TMC Green Sheet Review

How do you size a nasopharyngeal

from the pts nostril to the angle of the jaw to earlobe (conscious patients)

How do you size a oropharyngeal airway?

from the corner of the patients mouth to the angle of the jaw. (unconscious patients only)

if you have an inserted trach tube and you bag the patient and feel resistance, what would you do if subcutaneous emphysema develops?

take the trach tube out

10 mL of 1% albuterol solution how much would do you give?

give 0.5% mL give is 2.5mg of albuterol bc every 1mL of the 1% solution contains 5mg of albuterol

xray of a CHF

engorged pulmonary vessels, fine crackles and enlarged heart

apnea monitor alarms were intermittent sounding, what is wrong and how do you fix it?

electrode is not adhered properly

A patient on CPAP nasal mask, pressure set at 12cm H2O, pressure dips down to 5cm h2o. Blood pressure hypotensive

change to a full face mask

what would you use to monitor the patient's ventilatory status during transport?

capnography (ventilation)

DPI: patient had residue on the inhaler at the mouthpiece

pt had a insufficient flow

steriod inhaler

wash out mouth and hold the breath

a normal ABG that included the HgB that was 28

verify the results

Getting an ABG on a burn victim, severe burns on lower half of the body?

radial stick

CHF questions, would give symptoms and how do you treat?

CPAP or Diuretics (fursemide)

COPD pt had a DNI order, ph was out of range (acidosis)

put them on NPPV

pt was minimally arousable were they?

obtunded

What is the maximum SpO2 for a patient to qualify for home O2 at rest?

88%

pick a mode of ventilation that would reduce barotrauma

Volume, Pressure

NBRC states the patient had a systolic pressure of 80 and you need to collect an ABG

brachial

you are aiding a physician in inserting an A-line in the radial artery, the hand goes blanched, would you?

take the catheter out

administration of proper oxygen therapy to an emphysema patient what would that do?

increase PaCO2

Auto peep which breath would you observe it on?

flow-time scalar

Vent settings with no ABG: all settings were normal, but there would a PIP of 40 and a pPlat 20, no characteristics of the patient:

give a bronchodilator

vent settings with no ABG, peep of 15, fiO2 was 45, SpO2 was 97%. what would you wean?

decrease peep

21 day old neonate, elevated thymus, hilar region has increased lucency. What is wrong with pt?

Pneumo-mediastinum

contraindication to the apnea test?

administration of nimbex (cisatracurium besylate)

TB patient having orange sputum on rifampin, what causes the orange sputum?

benign effect of rifampin

Normal ICP

5-15 mmHg

Cleaning of the bronchoscope?

glutaraldehyde

You have to intubate a patient during transport on an ambulance. What landmark would you use?

visualize the cords

Administration of proper oxygen therapy to an emphysema patient, what would that do?

increase paco2

Beak waveform: everything was normal. Peak pressure was 28, ARDS pt, peep of 5, FIO2 was 80%.

NRBR doesn't want to change vent modes.

which patient would benefit from a prone position to increase oxygenation?

cystic fibrosis

Pt has gross hemoptysis and weight loss, find the source of the hemoptysis, or what is causing it?

bronchoscopy

over-distention loop. Lower part of the wave form was lying flat on the line below it. How do you fix?

increase peep

patient position for thoracentesis procedure?

sitting up and leaning over

Shock- what position would the patient be placed in?

trendelenberg

Vomiting- what position would you place patient in?

lateral flat

alveolar distention wave form- how do you fix the top of it>

decrease vt or pip

Neonate-described a neonate that had a pneumothorax: percussion, hyperresonate, diminished breath sounds on one side tachycardic. How would you determine what is wrong?

chest xray

What is this rhythm and how you treat it?

Epinephrine-patient is in vfib

Suspect the pt has TB, what question would you ask?

do you vomit blood?

What equals FRC?

ERV+ RV

Finding mip what would you use?

pressure manometter

PCWP 24, no history of pulmonary disease or disorder?

left ventricular end volume

Respiratory lung compliance is low what disorder is it?

interstitial edema

weaning criteria calculations are correct except?

VD/VT of 45

Cerebral palsey and CF, what therapy would you use?

IPV with a mask

Suction pressure set at 100 mm Hg suction is not working:

check the connect

to calibrate a pneumotachometer, you would use?

3.0 L syringe

FEV1/FVC is lower than predicated, what further tests are needed to confirm COPD?

lung volume

Hypertonic saline tx, patient has a bronchospasm, what would help prevent bronchospasm before the next tx?

give albuterol pre treatment

When we do a cardiac stress test do we terminate the test if they starting having PVC?

terminate the test

Which of the following concentrations of oxygen is used to balance point of calibration of the electrode of an arterial blood gas analyzer?

0%

Prior to performing pulmonary function testing on several patients, a respiratory therapist is performing quality control on the pneumotachometer. After injecting a 3.0 L syringe through the pneumotachometer, the therapist notes a measurement of 2.81 L. Based on this result the therapist should

B: avoid patient testing

While preparing for pulmonary function testing on a patient, the respiratory therapist notices that the disinfection pouch that contains the reusable mouthpiece has been breached. The therapist should

D; utilize the mouthpieces for patient testing. Although the mouthpiece container is breached, sterilization is not required for patient use. Since a patient's mouth is not considered a sterile area, simple disinfection is sufficient.

While facilitating extubation, the patient should be instructed to do which of the following while removing the ET tube?

inhale as the tube is being removed

CCase scenario Your patient with a smoking history has progressive worsening dyspnea on exertion

you should be thinking pulmonary fibrosis

What type of emphysema is typically seen in genetic Alpha-1 Antitrypsin deficiency?

Panlobular emphysema. - Prolastin is the medication which helps this type of emphysema.

Your asthma patient has episodes that are not linked to a specific antigen, they are not seasonal, and IgE levels are normal. This is...

Intrinsic Asthma, sometimes known as Atopic Asthma, often episodes are caused by exercise, cold air, emotion, or other factors

Your patient has a DNR order, but the patient's spouse expresses to you that she wishes to have that order changed. What should you do?

Notify the attending physician immediately. The ability of the spouse to alter the order will be impacted by his/her status as a Healthcare Proxy (Durable Power of Attorney for Healthcare

lung cancer

a large tumor would obviously be restrictive, but a tumor encroaching a bronchus would produce obstruction

Your patient tells you that she does not want any "heroic" measures to lengthen her life.What should this be documented in?

Advance Directives (you have heard of course of Living Will, but the term for testing is Advance Directive)

CVP catheter, "central line" where should it be located?

The tip in the superior vena cava

K+

Range: 3.5-5.5 mEq/L

Na

135-145 mEq/L

Cl-

80-100 mEq/L

Creatinine

Normal range 0.7-1.3 mg/dL - two kids, one is 7 and one is 13 Anything above 4.0 mg/dl indicates renal failure

BUN

Normal range 8-25 mg/dL - my 25 year old gf has great 8 BUNs 70 or above is renal failure

Hct

Normal 40-50%

Platelets

150,000-400,000 mm3 - polycythemia if over 400,000

WBC

Normal 5,000-10,000 per mm3 - elevated in bacterial infection, reduced in viral infection

Troponin

A useful test for heart attack, myocardial infarction (MI). CK-MB - slow! Troponin level above 0.1 microgram per ml is abnormal and may indicate a heart attack

Which pulmonary diagnosis is often associated with Polycythemia?

Emphysema - and certainly other chronic diseases with longstanding low PaO2, but emphysema most common

Your adult patient's hemoglobin level is 21 mg/dl.. What is the likely assessment? -

polycythemia

the patient is on diuretics You should be very careful to monitor.

Electrolytes, and potassium in particular. Often the patient presents with leg cramps.

CHF patient is taking furosemide for diuresis and he develops leg cramps. The likely cause...

hypokalemia, low potassium. Furosemide (Lasix) is well known for washing out potassium. Bumetanide - Bumex

Common Respiratory Gram-Negative Organisms: "Mycins kill the Gram Negatives"

· Haemophilus influenzae - Epiglottitis, Sinus Infections · Enterobacter species · Pseudomonas aeruginosa - CF, Bronchiectasis

Gram Respiratory Gram-Positive Organisms: "Cillins kill the Coccasuses"

· Streptococcal species - sore throat, pneumonia · Staphylococcal species - abscess, surgical infections

Normal Neonatal ABGs

PH: 7.25 - 7.40 PaCO2: 45 - 59 PaO2 : 50 - 70 - normal BE: 0 to -4

what can be obtained from a spirogram (spirometry) :

IRV, TV, ERV, FEV1

What Cannot be obtained from a spirogram:

RV, FRC, TLC - must use Helium Dilution, Nitrogen Washout, Body Plethysmography

Which Lung Capacity is being measured when the patient does Incentive Spirometry

that is the Inspiratory Capacity maneuver

What is the volume of air that can be exhaled below normal tidal volume?

This is Expiratory Reserve Volume (ERV) - again the name actually gives you the answer. Refer to the Spirogram above

What is the volume of air that can be inspired above normal tidal volume?

This is Inspiratory Reserve Volume (IRV). Notice that the name actually tells you the answer

Your ask your patient to take his deepest breath in and then exhale completely. What capacity are you measuring?

Vital Capacity

Chest radiography is the first diagnostic step in patients with

pneumonia, cancer, and chronic obstructive pulmonary disease (COPD).

CT should be carried out in patients with

tumors, acute pulmonary embolism, pulmonary hypertension, pulmonary fibrosis, and advanced COPD, and in at-risk patients with pneumonia.

· MRI of the lungs yields clinically relevant extra information and avoids radiation exposure. It is most clinically useful in diagnosing

cystic fibrosis, acute pulmonary embolism, pulmonary hypertension, and bronchial carcinoma.

2:1 L:S ratio

infant lungs are mature

<2:1 l;s ratio

lungs arent mature

What scale helps differentiate between a premature infant and just a smaller infant?

• Dubowitz ScaleThe higher the score, the higher gestational age in weeks. Normal is 40, >40-post term, <40-preterm.

What is pitting edema associated with?

CHF

Normal Urinary Output

Approximately 1 ml per kilogram of body weight per hour. So, if the patient is producing less urine than that, they are likely retaining fluid. More urine output would indicate that something is producing a diuretic effect.

Weaning Values

A-a Gradient: less than 300 mmHg, on 100% oxygen VD/VT: less than .60 RSBI <150

What condition is known to significantly impact the accuracy of pulse oximeter readings?

Shock - 80/50 or below, the low BP and poor tissue perfusion often makes it impossible to obtain a reliable SpO2 reading on patients in shock Pulse Oximeter readings are considered unreliable at SpO2 saturations below 70%. - in that situation you must get an ABG in order to have reliable data.

ECG Oscilloscope

This is just an old term for an ECG/EKG monitor, any kind of monitor