Respiratory Procedures

Question 1

5th vital sign

Answer 1

pulse ox

Question 2

messed up pulse ox

Answer 2

fingernail polish
hypothermia - decreased periph circulation
carboxy-hemoglobin

Question 3

carboxyhemoglobin

Answer 3

pulse ox doesn’t discriminate oxyhemoglobin vs. carboxyhemoglobin

carbon monoxide - may give false high pulse ox

Question 4

CXR

Answer 4

typically P-A and left lateral studies**

Question 5

correct CXR

Answer 5

9-10 ribs posteriorly

5-6 anteriorly

Question 6

when to order CXR

Answer 6

disease of lung, mediastinum, heart, chest wall

systemic disease with chest involvement

monitor life support devices** ensure correct placement

pneumoperitoneum - gas in abdominal cavity

Question 7

reading a CXR

Answer 7

technical quality of film

RIP - rotation, inspiration, penetration

Question 8

white on Xray

Answer 8

opacity - more dense tissue

black - air

Question 9

heart size on CXR**

Answer 9

transverse size of heart divided by transverse diameter of hemi-thorax should be <0.5

Question 10

hemi-diaphragm

Answer 10

on CXR

right usually higher (due to liver)

Question 11

AP CXR?**

Answer 11

with AP - heart will be enlarged

so PA - will show not falsely enlarged heart

Question 12

limits of CXR

Answer 12

patient cooperation

technician skill

normal CXR can correlate poorly with actual disease**

Question 13

early pneumonia

Answer 13

may not show infiltrate on CXR

Question 14

pulmonary embolus

Answer 14

normal CXR

Question 15

COPD, chronic bronchitis, asthma

Answer 15

increased PA diameter

increase retrosternal air space

Question 16

ABG

Answer 16

arterial blood gas
-acid-base and oxygen status of patient

pH
PaO2
PaCO2
HCO3
O2 sat

Question 17

common sites of arterial blood

Answer 17

radial artery
brachial artery
femoral artery

Question 18

ABG indications

Answer 18

assess for hypoxia
acid-base disorders
home O2 use
measure carboxyhemoglobin**
calculate O2 sat
blood sample - difficult draw patients - very obese patients**

Question 19

calculating arterial O2 sat with CO poisoning

Answer 19

O2 sat - CO Hg

ABG machine - cannot differentiate O2 and CO hemoglobin

Question 20

ABG machine

Answer 20

cannot differentiate between O2 and CO

Question 21

allens test

Answer 21

severe PAD with poor collaterals

contraindication for ABG

Question 22

ABG collection

Answer 22

• sterile gloves
• put it on ice
• lidocaine - maybe - you’re just sticking patient 2x

Question 23

allens test

Answer 23

radial and ulnar - occlude

squeeze hands until pale

release ulnar - to make sure it works

Question 24

ABG collection

Answer 24

• palpate artery
• allens test
• 45 degree to skin bevel up**
• blood will fill syringe
• apply firm pressure with gauze - up to 5 minutes**
• put sample on ice

Question 25

ET/NT tube intubation indications

Answer 25

``` resp failure airway protection maintain airway faciitate pulmonary tx and meds positiv pressure ventilation maintain oxygenation ```

Question 26

ET/NT tube intubation CIs

Answer 26

unskilled operator facial trauma inability to extend head and neck for endotracheal**

Question 27

only way to give 100% oxygen

Answer 27

through intubation

Question 28

C spine injury

Answer 28

use a nasotracheal

Question 29

prep for ET tube placement

Answer 29

- determine method - make sure equipment works - ensure IV access** - remove foreign bodies - hyperventilate - monitor - have appropriate staff

Question 30

before ET tube placement

Answer 30

ensure IV access

Question 31

rule of pinky finger

Answer 31

for size of ET tube

Question 32

contemplate sedation

Answer 32

for conscious patient

Question 33

rapid sequence intubation

Answer 33

to sedate - rapid sedative - propofol, thiopental, midazolam risk is sudden drop of BP

Question 34

sellick maneurver

Answer 34

cricoid pressure to assist intubation

Question 35

intubation position

Answer 35

sniffing position

Question 36

curved blade insertion

Answer 36

into vallecula - over epiglottis with cords in view - insert tip - to 21cm mark women or 23 mark men tip should be 4cm above carina

Question 37

straight blade insertion

Answer 37

just below epiglottis lift scope up and forward insert tip with cords in view

Question 38

verify ET tube placement

Answer 38

look for asymmetric chest wall listen for equal breath sounds b/l and over epigastrium do a CXR

Question 39

chest tube placement

Answer 39

5th and 6th ICS MCL - least amout of muscle don't go below - risk of injury to diaphragm/liver patient - lateral decubitus

Question 40

pneumothorax

Answer 40

22-24 french straight

Question 41

hemothorax or pleural effusion

Answer 41

32-36 french straight or right angled

Question 42

chest tube procedure

Answer 42

anesthetize subQ tissue avoid neurovascular bundle - inferior aspect of rib incision just superior to lower rib of interspace

Question 43

pneumothorax tube direction

Answer 43

posteriorly toward apex

Question 44

fluid tube direction

Answer 44

posteriorly keeping in dependent position

Question 45

water seal

Answer 45

at 20cm of water suction petroleum gauze

Question 46

once chest tube in place

Answer 46

- water seal it - have pt cough - sterile gauze - CXR to confirm placement**

Question 47

spirometry

Answer 47

quantitative measure of lung function based on air flow rates and lug volumes simple graph plot - volume as function of time PFT - flow-volume loop

Question 48

spirometry limitations

Answer 48

pt debilitation severe resp distress not motivated meds affecting resp cycle

Question 49

FEV1

Answer 49

forced exp volume in 1 second

Question 50

FVC

Answer 50

total exhaled volme

Question 51

average flow of rate during middle 50% of FVC

Answer 51

FEF 25-75

Question 52

V-Q scan

Answer 52

evaluate presence of blood clots or other abnormalities in ventilation/circulation

Question 53

CI VQ scan

Answer 53

kidney failure

Question 54

two step scan

Answer 54

VQ ventilation - gas xenon or technetium perfusion - IV technetium gamma camera

Question 55

VQ results

Answer 55

normal | low probability 80%

Question 56

multiple segmental perfusion deficits with normal ventilation

Answer 56

high probability