetaminophen (tylonol) poisoning
albuterol+ipratropium beta-agonist+anticholinergic, Combivent = Ventolin and Atrovent
albuterol sympathomimetic bronchodilator aka B2 bronchodilator Proventol, Ventolin, stimulates cAMP, strong B2, mild B1, rapid/short
atropine prototype anticholenergic,stimulant prior to surgery to decrease secretions
beclamethasone corticosteroids,Vanceril,low systemic side effects, rapid absorb, long lasting anti-inflammatory
bitolterol sympathomimetic bronchodilator PRODRUG, Tornalate, stimulates cAMP, strong B2, mild B1, rapid and short
budesonide corticosteroids, Pulmacort, only nebulized steroid, only in 10-20% solution special nebulizer, do not mix with other drugs
cromolyn sodium mast cell stabilizer,Intal, prophylactic anti-asthmatic, 2-4 week start up, very safe, not an anti inflammatory not for acute symptoms
Dornase alpha mucolytic,Pulmozyme,purulent secretions of cf and bronchiectisis, lyces DNA of bacteria and cellular debri
Epinephrine adrenergic catecholamine, strong side effects, ultra short duration less than 1 hour, strong a, B1, B2
flunisolide corticosteroids,Aerobid,rapid absorb, short life, several days to ramp up, long term asthma management anti-inflammatory
Fluticasone corticosteroids,Flovent,”rapid absorb, long life, low side effects, anti-inflammatory, “
glycopyrrolate anticholenergic,Robinal,drying agent used in bronchorrhea
Ipratropium anticholenergic,Atrovent,”blocks ACH, bronchodilation (COPD)”
Isoproterenol adrenergic catecholamine,Isuprel,very short duration ,less than 3 hours, stimulates cAMP, strong a, and B2, vasodilation bronchodilation
Levalbuterol beta agonist-short acting,Xopenex,” single isomer, no a, no B1, very low side effects”
Metaproterenol resorcinol/beta agonist,”Metaprel,Alupent”,”strong side affects, slow to reach peak”
montelukast leukotrine blocker,Singulair,”great for kids with RAD, exercise and maintenance, allergies and asthma-no side effects”
nedocromil sodium mast cell stabilizer,Tilade,”prophylactic anti-asthmatic, 2-4 week start up, can be used for exercise “
Pirbuterol beta agonist-short acting,Maxair,
Prednisone steroid,”acute asthma treatment, acute bronchospasm”
Racemic epinephrine adrenergic catecholamine,Micronephrine, Vaponephrine”,”very short duration < 3 hour, strong a, B1, B2used in croup, swelling and edema from burns or post extubation (never orally), hourly”
salmeterol beta agonist-long acting,Serevent,”not a rescue, best for treating chronic asthmatic symptoms,long acting”
salmeterol+fluticasone beta agonist+steroid,Advair (salmeterol+fluticasone),long acting management with anti-inflammatory for long term maintenance of asthma
Sodium bicarbonate mucolytic,pH disrupts amino acid chain, not used much
terbutaline resorcinol, modified catecholamine (used to treat contractions)
theophylline xanthine,,caffeine is first line for apnea in preemies
tiotropium anticholenergic,Spiriva,”blocks ACH, bronchodilation (COPD)”
Triamcinolone corticosteroids,Azmacort,
zafirlukast leukotrine blocker,Accolate,”side effect-liver failure, not convenient must take on empty stomach”
zileutin leukotrine blocker,Zyfloe,extended release pill
adrenergic catecholamine drugs are? epinephrine, isporoterenol (Isuprel), racemic epi(Vaponephrine)
Xanthines drugs theophylline (caffeine, used in treatment of apnea in preemies and drug of last resort for COPD
Resorcinol/beta agonist drugs metaproterenol (Metaprel, Alupent), terbutaline (Brethine, Brethaire)
Leukotrine blocker drugs montelukast (Singulair), Zafirlukast (Accolate), zileutin (Zyflo) (all leukotrine blockers are oral) FYI: great way to remember zafir-LUK-AST, monte-LUK-AST ARE anti-LUKkotrienes for ASThma
Mast cell stabilizer drugs cromolyn sodium (Intal), nedocromil sodium (Tilad)
Mucolytic Drugs n-acetylcysteine (Mucomyst), dornase alpha (Pulmozyme), sodium bicarb
Aerosol corticosteroids drugs beclamethasone (Vanceril), Budesonide (Pulmacort), flunisolide (Aerobid), fluticasone (Flovent), Triamcinolone (Azmacort)
Late phase anti-asthmatic anti-inflammatory drugs Decadron and salmeterol, by IV or IM
Beta agonist drugs short acting levalbuterol (Xopenex), pirbuterol (Maxair), Albuterol (Provental, Ventolin), bitolterol (Tornalate)
Beta agonist drugs long acting salmeterol (Serevent)
Beta agonist + steroid drugs Advair (salmeterol + Fluticasone}
Anticholenergic drugs atropine, glycopyrrolate (Robinal), ipratropium (Atrovent), tiatropium (Spiriva)
Oral corticosteroid drugs Prednisone
Anti-asthmatic drugs mast cell stabilizers (Intal & Tilade) and leukotriene blockers (Singulair, Accolate & zileutin aka Zyflo)
aerosol Antiprotozoal drugs pentadine (treatment of pneumonia in AIDS patients)
aerosol Antiviral drugs ribavarin (treatment for RSV in infants and children)
Combivent (albuterol + ipratropium) B2 + anticholenergic 1+1+3
beractant Survanta, prophylactic surface tention lowering agent given as surfactant replacement drug via direct installation to preemies
colfosceril Exosurf, synthetic surfactant replacement for preemies
ethyl alcohol Ethanol, drying agent, treatment for fulminant alveolar pulomary edema, dose is 5-15 ml of 30-50% via svn
pentadine Antiprotozoal drug (treatment of pneumonia in AIDS patients)
ribavarin Antiviral drug (treatment for RSV in infants and children)FYI, remember this one because RIBAvarin treats Rsv, Influenza B, and is Anti-VIRus
Advair Beta agonist + steroid drug (salmeterol + Fluticasone)
Prednisone Oral corticosteroid drug
theophylline Xanthines drugs caffeine, used in treatment of apnea in preemies and drug of last resort for COPD
Mucomyst n-acetylcysteine, mucolytic, ,acetaminophen (tylonol) poisoning
Combivent Ventelin and Atrovent Albuterol sympathomimetic bronchodilator,”Proventol, Ventolin”stimulates cAMP, strong B2, mild B1, rapid/short”
prototype anticholenergic atropine
Vanceril beclamethasone, corticosteroids, ,low systemic side effects, rapid absorb, long lasting anti-inflammatory
Tornalate bitolterol, sympathomimetic bronchodilator, stimulates cAMP, strong B2, mild B1, rapid/short, PRODRUG
sympathomimetic bronchodilator PRODRUG Tornalate/ bitolterol
Pulmacort budesonide corticosteroids, , only nebulized steroid, only in 10-20% solution” special nebulizer, do not mix with other drugs
Intal cromolyn sodium, mast cell stabilizer, prophylactic anti-asthmatic, 2-4 week start up, very safe, not an anti inflammatory not for acute symptoms
Pulmozyme Dornase alpha, mucolytic, purulent secretions of CF and bronchiectisis, lyces DNA of bacteria and cellular debri
adrenergic catecholamine drugs Epinephrine, Isoproterenol (Isuprel) and racemic epi (Vaponephrine)
Aerobid flunisolide corticosteroids, ,rapid absorb, short life, several days to ramp up, long term asthma management anti-inflammatory
Flovent fluticasone, corticosteroids, rapid absorb, long life, low side effects, anti-inflammatory
Robinal glycopyrrolate, anticholenergic, drying agent used in bronchorrhea
Atrovent Ipratropium , anticholenergic, blocks ACH, bronchodilation (COPD)
Isuprel Isoproterenol, adrenergic catecholamine, very short duration ,<3 hours, stimulates cAMP, strong a, and B2, vasodilation bronchodilation
Xopenex Levalbuterol, B2-agonist, short acting, single isomer, no a, no B1, very low side effects”
Alupent metaproterenol, resorcinol/beta agonist, strong side affects, slow to reach peak
Singulair montelukast, leukotrine blocker, great for kids with RAD, exercise and maintenance, allergies and asthma-no side effects
Tilade nedocromil sodium, mast cell stabilizer, prophylactic anti-asthmatic, 2-4 week start up, can be used for exercise
Maxair pirbuterol, beta agonist-short acting
Vaponephrine Racemic epinephrine, adrenergic catecholamine, very short duration < 3 hour, strong a, B1, B2, used in croup, swelling and edema from burns or post extubation (never orally), can be given hourly”
Serevent salmeterol, beta agonist-long acting, not a rescue, best for treating chronic asthmatic symptoms
Advair salmeterol+fluticasone, B2-agonist+steroid, long acting management with anti-inflammatory for long term maintenance of asthma
Spiriva tiatropium, anticholenergic, blocks ACH, bronchodilation (COPD)
Azmacort Triamcinolone, corticosteroid
Accolate zafirlukast, leukotrine blocker, side effect-liver failure, not convenient must take on empty stomach
Zyfloe zileutin, leukotrine blocker, extended release pill
Xanthines drug is theophylline (caffeine, used in treatment of apnea in preemies and drug of last resort for COPD
Survanta beractant, prophylactic surface tension lowering agent given as surfactant replacement drug via direct installation to preemies
Exosurf colfosceril, synthetic surfactant replacement for preemies
Question Answer
What does assisting ventilation related to? It relates to an Acute need to resolve a threathening under a ventilation problem
What are the 3 devices used for assisting Ventilation? 1. IPPB 2. BIPAP 3. Resuscitation Bag-valve.
What is IPPB? 1. It is a therapy to improve ventilation but can also provide complete ventilation. 2. the problem is that ventilatory support by mask is only effective during the therapy. 3.Pt. may have ventilatory problems when the treatment is over.
What is BIPAP? It delivers an inspiratory & expiratory pressure. Inspiratory pressure must exceed expiriatory pressure. Actual ventilatory pressure = inspiratory pressure – expiratory pressure.
What are the other names of BIPAP? 1. Bilevel Therapy 2. Non-invasive positive pressure ventilation(NPPV/NIPPV)
What is Resuscitation Bag-valve? 1.Ventilatory assistance can be provided using a bag & mask. 2.It provides full ventillatory support. 3. It is not a long term solution
How do you we react in a situation in which a pt. is having a Foreign Object & is causing Airway Obstruction? 1. Pt. is unable to speak 2. We may hold hand to neck to check sign of breathing & we address the problem by doing ABDOMINAL THRUSTS.
What is the procedure for an ABDOMINAL THRUST? Wrap arms around pt. from behind, place fist mid-abdomen &deliver upward thrust. Periodically check for clear airway/chest movement. Continue thrusts until airway is clear- even if pt. loses HR & Collapses. Before anything we must 1st address ventilation
In what patients are we not suppose to do the ABDOMINAL THRUST? What is the alternative for those patients? If patient is obese/pregnants/infant, use CHEST THRUSTS.
What are the hazards for these procedures – ABDOMINAL & chest thrust? 1. Organ trauma 2.Fractured ribs 3. Cardiac Contusion(chest thrust 4. Pneumothorax. Even if these occurs do not stop CPR.
Question Answer
Anticholenergic action blocks ACH causing bronchodilation
calculating dose mg=mL x % x 10
powder aerosols activated by pt breath, advantage is pt must breath correctly for device to work, no propellant
Checking MDI contents full=fully submerged and upside down in water, 1/2 full= upside down but not fully submerged, empty, canister will float on side
MDI technique hold 1″ from mouth, exhale normally, squeeze MDI at beginning of slow deep inhalation, inhale fully and hold for 5 seconds, exhale-wait 2 mins and repeat.
sympathomimetic bronchodilators method of action stimulate production of cAMP causing bronchodilation
Adrenergic agonist method of action stimulates G protein in bronchial smooth muscle, G protein makes cAMP and cAMP equals bronchodilation
atropine and method of action aka anticholinergic, aka antimuscarinic, blocks ACH receptor sites, causes bronchodilation by blocking ACH, competitive antagonist for M receptor
Cholinergic indirect acting, drug that acts or mimics parasympathetic action, stimulates M receptor
ACH regulation 1. metabolized by enzyme ACHase aka acetylcholinesterase 2. ACH blockers like atropine, Ipratropium or Tiotropium
NE regulation at synapse 1. re-uptake via active transport 2. MOA and COMT enzymes
NE regulation at cells cells regulate NE by increasing cAMP or blocking phosphodiesterase (enzyme that breaks up cAMP)
Un-ionized un-ionized are very water and lipid soluble and absorb quickly, because they are able to pass easily through plasma membrane
Muscarinic receptor site of ACH, parasympathetic, class of drugs that stimulate ACH, action is decreased HR, bronchoconstriction and vasodilation
Potentiation special case of synergism where one has no effect but can increase the effectiveness of the other 1+0=2
Ne norepinephrine, neurotransmitter of sympathetic nervous system, receptors sites are a, B1 and B2
a action vasoconstriction, increased BP, stops bleeding,decrease swelling,
B1 action increased HR, increased contractility, increased cardiac output
B2 action smooth muscle relax, bronchodilation
Metabolism liver * alphabetically e and k come first in alphabet fallowed by l and m, so excretion = kidney and liver=metabolism
Excretion kidneys * alphabetically e and k come first in alphabet fallowed by l and m, so excretion equal kidney and liver equals metabolism, excretions also takes place in lungs and GI tract
ACHase acetylcholinesterase aka ACHE, enzyme that metabolizes excess ACH
Drug absorption many membranes; stomach, capillaries and tissues-3 factors, transport mechanism, lipid solubility and drug ionization (un-ionized)
ACH aka acetylcholine, aka cholinergic, aka parasympathetic, receptor site M, action decreased HR, decreased BP, bronchoconstriction
Potency more physiological effect with smaller dose, more potent-more toxic, lower the effective dose-more potent
Parenteral injectable aka IM, IV
Entral GI tract, pills caplets, suppository, elixir, suspension (most common)
Topical transdermal, cream patch ointment, inhaled, MDI, DPI, SVN, USN, atomized, vaporized
Adrenergic receptor site of Sympathetic NS aka adrenomimetic, receptors sites are a, B1 and B2
Pharmacokinetics quantifies the time required for drug absorption, distribution, metabolism and method of excretion
tid 3 times per day
q4h every 4 hours
qid 4 times daily
bid 2 times daily
drug distribution plasma protein binding, tissue affinity and blood flow
drug transport passive diffusion (most common) moves from high to low, filtration, and active transport
prototype “a drug that acts like” i.e. atropine is prototype anticholinergic and epinephrine is prototype adrenergic
pharmacodynamics studies the actions of drugs on the body, how drugs work
sympathetic nervous system fight or flight aka adrenergic, more dominant side of ANS, functions as a unit, effector site neurotransmitter is Ne. increases HR, increases BP, vasoconstriction, bronchodilation, contractility
LD 50 median lethal dose
TI Therapeutic Index, ratio of LD50 to ED50 indicates drugs safety, lower TI is the more toxic the drug, higher the TI, the safer the drug.
Antimuscarinic specifically blocks m receptor sites
Competitive antagonist competes for receptor site, blocks but has no effect
Functional antagonist effects of two drugs cancel each other out
ED50 effective dose
Idiosyncrasy unexplained or unpredictable susceptibility to a drugs action
Tachyphylaxis rapidly developing tolerance to a drug
Anticholinesterase blocks ACHase enzyme
COMP & MOA enzymes that metabolize excess Ne, can be injected or inhaled
Pharmacology study of drugs and their origin plants animals and minerals
Epinephrine not a neurotransmitter, released by adrenal gland in response to sympathetic activation
Ceiling effect response increases with dose until dosage increase does not increase effect-used to check relative potency of 2 or more drugs
Phosphodiesterase enzyme that breaks up cAMP
Choline esters action stimulate m receptors and mimic effects of ACH
SLUD salivation, lacrimation, urination, defecation; to much ACH to much slud, to much slud –death
Antagonist categories competitive (affinity but no effect), functional (effects of 2 cancel each other), chemical (physically chemically binds in blood stream)
Additive effect two drugs act on receptors to have a combined effect that is the sum of the two drugs effect 1+1-2
Drug info USP, NF, PDR
drug class that includes Albuterol that cause bronchodilation adenergic B-agonist
Synergistic response aka synergism when two drugs are combined and the effect is greater than the sum, 1+1-3
Parasympathetic aka cholinergic, rest and digest, neurotransmitter is ACH, receptor sites are Muscarinic and nicotinic, blocker is atropine, does not function as a unit
MDI on Mechanical Vent medial to pt on circuit, actuate at end expiration adjust dosage as needed, minimum 8 puffs may go to 20, 15 seconds between puffs
High dosing Albuterol effective ceiling is 15 mg, heart neb for continuous, hazard is hypovolemia, decreased k+, increased glucose
Aerosol advantages immediate onset of action at site, reduced systemic side effects, smaller doses, pt can be taught to self admin, convenient and rapidly effective while minimizing side effects
Aerosol disadvantages exact dose is unknown, only 10-20% is deposited, breathing pattern effects airway deposit, 2/3 exhaled, much swallowed, wrong neb or flow effects delivery
Nebulizer flow rates 6-7 L/min * however since neb can run at 10 L/min and not 4 L/min appropriate answer on test is 7-10 L/min
SVN delivery factors inspiratory hold (3-5 seconds) is most important for distribution and retention of meds-slow deep breath, 6 L/min flow for 1-5 micron particles, 2.5-4 ml’s solution, inspiration only
MDI advantages convenient, inexpensive, no prep, new MDI’s are patent actuated and assures proper aspiratory flow and pattern
MDI disadvantages requires pt coordination, pharyngeal deposits, abuse risks, cfc’s 75% of pt’s and 50% of medical workers don’t know how to use them
Mech vent and SVN meds tend to stick to tube or baffle, 1.5 to 3% make it to airway, SVN should be distal to pt in circuit (close to flow source) often requires double dose
Spacer reservoir, improves med delivery, holds in suspension
Bronchodilator side effects tachycardia and shakiness
SVN particle size 1-5 microns
Direct installation giving meds directly down ET tube or trach, 3-5 ml normal dose, no guarantee of dose, most often used for mucus plugging. Disadvantage, violent cough and systemic side effects
Direct installation drugs Epi-cardiac arrest, NS-sputum sample, B2, mucomyst, surfactant in premies.
Combivent ventolen + atrovent combination sympathomimetic and anticholinergic, best with copd’er
Finding active ingrediance mg-mL* % * 10
Bronchodilator categories sympathomimetic (increase cAMP), anticholinergic (block ACH), Xanthines (inhibit Phosphodiesterase increasing cAMP)
Xanthines aka theophylline, caffeine, thrombromine & theophylline, Phosphodiesterase inhibiter, used in treating neonate apnea and bradycardia, long term COPD. Bad side effects.
Finding desired dose desired dose/dose on hand=amount/X example morphine in 10 mg/5mL vial, need 4 mg…..10/5=4/X…..10X/10=20/10…..X=2 vials
Anticholinergic bronchodilators blocks ACH-blocks SLUD, causes decreased secretions, increased HR, bronchodilation, prototype is atropine (bad side effects) Ipratropium is safer alternative, good choice for bronchospasm in COPD with B2 agonist
Swelling & edema treatment alpha (racemic epi)+ steroids. Steroids also treats secretions, treat swelling and secretions will go down too.
what is Bronchoconstriction REDUCED AIRWAY LUMEN , caused by smooth muscle bronchospasm, swelling and edema, excess secretions
the anticholinergic bronchodilators drugs are atropine (prototype), ipratropium (Atrovent) tiatropium (Spiriva) glycopyrrolate (Robinol)
Combovent albuterol + ipratropium (Ventolen + Atrovent), B2 agonist plus anticholinergic
Albuterol dosage .5% mL or 2.5 mg (.5mL+2.5mL NS), MDI 2 puffs 3-4 hrs, rapid onset=5 mins, effective 4-6 hrs aka Provental or Ventolen,
Xopenex dosage aka levalbuteral, single isomer albuterol with no side effects, but very expensive, standard dose .63 mg, max 1.25 every 4-6 hrs
what are catecholamines and what are their actions? strong a, B1, and B2 drugs, cannot be taken orally, (because of stomach MAO & COMT), very short duration 1- 3 hrs, epi, racemic epi (Vapoenephrine), isoproterenal (Isuprel)
the recorcinol drugs are modified catecholamines, resistant to MAO and COMT, terbuterline (stops contractions) and metaproterenol (not used now because of B1 side effects, hard on heart)
the saligenin drugs are albuterol, levalbuterol, (Xopenex) and salmeterol (Serevent)
strong a, B1, B2 drugs epinephrine and racemic epinephrine (Vaponephrine)
Strong B2 agonist drugs levalbuterol (Xopenex) is the only single isomer B2 agonist drug, all others have some B1 effects
Strong B2, strong B1 agonist are Isoproterenol (Isuprel)
strong B2, mild B1 agonist are bitolterol (Tornalate), albuterol, (Provental, Ventolen), pirbuterol (Maxair), salmeterol (Serevent) terbutaline, metaproterenol (Alupent)
Question Answer
Pressure range for PEP 10 to 20 cmH2O
Pressure range for flutter valve 10 to 25 cmH2O
What type Pt benefit most for IPV intrapulmonary percussive ventilation- CF pt who needs meds delivered
What is an IVP airway clearance technique that uses a pneumatic ventilator t deliver a series of small VT’s at high frequency, acts like internal CPT, mostly used to deliver meds to CF
What is MIE mechanical insufflations exsufflation, artificial cough machine, used mostly for pts with neuromuscular, usually at home, press plus 30 to 50 1 to 3 secs then neg 30 to 50 2 to 3 secs, oral nasal mask or trach
What pt benefits most from MIE neuromuscular ie muscular dystrophy myasthenia gravis etc. caustion with spinal shock and avoid abdominal distention with decreased insufflations pressure
8 complications of CPT and actions to be taken hypoxemia, increased intracranial press, hypotention, pulm hemorrhage, pain or injury to muscle ribs or spine, vomit or aspiration, bronchospasm and arrhythmias…follow 3 S rule, stop stabilize stay
What action should be taken for pt who has potential for hypoxemia during CPT admin higher FIO2
What action should be taken if a pt becomes hypoxic during CPT stop, return to resting position, give 100 percent O2, call doc
What action should be taken if a pt has increased intracranial press or gets hypotention during CPT stop, return to resting position, call doc
What action should be taken for a pt who has a pulm hemorrhage during CPT stop, return to resting position, call doc, admin O2, maintain airway til doc comes
What action should be taken for a pt who has pain or injury to muscle ribs or spine during CPT stop, use care return to resting position, call doc
What action should be taken for a pt who vomits or aspirates during CPT stop, clear airway (suction prn) admin O2, return to resting position, call doc
What action should be taken for a pt who has a bronchospasm during CPT stop, return to resting position, admin or increase O2, call doc, admin bronchodilators
What action should be taken for a pt who has arrhythmias during CPT stop, return to resting position, admin or increase O2, call doc
4 complications of PEP pulm barotraumas, increased ICP, cardio probs (hypotention), rash, air swallowing, aspirations, increased WOB
3 phases of autogenic drainage and what happens in each phase 1. Full inspiration followed by breathing at low lung volume to unstuck periph 2. Breathing at low to middle volumes collects mucus in middle airways, 3 evacuation, middle to large volume then huff
4 contraindications of PEP no absolutes, sinusitis, ear infection, epitaxis (nose blead, recent head or face surgery
Frequency range for high frequency chest wall oscillation 5-25 hz (vest)
Frequency range for high frequency chest wall compression is 15 hz for flutter and 1.6 to 3.75 hz for IPV
Describe directed cough mimics directed cough, shoulders forward, head and spine flexed, good teaching instruct on control and exercise muscles for neuro, splint for pain
What is manually assisted cough alternative to directive cough, used for pt who is to week for directive, RT uses pressure to help with expulsion
Describe staccado cough short low output series of coughs, use splint, helps with pain
Describe huff cough open glottis, say huuufff, used in CF, bronchiectisis and emphysema
4 phases of a cough and what happens in each phase 1 irritation, impulse to medulla, 2inspiration, breath in 1-2 liters, 3 compression, glottis close, contraction, alveolar pressure up, (100 mmhg) 4 expulsion, glottis opens press change and contraction expels 500 mph
4 mechanisms that hinder a cough and examples irritation cns, inspiration pain or restriction, compression surgery or nerve damage, expulsion obstruction weakness copd
Absolute pre and post assessments for postural drainage pt vitals (HR RR SPO2) and auscultation to confirm outcome
How do you instruct a pt for PEP therapy explain Huff, inspiration larger thatn normal, but not full, active exhale but not forcefull, pap of 10-20 (use nuemometer), I:E is 1 to 3 10 to 20 breaths if they are still alive, 2 to 3 huffs repeat 4 to 8 times or 20 minutes
Describe ACB active cycle breathing 1. relax and control breathing then 3 or 4 expansion breaths, 2 repeat, 3 repeat then 1 or 2 huff coughs relax control and done
Major factor in contributing to retained secretions ineffective cough, absent or increased sputum production, lobored breathing, decreased BS, crackle, rhonki, tachypnea, tachycardia, fever
Frequency when using IPV 1.6 to 3.75 hz
Who controls percussive cycle in IPV (used with bland aerosol or meds) pt or rt controls
How long does the vest therapy usually last 30 mins
Vest therapy may not be as effective as postural drainage or percussion in what pt CF
Position for greatest lung expansion dangling
clinical signs observed with retained secretions audible breath sounds, deteriorating ABG, xray with infiltrates or consolidation, atelectasis, VQ abnormalities
Areas never to be percussed tender areas, site of trauma or surgery or bony spot
Normal airway clearance requires patent (clear) airway, functioning mucociliary escalator (cilia) and effective cough
Mucociliary clearance mechanism operates from respiratory bronchioles to larynx, we then swallow or spit
Ciliated epithelial cells move secretions via coordinated wave toward the larynx
Why is the cough important it is a protective reflex that keeps a patent airway
The 4 distinct phases of a normal cough are irritation (can be mechanical, chemical, thermal, inflammatory), inspiration (1 to 2 liters), compression (rapid rise in press), expulsion (500 mph displaces mucus from air walls)
Abnormal airway clearance is any abnormality that alters patent airway, mucociliary escalatory, normal cough, or causes retained secretions
Partial airway obstruction can cause increase WOB, air trapping, over distention, and V/Q mismatch (vent/perfusion imbalance)
Which one of the 4 phases of a normal cough can retained secretions interfere with ? all ¬タモ retained secretions cause an ineffective clearance
Mechanisms impairing the cough irritation phase anesthesia, cns depression
Mechanisms impairing the cough inspiration phase pain, neuromuscular dysfunction, pulm or abdominal restriction
Mechanisms impairing the cough compression phase laryngeal nerve damage, artificial airway, abs muscle weakness, ab surgery
Mechanisms impairing the cough expulsion phase airway compression, airway obstruction, ab weakness, inadequate lung recoil (emphysema)
Diseases associated with abnormal clearance of mucus tumor, abnormality, bronchospasm (asthma, bronchitis) CF, Dyskintic Syndrome (impaired cilia)bronchiectisis, poor cough reflex (ALS, MD, etc)
Most common conditions affecting cough reflex are ALS, muscular dystrophy, myasthenia gravis, poliomyelitis, cerebral palsy, and spinal muscular atrophy
The primary goal of bronchial hygiene therapy is to mobilize and remove retained secretions with the ultimate goal of improving gas exchange and reducing WOB
Acute conditions for bronchial hygiene therapy are acutely ill with copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by lung disease
Acute conditions that do not need bronchial hygiene therapy are COPD, pneumonia and uncomplicated asthma
Chronic conditions that usually require bronchial hygiene therapy CF, bronchiectisis, ciliary dyskinetic Syndromes and chronic bronchitis
When getting sputum production info from a patient, use language a pt like Chris can understand, how many buggers in a shot glass? 25 to 30 mL or one fluid ounce
What are the best documented preventive uses of bronchial hygiene therapy body positioning and patient mobilization for acute and PVPD with exercise for CF
PDPV is postural drainage and percussion vibration therapy
5 methods of bronchial hygiene are 1 postural drainage, 2 coughing and expulsive techniques, 3 PAP adjunct (PEP, CPAP and EPAP), 4 high frequency compression oscillation (vest and flutter) 5 mobilization and exercise
The 3 types of postural drainage are 1 turning 2 Percussion (on exhalation) 3 vibration
Turning ration of the body on its longitudal axis, aka kinetic therapy or continuous lateral rotational therapy, pt can do it, care giver can or rotational bed, purpose is to expand lungs and improve oxygenation, mobilize secretions, never with traction, head or
Relative contraindications of turning severe diarrhea, agitation, increased ICP, decreased BP, dyspnea, hypoxia, arrhythmias
Proning and acute lung injuries improves oxygentation w/o affecting hemodynamics and lower FIO2 press on vent, may also decrease further lung injury associated with positive pressure vent in ARDS pt
Plumbing problems and turning always drain vent tubes first, caution with vent disconnection, accident extubation, accidental aspiration of vent condensation, , IV¬タルs, and urinary catheters
Postural drainage is the use of gravity to help move secretions from lobes or segments into central airway, by placing the segmental bronchi to be drained in a vertical position relative to gravity for 3 to 15 minutes
How long should the position be held in postural drainage 3 to 15 minutes
How much sputum does effective postural drainage produce 25 -30 mL/day (1 fluid ounce or 1 shot glass)
Postural drainage technique identify lobe or segment, position pt, avoid aspiration wait 1.5 hrs after food, coordinate treatment with pain meds, explain procedure, take baseline (HR, RR, SPO2, BS), check wiring tubing ect rail up, pt comfortable, restore pt posit,document/follow up
Initial assessment of need for bronchial hygiene therapy from medical records includes history of pulm probs with secretions, admission for upper abdom or thoracic surg, artificial trach, Cxr with atelectasis or infiltrates, PFTs with decreased flow (not enough to cough), ABG or SpO2 values
Initial assessment of need for bronchial hygiene therapy from Patients include posture and muscle tone, ineffective cough, sputum, breathing pattern, physical fitness, breath sounds and vitals
Percussion and vibration refers to mechanical energy to the chest wall by hands, electrical or pneumatic devices to augment secretion clearance. Percussion jars it loose, vibration helps move it along
Documentation and follow up includes pt position, time in position, tolerance, objective and subjective response to tx, sputum color consistency, volume odor and any bad effects of treatments
Directed cough mimics spontaneous cough, helps voluntary control reflex, compensate for physical limits
What is the most effective way to clear the central airways coughing
What is the most effective way to clear the peripheral airways cilia
What are the three important factors for good patient teaching instruction of proper positioning, instruction of breathing control, exercises to strengthen expiratory muscles
Directed cough patient position place pt in sitting position, shoulders rotated inward, head and spine slightly flexed, forearms relaxed or supported, support feet (raise head of bed if needed)
Directed cough technique good deep inspiration, bear down against glottis (straining like stool)
Manually assisted cough applying press to thorax coordinating with forced exhalation
Forced expiratory technique (HUFF cough) a modification to the directed cough, one or two forced expirations of middle to low lung volumes with out closure of glottis, followed by diaphragmatic breathing and relaxation
Active cycle of breathing FET including breathing exercises, and thoracic expansion.
ACB sequence relaxation and breathing control, 3 to 4 thoracic exercises, relax and bc, 3 to 4 thoracic exercise, relax and bc, 1 or 2 huff coughs, relax and breath control
Thoracic expansion exercises big expansive inhalation with relaxed exhalation (may include percussion, vibration or compression)
ACB breathing control involves repeated cycles of breathing control, thoracic expansion and huff or FET
Autogenic drainage is modification of directed cough pt uses 3 phases of inspiration capacity to unstuck, collect and evacuate
Mechanical insufflation exsuffation artificial cough machine, in at 30 to 50 for 1 to 3 seconds then abruptly reversed at negative 30 to 50 for 2 to 5 seconds
PAP adjuncts mobilize secretions and treat atelectasis, CPAP, EPAP, PEP
PEP positive expiratory pressure for post op atelectasis, good for cf and bronchiectisis exhale through valve at 10 to 20 cmh20
Therapeutic effects of PEP improves distribution of inspired volume, prevents airway collapse, generates pressure distal to mucus obstruction
Contraindication to PEP sinusitis, ear infection, nose bleed or epitaxis facial or head surgery, active hempotysis
How long for PEP therapy no more than 20 mins, active but not forcible breathing
What is an effective alternative to postural drainage and percussion that a pt can perform independently with few side effects? PEP
How do you clean a flutter valve disassembled after each use and rinsed in water wash in soap every 2 days and disinfect by soaking in 1 to 3 solution of vinegar and water for 15 mins dry and reassemble
Question Answer
Anatomic Reservoir Fills with O2 during the pause between inspiration and expiration and helps raise the FiO2 in the lungs
Normal Inspiratory Flow Rate 40 to 60 LPM
Nasal Cannula is high flow or low flow system? Low Flow System
Nasal Cannula Fi02 1 Lpm= 24%, 2 Lpm= 28%, 3 Lpm= 32%, 4 Lpm= 36%, 5 Lpm= 40%, 6 Lpm= 44%
Nasal Catheter is high flow or low system? Low Flow System
Simple O2 mask is a high flow or low flow system? Low Flow System
Why is the minimum flow 5 Lpm for a Simple O2 mask? If flow rate is too low, patient will re breathe CO
High Flow systems Designed to satisfy the patients inspiratory demands. Usually use a “mixing cartridge” or other feature.
Low Flow Systems Not designed to satisfy all the patients inspiratory demands
Is the Venturi Mask a high flow or low flow system? High Flow System
Qualifications of a Low Flow System RR<25, normally 8-25; Vt= 350 ml to 700 ml, Respiratory pattern regular and consistent
Is the Non Breathing Mask a high flow or low flow system? Fixed performance high flow system
Non Breathing Mask Fi02= 95%, Two one way valves, Bag, Flow between 10 to 15 Lpm; Bag should never collapse. If so, flow rate is too low.
How to convert from a Non Breathing mask to Partial Rebreathing Mask Remove valves and reduce flow rate by 2-3 L. CO2 does not increase because last 1/3 of air inhaled from the air is exhaled in the bag and the rest of air (CO2) exits the mask.
Continuous Aerosol Oxygen Delivery Devices Trach Collar, Aerosol Tree/Briggs Adapter, Aerosol Mask, Face Tent
Small Volume Nebulizers Used for short time aerosol medication administration “aerosol treatment”
Large Volume Nebulizers Used for artifical airways and patients straight off vent to moisturize throat and vocal cords. Also used on Aerosol Devices
Question Answer
adrenergic receptors AKA adrenoreceptors
these are a class of G- protein coupled receptors that r targets of catecholamines adrenergic receptors
norepinephrine AKA noradrenaline
adrenaline is AKA apinephrine
2 component of catecholamines are eponephrine & norepinephrine
mast cells possess these receptors binding of catecholamine 2 receptor= stimulation of sympathetic nervouse system
catecholamine receptors stimulate _ nervouse system sympothetic
sympothetic nervouse system is responsiable for what bodys response fight-or-flight response
most useful & potent group of Resp. care drugs primaryaly used to relax bronchial smooth muscle & dilates airway; 2ndly effects facillitate mucocilliary transport of secretion & promotes expectoration adrenergic {sympathomimetic} bronchodilators
Both A&B adrenergic activity; if inhaled =quick onset {1-5}minutes; & metabolized quickly; Duration 1-3 hrs prevents release of histamine epinephrine A&B
promote vasoconstriction both in priphery & in lungs= <capillary leakage A adrenergic effects
relax bronchial smooth muscle; ^HR & cardiac contractility & inhibit further release of nnflammatory mediators B adrenergic effects
Catecholamines are good for ONLY the attck
all sympathomimetic B2 __ or derivatives of catecholamine catecholamines
these sympathomimetic amines mimic epinephrine fairly closely catecholamines
Dopamine epinephrine norepinephrine & isoproterenol are examples of.. B2 sympathomimetic
these cause tachycardia elevated BP bronchial & skeletal smoothmuscle relaxation & skeletal muscle tremor & CNS stimulation catecholamines/ epinephrine caution w/ CHF Pt
catecholamines are inactivated by_= limits actions of the drug to1.5-3 hrs; anr r inactivated by the gut {NEVER ORALLY} COMT
catecholamines R also inactivated by _; _; _ they R stored in Amber bottles & residue tubing maybe pink colored Heat light air
these R more B2 specific COMT can longer inactivate drug= duration is > up2 6hrs Can be taken orally cuz not effected by gut or liver Resorcinols
even more B2 specific {albuterol} Available as MDI; Tab.: syrupp; aerosol solution; effective by mouth & up 2 6 hrs Saligenins
levalbuterol (Xopenex) is most common B2 bronchodilator on market; others are Albuterol/Ventolin/Proventil saligenins example drugs
serevent AKA salmeterol
DONT USE IN ACUTE ATTCK lasts up2 12 hrs 2 puffs BIDonset 10-20 minutes w/ pk in 180 minutes Salmeterol {servent}
ion of the bronchial smooth muscle (bronchodilation) 2. inhibits mast cell release 3. stimulates mucocilliary clearance B2 stimulation effects
vasoconstriction A1 adrenergic
^HR ^inotropy ^conductivity B1 adrenergic
B2 stimulation~ ^ adenyl cyclase~ ^ cAMP~ <intracellular Ca+2= bronchodilation break down
in order for histamine 2 be released from the mast cells there must be free _ free calcium
naturally occurs in the adrenal medulla rapid onset/ short duration do2 inactivated by COMT inhaled or S.C. Epinephrine specific adrenergic agents
synthetic form of epinephrine action same as epinephrine + vasoconstrictor effect is 1/2 do to synthetic compensation Tx croup & ^airway swelling/edema Racemic Epinephrine
non-Catecholamines long duration 4-6hrs good 4 maintenance dose 4 BRONCHOPASM inhalation;oral;injection slow pk effect 30-60minutes
tis drug is different cuz administration form must be converted 2 active drug in the body +(pro-drug) Bitoterol (tornalate) prodrug
tremor; tachycardia; headaches; ^BP;nervousness;dizziness N/V; E of adrenergic agents
SE <after _ weeks do to tolerance to adregic agents 2 weeks
Question Answer
AFOSH AFI 91-302
Electrical Safety in MTF AFI 41-203
Hazard Report Form 457
Use this if N95 not available PAPR – powered air purifying respirator
PAPR and N95 are ____ masks HEPA – high efficiency particulate air
Hazardous Waste Management Guide AFPAM 32-7043
Measures amount of radiation exposure TLD – thermolucent dosimeter
Double vision Biplopia
Fixed and dilated pupils Mydriasis
Mydriasis results from catecholamines, atropine, brain death
Pinpoint pupils parasympathetic stimulants, opiates
Eyelid drooping ptosis
Nystagmus involuntary eye movement
JVD indicates right heart failure
Right heart failure is also known as Cor pulmonale
Hemoglobin male 13.5 – 16.5
Hemoglobin female 12 – 15
Hematocrit male (%) 40 – 54
Hematocrit female (%) 37 – 47
Sodium 137 – 147
Potassium 3.5 – 4.8
Glucose 70 – 105
Radionuclide Lung Scanning measures ventilation/perfusion and pulmonary embolism
Positron Emission Tomopgraphy (PET scan) measures lesions and cancer
Pulmonary Angiography measures pulmonary circulation
Urine output (ml/hr) 40 – 80
Inspiratory pressures male (cmH2O) > -75
Inspiratory pressures female (cmH2O) > -50
Expiratory pressures male (cmH2O) > 100
Expiratory pressures female (cmH2O) > 80
Vital Capacity less than ___ (ml/kg) = respiratory failure < 10
PEFR (LPM) > 500
RR (BPM) 12 – 20
VT (ml/kg of IBW) 5 – 7
Minute Volume (LPM) < 10 (normal 6 – 10)
Static Compliance VT/Pplat – PEEP
Dynamic Compliance VT/PiP – PEEP
RAW (cmH2O/L/sec) 0.6 – 2.4
PtcCO2 severinghaus electrode
PtcO2 clark electrode
Increase PETCO2 results in decreased ventilation
CVP (mmHg and cmH2O) < 6 or < 12
CVP measures Right heart
Pulmonary Artery Pressure systolic (mmHg) 20 – 30
Pulmonary Artery Pressure distolic (mmHg) 6 – 15
Pulmonary Artery Pressure mean (mmHg) 10 – 20
PAWP/PCWP (mmHg) 2 -12
Increase in PAWP/PCWP indicates left heart
Hypertension > 160/90
Hypotension < 90/60
SVR (dynes/s/cm-5) 900 -1400; left heart
PVR (dynes/s/cm-5) 150 – 250; right heart
Pre-ductal PaO2 right arm
Post-ductal PaO2 umbilical artery
Pre/post ductal PaO2 difference > 15 torr indicates right to left shunt
If > 15 torr measured recommend this test echocardiogram
CT scan (computed tomography) slices of body – (useful in lung tumors, pneumonia, COPD, bronchiectasis, AIDS)
MRI high technology radiograph imaging technique
IBW equation 50 + 2.3(height inches – 60) 45.5 + 2.3 (height inches – 60) [multiply by 2.2 for pounds]
Pulse Pressure is the difference between systolic and diastolic
Pulse Pressure (mmHg) 30 – 40
MAP (mean arterial pressure) mmHg 80 – 100
Cardiac output fick equation: QC =VO2/C(a-v)O2 ;QC = HR x SV
Cardiac output (L/min) 5 – 8
Polysomnography sleep study
OSA 10s apnea with abdominal efforts
CSA 10s apnea without abdominal efforts
SOB scale Borg 0-10
CXR, PA scapulae are rotated away from lung
CXR, AP heart size magnified
CXR, lateral views lung bases and parenchyma
CXR, oblique projects abnormalities away from overlying structures
CXR, lordotic view lung apex, lingual, right middle lobe
CXR, lateral decubitus affected side down; to determine presence of free pleural fluid or air fluid level in lung
CXR, lateral neck distinguishes between croup and epiglottits
CXR honeycomb, ground glass, or reticulogranular indicates ARDS
CXR heart measurement horizontal width of heart divided by widest width of thorax – 1:2 or less
CXR COPD hyperlucency and bullae
CXR Pneumonia white consolidations
CXR Atelectasis displacement of fissures toward collapsed lung; dicoid or platelike
CXR left heart failure (CHF) cardiac silhouette enlarged
Mild left heart failure interstitial edema, pulmonary vessel margins less sharp, peripheral interstitial markings dominant
Moderate left heart failure short lines, Kerley B Lines
Severe left heart failure alveolar edema resulting in opacification of lower lung zones
CXR pulmonary embolism wedge-shaped infiltrate, right heart failure
CXR ET tube position T4-T5; 4-6cm above carina
ET tube diameter 1/2 – 2/3 of tracheal lumen
Tracheostomy tube 1/2 – 2/3 distance between stoma and carina
Transcutaneous electrode is placed on fatty tissue
Transcutaneous electrode is ___ degrees celsius 44
Patient positioning prevents bed sores, thromboembolism, muscle wasting, atelectasis, pneumonia
Absolute contraindications for repositioning patient unstable spinal cord injuries and traction
Avoid leaving ____ patients in supine comatose / helpless
Radiolucent body tissues that are penetrated by x-rays; produces black area on CXR
Radiodensity ability of object to block x-ray energy, determined by composition and thickness
Radiopaque body tissues that cannot be penetrated produces white area on CXR
Consolidation occurs when fluid present in lung; increase radiodensity
Infiltrate demonstrates area of lung with increased opacity; ill defined
MIP measures muscle strength (diaphragm)
MEP varies depending on function of abdominal, accessory muscles and elastic recoil
Pleural friction rub is also known as pleurisy
Stridor caused by croup, epiglottitis, extubation
Kussmaul’s increased RR and depth / labored (DKA patients)
Biot’s increased RR and depth w irregular apnea
Enlarged and tender lymph nodes respiratory infection
Enlarged, non-tender lymph nodes malignancy, HIV
PERRLA pupils, equal, round, reactive to light and accommodation
Tracheal shift towards atelectasis
Tracheal shift away pneumothorax, pleural effusion, tumor
Two sterile preventative procedures tracheostomy care, open suctioning
Most common method for disinfection pasteurization
Neutropenic immunosuppressed patient
Contact direct and indirect
Droplet 3-6 feet distance, cough, sneeze, talking, rhinovirus, influenza, rubella
Airborne hangs in air longer, legionellosis, TB, varicella
Vehicle waterborne, foodborne
Vector insect
What do we identify when incident occurs identify who is involved (name and ID), identify witnesses
What 3 places can information about chemicals in hospital be found MSDS, Bioenvironmental, CDC