ABG measures what? What is Calculated?
Measured:
- pH
- PaCO2
- PaO2
Estimated:
- HCO3
What are the four life functions and what order do they go
... [Show More] in to fix an issue?
- Ventilation
- Oxygenation
- Circulation
- Perfusion
Out of the four life functions, which one is the most common problem?
Oxygenation
What does HPI stand for?
History of Present illness
What is the pack years equation?
# of packs per day X number of years smoked
How many pack years are significant and usually indicate possible COPD?
20 pack years
Calculate the pack years:
4 packs per day
10 years of smoking
4 packs x 10 yeas = 40 pack years
If a patient has a change in prognosis, what should you look for?
Change in orders
(To start new methods of treatment)
What is a normal urine output?
40 mL/hr
(approximately 1 Liter/day)
Difference between CVP Swan Ganz catheter and Central line?
CVP Swan Ganz = 2-6 mmHg
CVP Central Line = 4-12 cmH20
What does Medication Reconciliation mean?
To check whether or not the medications that a patient is on match the ones they use at home if possible
If carbohydrates are increased, how does that affect the RQ (Respiratory Quotient)?
↑ Carbohydrates = ↑ RQ = ↑ CO2
Rapid weight loss vs Rapid weight gain?
Rapid weight loss = Cancer
Rapid weight gain = Fluid overload
Recommended diet for COPD patient?
Recommended Diet:
↑ Proteins
↑ Fats
↓ Carbohydrates
Peripheral Edema shows what?
Excessive fluid in the tissue
How is Peripheral Edema Rated?
+1, +2, +3, etc. the higher the number, the greater the swelling
What causes Peripheral Edema?
- CHF (Congestive Heart Failure)
- Renal Failure
What does Ascites mean?
Accumulation of fluid in the abdomen
(Usually caused by Liver failure)
Clubbing of fingers is caused by?
Chronic Hypoxemia
Chronic hypoxemia is defined as?
↓ PaO2 for a long period of time
Venous Distention is usually seen in what patients and when should you look for it?
CHF
(Seen during exhalation in obstructive air trapping patients)
How do you test for peripheral circulation?
Using Capillary Refill by blanching the hand and waiting for color to return
What is a normal Capillary Refill?
≤ 3 seconds = normal
What does Diaphoresis mean?
Profuse/heavy Sweating
What patient usually has Diaphoresis during the night?
Tuberculosis
(Night Sweats)
Jaundice is caused by?
increased bilirubin levels in the blood and tissue
(Usually alcoholics)
What does Erythema mean?
Redness of the skin
Erythema is usually a sign on what type of patients?
CO poisoning
(Carbon monoxide)
What are the 3 stages to checking skin integrity?
Stage 1 = Redness/warm to touch
Stage 2 = Skin is broken
Stage 3 = Crevice (Can go past the fatty tissue)
Pectus Carinatum shows what?
Anterior protrusion of the sternum
(Pigeon Chest/Bird beak)
Pectus Excavatum shows what?
Depression of the sternum
(Excavate = to dig, so it digs down into the chest)
Pectus excavatum is usually seen with what kind of patients?
CHF
Kyphosis shows what?
Convex curvature of the spine (Forward lean)
Scoliosis shows what?
Lateral "S" shape curvature of the spine (Lean side to side)
Kyphoscoliosis is a combination of Kyphosis and Scoliosis and shows what kind of lung pattern?
Restrictive pattern
(Reduced lung volumes)
↓ Vital Capacity
Barrel Chest shows what?
Increased Anterior Posterior Diameter
(Puffed up like a balloon)
Barrel Chest is usually seen in what type of patients?
COPD
(Due to lose in elasticity in lung muscles from air trapping for a long amount of time)
What does Eupnea mean?
Normal breathing pattern
What is a normal respiratory rate for adults?
12-20 bpm
What does Apnea mean?
absence of breathing
What does Cheyne-Stokes breathing pattern show?
Gradually increasing then decreasing rate and depth in a cycle lasting 30-180 seconds with periods of apnea lasting up to 60 seconds
What patients show Cheyne-Stokes?
- Increased ICP levels
- Brainstem Injury
- Drug overdose
What does Biot's breathing pattern show?
Increased respiratory rate and depth with irregular periods of apnea
What patients show Biot's?
- CNS problems
- Brain injury
What does Kussmauls breathing pattern show?
Increased Respiratory Rate, increased depth, irregular rhythm, breathing sounds labored
What patient show Kussmauls?
Diabetics
What does Apneustic mean?
Prolonged gasping inspiration followed by extremely short, insufficient expiration
(Fish/Guppy breathing)
Severe, Marked, or Profound indicate what type of issue?
Emergency
What are the normal muscles of ventilation?
- Diaphragm
- External intercostals
What are the accessory muscles of ventilation?
- Internal intercostals
- Scalene
- Sternocleidomastoid
- Pectoralis Major
- Obliques
- Rectus abdominis
Accessory muscle use indicates?
↑ Work of breathing
What does Atrophy mean?
Muscle wasting
What does Cachexia mean?
Extreme muscle atrophy
(Muscle Wasting)
What does Retractions mean?
Chest moves inward during inspiratory efforts instead of outward
Retractions are usually seen in what type of patients?
- Severe airway obstruction
- Respiratory Distress
What is the most two most common signs of respiratory distress in infants?
- Nasal Flaring
- Grunting
If an asthmatic is not well controlled, what is a good indicator?
Dry non-productive cough
Dry non-productive cough can indicate?
Possible tumor in lungs
What does Macroglossia mean?
Enlarged Tongue
What score is used to visualize the soft palate, uvula, and fauces?
Mallampati Score
What is the purpose of the Mallampati score and how is it measured?
To see if a patient will be difficult to intubate or not
Measure from I-IV
(The higher the number the harder the intubation)
If a Mallampati score is III or IV, what device do we need to use to intubate?
Fiberoptic bronchoscope
What is a normal pulse for an adult?
60-100 bpm
What drug is used to treat bradycardia?
Atropine
A change in _____ bpm indicates an adverse reaction?
20 bpm or more increase means we need to stop the treatment
What does Paradoxical pulse/pulsus paradoxus mean?
Pulse/blood pressure varies with respiration
> 10mmHg drop in systolic blood pressure during inspiration
Paradoixcal pulse/Pulsus paradoxus may indicate?
Severe air trapping
How to tell which way the trachea will deviate?
Inside the lung = Toward
Outside the lung = Away
Examples:
Inside:
- Atelectasis
- Pneumonia
Outside:
- Pneumothorax
- Pleural effusion
- Tumor or mass
What is Tactile fremitus?
Vibrations that are felt by the hand on the chest wall
Fremitus shows?
Patient has secretions
What does Crepitus mean?
Extra pulmonary air under the skin
What patient shows Crepitus?
Subcutaneous emphysema
What do each of these breath sounds mean:
- Resonant
- Flat
- Dull
- Tympanic
- Hyperressonant
Resonant = Normal air filled lungs (Hollow sound)
Flat = Fluid filled or bone
Dull = Fluid filled
Tympanic = Air filled stomach (Increased volumes)
Hyperresonant = Extra air filled
Hyperresonant can indicate unilateral or bilateral lung issues, what is shown with each?
Unilateral = Pneumothorax
Bilateral = Emphysema
What does Vesicular mean?
Normal breath sounds
What does Adventitious mean?
Abnormal breath sounds
Bronchial breath sounds are normal and are heard where?
Over the trachea and bronchi
If bronchial breath sounds are heard over the periphery, this would indicate?
Lung consolidation = Pneumonia
What does Egophony mean?
Patient is instructed to say "E" but it sounds like "A" this indicates consolidation of the lung
Coarse crackles (rhonchi that clear with a cough) show what?
Large airway secretions
If a patient has coarse crackles, what should we do?
Suction them
Fine crackles/rales indicates?
Alveoli are full of fluid
- CHF
- Pulmonary Edema
If a patient has fine crackles/rale, what should we do?
- Positive pressure
- Positive inotropic agents
- Diuretics
What is the most common breath sounds heard from a bronchospasm?
Wheeze
Unilateral vs Bilateral wheeze?
Unilateral = Indicates Aspiration/foreign body obstruction
Bilateral = SABA needed
Stridor indicates?
Upper airway obstruction
(high pitched or crowing inspiratory sound)
What are some things that commonly cause stridor?
- Supraglottic swelling (Epiglottis)
- Subglottic swelling (Croup/post extubation)
How do we treat stridor?
- Humidified O2
- Racemic Epinephrine
- Corticosteroid
- Heliox
What does Stertor sound like?
Noisy breathing during inhalation
(Low pitched snoring type of sound arises from vibration of fluid)
What does Pleural friction rub sound like?
A coarse grating, raspy, or crunching sound
What is Pleural friction rub usually indicated in?
- Pleurisy
- Tuberculosis
- Pneumonia (Possibly)
What does Pleurisy mean?
Inflammation of the lining of the lungs
What is a heart murmur?
abnormal heart sound is typically due to a leaky valve
(Blood going the wrong direction)
What does Bruits mean?
sound made when turbulent blood is going through a narrowing
(Carotid artery is a good place to check)
What device do we use to measure cuff pressures?
Sphygmomanometer
What is a normal Blood pressure Systolic/Diastolic for an adult?
120/80 mmHg
What are the normal ranges for Systolic and Diastolic?
Systolic = 90-140 mmHg
Diastolic = 90-60 mmHg
Increased blood pressure indicates cardiac stress, which causes?
Hypoxemia
Decreased cardiac stress indicates poor perfusion, which causes?
Hypovolemia
What level should the right hemidiaphragm be at on an CXray?
6th anterior rib
If the right hemidiaphragm is higher than 6th anterior rib on a CXray, it indicates?
Air trapping
Under exposed vs Over exposed CXray?
Under exposed = White out
Over exposed = Black out
(Black in over exposed because Xray penetrates matter, so there is too much penetration)
White vs Black on Xray?
Black = Radiolucent
(Air filled)
White = Radiopaque/Radiodense
(Solid/Fluid)
Right cardiac border vs Left Cardiac Border?
Right Cardiac Border = 2 bulges
- Superior Vena Cava
- Right Atrium
Left Cardiac Broder = 3 bulges
- Aorta
- Pulmonary Artery
- Left Ventricle
Crowding of ribs together is a sign of?
Atelectasis
Straight or Horizontal ribs indicates?
Air trapping
(Ribs should have some curvature)
What is a standard Xray? [Show Less]