_______ can decrease peripheral circulation and cause a falsely lowered O2 saturation
hypothermia
fingernail polish cannot penetrate though it, what is the alternate site for O2 measurement?
ear lobe
which CXR view is typically done?
PA and lateral studies
which CXR view for bed bound patients?
AP view
when to order CXR
- suspecting disease of the lungs, mediastinum, heart, or chest wall
- suspecting systemic disease and suspicion of chest involvement
- monitor life-support devices to make sure it is inserted correctly
- pneumoperitoneum (gase in abdominal cavity)
on AP CXR view, which structure is falsely enlarged?
heart
ABG is used to determine
- pH of blood
- PaO2
- PaCO2
- HCO3
- O2 sat
most common sites to do ABG
- radial artery
- brachial arter
- femoral artery (used in ICU patients)
indications for ABG
- asses for hypoxia and severity
- evaluation of acid-base disorders
- assess need for home O2 use (chronic patients)
- measure CO-Hb levels in patients suffering from smoke inhalation or other exposures
- calculate arterial O2 saturation content
- blood sample in difficult draw patients (obese)
calculating arterial O2 saturation
ABG cannot differentiate between O2 and CO, so subtract O2 sat and CO-Hb to get actual O2 saturation
relative contraindications to ABG
- invasive procedure
- coagulopathy
- severe PAD with poor collaterals (Allen’s test)
- trauma or infection at draw site
- difficult to standarize d/t factors such as hyperventilation, breath holding, altitude, obesity
what degree should bevel be when inserting syringe for ABG?
45 degrees
equipments for ABG
- sterile gloves
- rolled towel to support wrist or elbow
- ice for transport to lab to slow down blood metabolism
- ABG kit
ET/NT tube intubate indications
- resp failure
- airway protection
- maintaince of airway
- help facilitate pulm tx and meds
- use pos pressure ventilation
- maintain adequate oxygenation
ET/NT tube intubation contraindications
- operator unskilled
- excessive trauma to face, neck, c-spine (relative)
- inability to extend the head and neck (ET)
risk when sedating conscious patients for ET intubation
- rapid IV admin of sedative can cause sudden drop of BP
2. fast acting mm relaxant might cause arrhythmias and post-op myalgias
blades used for ET intubation and location of insertion
- curved blade - into the vallecula
2. straight blade - below epiglottis
verification of ET tube placement
- look for symmetrical rise of the chest wall
- listen for equal breath sounds b/l and over the epigastrium
- Do CXR to confirm placement is correct
chest tubes indication
- pneumothorax causing resp distress
- hemothorax
- large pleural effusions causing resp distress
- empyema
- post thoracotomy
chest tubes contraindication
- small pneumothorax not causing resp distress
- pleura adherent to the chest wall
- coagulopathy (relative)
- previous chest tube in the same site
patient position for doing chest tube
lateral decubitous position with affected side up
where to place the chest tube and why
5th and 6th intercostal space in MAL because are below this will risk injury to diaphragm or liver
appropriate size chest tube for pneumothorax and hemothorax
pneumothorax - 22-24 French straight
hemothorax - 32-36 French straight of right angled
where to anesthetize for chest tube
top edge of rib to avoid neurovascular bundle
