Details Title: 000 Kettering B Description: Kettering B pulmonary testing Total Flash Cards: 55 Created: 09/17/2009 15:53:30		New Users: To study from this flashcard set, or to create your own your own study flash cards, REGISTER HERE. Existing Users: CLICK HERE. Additional Health Care Flashcards
Cards in this set: Term When would you choose femoral arterial blood draw Definition emergency situation, radial and brachial not palpatable Term What is a capillary sample Definition heel stick, arterialized, PO2 is not trustworthy, don't use blood gases from capillary sample for oxygen therapy; can use for pH and CO2 and acid-base status Term What would be a good place to obtain oxygen status on newborn Definition ubilical Term How do you best check for collateral blood flow before doing an ABG Definition MODIFIED allen's test (make sure MODIFIED, not plain allen's test) - should be positive Term How long do you apply pressure to an ABG stick Definition 3-5 minutes, if on blood thinners then longer until stops bleeding however long it takes Term What happens to PO2 and CO2 if there is an air bubble in the blood gas sample Definition PO2 will rise to equilibriate with the air bubble, the CO2 will equilibriate toward zero to equilibriate with the bubble Term What happens if the blood gas sample does not get drawn immediately nor cooled Definition metabolizes - PO2 burns up and CO2 is produced (opposite of air bubble) Term What would you do if too much heparin contaminated the blood gas sample Definition obtain another specimen; would have false readings Term How do you calibrate an ABG analyzer Definition put in a known value and if the value comes out incorrect, adjust until matches - would do a high value and a low value. Would calibrate for PCO2 and PO2 Term Levey-Jennings Chart Definition quality control, standard deviation of 1 or 2 is acceptable and considered in control, values are plotted on a chart - OK if everything falls within the boundary of 2 standard deviations Term What would be the calibrating value of 5% of a gas Definition 5x7 = 35 which would be a reasonable range Term content equation - best index of oxygen transport CaO2 Definition Hemoglobin and saturation are key factors; if you know normal, you can choose an answer into the high teens (approaching 20, anything higher throw it out) - good blood gas, good saturations, good hemoglobin, good PO2. If bad, lower teens (below low teens, throw out) Term PAO2 (alveolar air equation) PAO2 patient on 50% O2 with PaCO2 40 torr with barometric pressure of 747 - estimate Definition (FIO2 x 7) - alveolar CO2 (shortcut is Arterial CO2 + 10) - 50x7 = 350 - 50 = 300 - also remember that 50% FIO2 = 300 so estmate that 100% FIO2 would be 600's; etc Term A-a gradient - Example: 50% Fio2; blood gas has PO2 of 80 Definition Calculate the big A (alveolar air equation) - blood gas (PO2) ; 300 - 80 = 220 (approx) Term Venous Content - CvO2 Definition "Bad arterial" with regard to values. Draw venous blood from an artery - pulmonary artery at end of swan ganz (pulmonary artery) catheter. LOWER TEENS what we expect on venous blood gas. It represents cardiac function (cardiac output, cardiac index). Want to know how heart is working, obtain venous sample.REMEMBER VENOUS CONTENT IS DIRECTLY RELATED TO CARDIAC OUTPUT) Term arterial venous oxygen content difference C(a-v) O2 Definition "high teen" vs "low teen" ; normal would be 4 or 5 and represents cardiac function, so if good cardiac output then normal number. If cardiac output drops, content difference goes higher Term PaO2/Fio2 ratio or P/F ratio - Definition to determine acute lung injury or ARDS. Normal values are above 300 approaching 400, if dropping below 300 then you have acute lung injury, below 200 would be ARDS Term Cardiac Output - Qt Definition 4-6 liters Fick equation is oxygen consumption divided by a-v difference. It is measured through hemodynamics Term Shunt equation Qs/Qt Definition Normal shunt is 5%; therefore, add A-a gradient to get shunt (5 for every 100). So normal is 5 plus say 15 for 300 (A-a) Term SaO2 Definition estimate by looking at PO2 and adding 30 (for PO2's in the range of 40-60) Term Vd/Vt ratio (deadspace ventilation/tidal ventilation Definition comparing blood gas with exhaled. Normal values are 20's 30's up to 40. blood gas CO2- exhaled CO2/blood gas CO2. If original values are normal, then answer will be normal. Exhaled drops, deadspace goes up; exhaled goes up, deadspace goes down Term What is the primary cause of deadspace Definition pulmonary embolism Term Desired Minute Volume Definition Minute Ventilation times blood gas x CO2 = desired ; actual VE x blood gas CO2 = desired Vex desired CO2 Term what is the relationship between chronic and compensated Definition synonyms Term What is partial compensated Definition outside the range of pH, there is an attempt to compensate - bicarb and CO2 are changing in same direction. TIP - if one of the answers says partial, be suspicious that it is the situation Term Mixed compensated Definition CO2 and Bicarb are going in opposite directions, both contributing to the problem. Term Special pathologies, exceptions to the rule Definition type 1 - ABG good, patient feels bad. Type 2, ABG is bad, patient looks good Term What are three special pathology exceptions to rule Definition CO poisoning, anemia, pulmonary embolous Term How could you tell the difference between CO poisoning vs anemia vs pulmonary embolus Definition patient history, patient will feel terrible but blood gas is bad. Co-oximetry to determine, 100% oxygen for treatment, "all of the sudden" would be pulmonary embolus Term COPD - blood gas exception to the rule Definition blood gas looks bad, patient is ok. Recognize pattern of chronic lung patient with CO2 50's - 60's and PO2 also in 50's and 60's, pH will be compensated (on acidotic side but within acceptable standard deviation) Term What factors can shift the Hb dissociation curve Definition shift to left - decreased H+ (increased pH), decreased PCO2, decreased temperature, decreased 2-3 DPG; shift to right - increased H (decreased pH), increased PCO2, increased temp, increased2-3 DPG. SO right is decreased affinity; left is increased affinity. Know what would cause the patient to become hypoxic Term What is a spirometer Definition device that measures volume; calculates flow by volume vs. time is the flow time curve Term pneumotachometer Definition device that measures flow. Gets volumes based on measurement of flow Term How do you calibrate a spirometer Definition use a 3 L syringe Term Gas analyzer Definition galvonic fuel cell (galvonic means fuel cell) Term MIP/MEP device Definition pressure manometer - measures inspiratory and expiratory pressures Term slow vital capacity - SVC Definition volumes which measures restrictive disease Term Most important volume Definition Vital Capacity - IRV + Vt + IRV Term What goes with restrictive Definition volume Term What is the only indicator for restrictive lung disease Definition VC (anything with vital capacity in the wording) - if decreased, restrictive disease. If normal, not restrictive Term Restrictive vs Obstructive Definition VC/volume is restrictive; flow is obstructive Term What is most important flow rate Definition FEV1 Term What is most important ratio Definition 1 second ratio Term FEV1/FVC Definition 75% - should be able to blow out 75% or more in one second, and if not you have obstructive problem Term With regard to pulmonary diagnostic testing, what do you look for Definition looking to see if obstructive or restrictive - VC - if normal, not if bad then restrictive. FEV1/FVC - obstructive if less than 75% - if both bad, both problems, if neither one, acceptable Term pre and post bronchodilator testing Definition minimum increase of 12% or 200 mL is standard, small amount - doesn't go up at all, do not bronchodilator (6% - 7% not significant enough) Term Flow/Volume loop Definition skinny is bad volume - restrictive; up and down is flow so if it's bad, then obstructive Term PFT - predicted normal Definition compared with predicted for that individual, affected by AGE, HEIGHT, GENDER Term What are the classifications of Interpretation Definition 80% - 100% predicted = normal; 60-79% predicted - mild; 40-59% predicted = moderate; <40% of predicted = severe (kind of like the PO2 of a blood gas) Term What are the Obstructive Diseases and what are the Restrictive Diseases Definition Obstructive is - CBABE (cystic fibrosis, bronchtis, asthma, bronchiectasis, emphysema) everything else is restrictive - EVERYTHING Term What is the purpose of bronchcoscopy Definition therapeutic and diagnostic - can visualize the trachea and bronchi Term Why would the bronchoscopy be used during intubation Definition suspected neck fracture, nasal intubation using bronchoscope since cannot use laryngoscope for neck fracture Term Procedure summary for bronchoscopy Definition topical anesthetic is administered to control the gag/cough reflex and prevent laryngospasm (a "cain" like lidocaine), intubation is preferred but not required, scope is inserted and airways are viewed, oxygen needs to be provided to the patient via mask or by removing one prong of the nasal cannula from the nose to allow for insertion of the scope. Diagnostic and/or therapeutic procedures are performed Term Hazards and complications of bronchoscopy Definition mild epistaxis (nasal bleeding) - most common; internal hemorrhage and can be controlled with saline lavage and time. Instill epinephrine for strong bleeding, compress, insert a fogarty catheter; bronchospasm/laryngospasm are possible (bronchodilator or anesthetics); pneumothorax is possible when taking tissue samples Term What are contraindications for bronchoscopy Definition refractory hypoxemia, bleeding disorders, cardiovascular instability, status asthmaticus, marked hypercapnea