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Glasgow Coma Scale

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is used to assess level of consciousness after head injury. Eye=4: verbal stimuli 3, to pain 2 Mouth=5: confused 4, inappropriate 3, incoherent 2. arm=6, localize pain 5, withdraw from pain 4, flex to pain 3, extension to pain 2. 8 or less intubate

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Changes in CVP can indicates

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changes in Fluid balance, decreased CVp6 can indicate hypervolemia

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Orthopnea

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difficulty breathing except in the upright position, CHF patients

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General malaise

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Electrolyte imbalance - nausea, weakness, headache

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Hemiparesis

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abnormal posturing, could indicate brain injury.

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Miosis

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pinpoint pupils

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ptosis

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drooping of the upper lids

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diplopia

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blurred or double vision

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nystagmus

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cyclic movement of the eyeballs

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Erythema

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redness of the skin

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Ecchymosis

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subcutaneous hematoma or bruises

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Tracheal Deviation: Pulled to Abnormal side

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Pulmonary atelectasis, Pulmonary fibrosis, diaphragmatic paralysis

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Tracheal Deviation: Pushed to normal side

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Massive PE, Tension Pneumothorax, Neck or Thyroid tumors outside of lung

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Flat or Dull sounds

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flat- heard over the sternum, muscle or areas of atelactsis, dull- heard over fluid-filled organs, heart or liver (PE, or pneumonia)

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If PaO2 increases with Oxygen therapy

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then the patient has a V/Q Mismatch 66- 300 torr

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If PaO2 does not increase with Oxygen therapy then

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the patient has a shunt >300 torr

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Arterial Oxygen Content (CaO2)

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Best measurement of oxygen delivered to the tissues, Normal = 17-20 vol% ml/dL

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Mixed Venous Oxygen Content (CvO2)

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Total amount of oxygen carried in the Mixed venous blood, Normal = 12 - 16 vol%, CvO2 values will decreases when Cardiac output decreases

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C(a-v)O2 difference will increases when the CvO2 is decreases and would indicate

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decreasing in Cardiac output

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Arterial-Venous Oxygen Content Differences C(a-v)O2

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normal :4 - 5 %

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Shunt Equation (Qs/Qt)

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For every 100 A-aDO2 = 5% shunt, 300= 20% shunt; (5x3) + Normal 5 = 20%

question

calculating PAO2

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(FiO2 x 7) + 10 A-aDO2 = PAO2 - PaO2, Alveolar-Arterial Oxygen Gradient

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P/F Ratio

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Normal 380 or greater, Mild ARDS = Less than 300, Moderate ARDS = Less than 200, Severe ARDS = Less than 100,

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Arterial catheter with Pressure transducer should be at

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- should be at the level of heart, - if transducer is placed above the heart, reading are lower than actual, -if transducer is placed below the heart, reading are higher than actual,

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PAP inserted through

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the jugular or subclavian vein are position in the the pulmonary artery approximately 50cm of catheter is inserted, if >50cm of catherete is inserted - catheter is curling in the right atrium or right ventricle, Ballon should be deflated and the catheter withdrawn

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PAP normal

answer

25/8, Mean 14

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PCWP, pulmonary Wedge Pressure

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4-12 mmHg Left Heart

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MAP (systemic Arterial System) Mean Arterial PRessure

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120/80

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CVP Systemic Venous System (Central Venous Pressure)

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2-6 mmHg or 4-12 CmH2O

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Normal Cardiac Output (Qt)

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4-8 L/min

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Normal Cardiac Index (CI)

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2-4 L/min

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Pt with Right Heart Failure (Cor Pulmonale, Tricuspid Valve stenosis) indicates

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elevated CVP and low PAP

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Pt with Lung Diseases ARDS, PHTN, Pulmonary Embolism indicates

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elevated PAP and Elevated CVP

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Pt with Left Heart Failure ,CHF, Pulmonary Edema, Mitral Valve Stenosis indicates

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Elevated PCWP

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Normal Pulse Pressure

answer

40 mmHg

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Normal SVR, Systemic Vascular Resistance

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Normal <20 mmHg/L/min or 1600 Dynes, Indication of Left ventricular afterload

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Normal PVR, Pulmonary Vascular Resistance

answer

Normal <2.5 mmHg/L/min or 200 Dynes, Indicatation of Right ventricular afterload

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RBC, Red Blood Cell

answer

4-6 mill, High RBC, polycythemia occurs with chronic tissue hypoxemia COPD, Low RBC, anemia- occurs with blood loss or hemorrhage

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Hb, Hemoglobin

answer

12-16

question

Hematocrit (Hct)

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40 - 50%

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WBC (white Blood Cell)

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5,000 - 10,000, increased WBC - leukocytosis - bacterial infection, decreased WBC - leukopenia - viral infection,

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WBC, Eosinophils increase with what Chonic condition?

answer

Asthma

question

WBC, Monocytes increase with what chronic condition?

answer

TB

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WBC, Neutrophils increase with what chronic conditions?

answer

COPD

question

Potassium (K+)

answer

3.5-4.5, major intracellular cation, Hypokalemia = occurs with metabolic alkalosis (excessive exretion, renal loss, vomiting, diarrhea), HyperKalemia = Kidney failure

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Sodium (Na)

answer

135-145, Major extracelluar cation controlled by kidneys, hyponatremia = fluid loss from diuretics, vomitting, fluid gain from CHF , Hypernatremia = dehydration

question

Chloride (Cl)

answer

80 - 100

question

Magnesium (Mg)

answer

1.7-2.4

question

Calcium (Ca)

answer

4.5 - 5.2

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Troponin

answer

a protein found in Myocardial cells, Troponin Levels>0.1 place the pt at high risk for death from MI

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Brain Natriuretic Peptide (BNP)

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Secreated by the cardiac muscle when heart failure, Normal value is 100 indicate CHF

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Lactate

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4.5-19.8 mg/dL, 0.5-2.2 mmol/L

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Platelet Count

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150,000 - 400,000

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APTT, activated Partial Thromboplastin Time

answer

24 - 32 seconds , if >100 sec may cause spontaneous bleeding. used for monitoring heparin therapy

question

PT, Prothromblin Time

answer

12-15 sec, Used for monitoring warfarin /Coumadin therapy

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INR (International Normalized Ratio)

answer

0.8 -1.2, if on warfarin therapy (2 - 3)

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Thrombocytopenia

answer

Persistent decrease in the number of platelets in the blood that is often associated with hemorrhagic conditions. Characterized by Spontaneous bleeding (nose bleeds, bleeding gums), platelet count < 50,000

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Thrombocytosis

answer

characterized by high platelet counts, related to acute inflammatory reactions or trauma

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CO-Oximetry

answer

used to diagnose Carbon Monoxide poisoning , normal COHb 1-3%, High as 15% on smokers

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Creatinine

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waste product that is filtered by the kidney, 0.7-1.3 mg/dL, best indicator of Renal Function

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BUN (blood Urea Nitrogen)

answer

7-20 mg/dL

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ARDS on X-ray

answer

Ground Glass Appearance, Honeycomb Pattern, Bilateral patchy infiltrates Diffuse bilateral radiopacity

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Pulmonary Edema on X-ray

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Fluffy infiltrates or Butterfly/Batwing pattern

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Atelectasis on X-ray

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Patchy infiltrates or platelike infiltrates

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Pneumothorax on X-ray

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Deep Sulcus Sign, presence of lung marking on a CT scan

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Pleural Effusion on X-ray

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Concave shape border or basilar infiltrates with Meniscus

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Term Opaque means

answer

fluid, solid - consolidation on xray, pneumonia or PE

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Hyperlucency on Xray means

answer

Extra pulmonary air (COPD, Asthma attack, Pneumothorax

question

Vascular Markings indicates

answer

increased with CHF, absent with pneumothorax

question

Term Diffuse means

answer

spread throught (atelectasis/Pneumonia

question

PET scan used for

answer

useful in determining the presence of cancer, brain disorders and heart disease

question

PVC, premature ventricular contractions give

answer

Oxygen and Amiodarone

question

1st and 2nd Degree AV block give

answer

Atropine

question

Myocardial Ischemia

answer

Reduced blow flow to tissue, is indicated by inverted T wave in EKG

question

Myocardial Injury

answer

acute damage to tissue

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Myocardial Infarction

answer

necrosis or death of tissue

question

Spiked T waves in EKG shows

answer

Hyperkalemia

question

Infarction is diagnosed by

answer

significant Q waves in EKG

question

Mallampati classifications

answer

Class I: soft palate, uvula, fauces, pillars visible, Class II: soft palate, uvula, fauces visible, Class III: soft palate, base of uvula visible, Class IV: Hard Palate only visible, Class III & IV are considered difficult intubation

question

Double-Lumen or Endobronchial Tube ,Carlens Tube

answer

Independent lung ventilation, Uncontrolled unilateral hemoptysis

question

Most Definitive ways to diagnose brain death

answer

best option is Brain perfusion study Apnea Test ,pt must be normothermic , EEG-

question

Rhabdomyolysis

answer

A condition in which damaged skeletal muscle breaks down rapidly,which releases Myoglobin. It can damage the kidneys. Diagnosed with Urinalysis, Treated with Fluids or dialysis, Mostly seen on obese or bedridden pts, or pt who might be trapped in the collapsed home after tornado.

question

Cystitis

answer

Inflammation of the bladder. Causes pain on urination

question

What treats bacterial Pulmonary infection

answer

Levaquin - Levofloxacin

question

What is used to treat fungal infections

answer

Diflucan -Fluconazole

question

Increasing a arterial catheter length can cause

answer

noisy waveform

question

Best way to increase arterial oxygen content for a patient with severely low hemoglobin and refuses blood?

answer

place pt on CPAP at 100%

question

Pulmonary contusion

answer

Caused by chest trauma. Blood and fluid accumulate in lung tissue. it interferes with gas exchange

question

Ascites

answer

fluid in the abdomen caused by liver failure. common causes of ascites include liver disease or cirrhosis

question

Alveolar Oxygen Tension, PAO2

answer

FiO2 x 7 - PaCO2 +10 A-aDO2 = PAO2 - PaO2

question

If the PaO2 increases with oxygen therapy, then the patient has a

answer

V/Q mismatch

question

If PaO2 does not increase with oxygen therapy, then the patient has a

answer

shunt

question

Elevated BNP levels > 100 pg/ml are associate with what pathology? Brain Natriuretic Peptide

answer

CHF, if its <100 then indicates COPD

question

what bacteria are identified by an acid-fast stain?

answer

TB

question

When Patient has high pulmonary artery pressure, PAP, it means that

answer

pt has a problem with his after-load, pt has lung problem

question

Diaphoresis

answer

Heavy sweating, heart failure, fever, infection

question

Tactile fremitus

answer

vibrations that are felt by the hand on the chest wall

question

abnormal heart sound, S3 & S4

answer

S3- may suggest CHF, S4- is indicative of cardiac abnormality such as Myocardial infarction or cardiomegaly.

question

EKG

answer

Ischemia is indicated by a depressed or inverted T wave, Inverted T waves can also be caused by digitalis toxicity and hypokalemia. Injury is indicated by an elevated S-T segment, Infarction is diagnosed by significant Q waves, HyperKalemia will cause elevated or spiked T waves.

ACCS Review Part 1 Respiratory – Flashcards

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