TMC special procedures

at what pressure is most HBO therapy conducted?

between 2-3 atmosphere pressure absolute (ATA)

what is the benefit of INO therapy? when is it indicated?

• acts like a pulmonary vasodilator which improves blood flow and PaO2 but does not affect systemic blood pressure

• indicated for pulmonary hypotension

what is the standard dose of INO? dose should not exceed what? what are teh side effects of INO therapy?

• 20-40 ppm

• should not exceed 80 ppm

side effect: methemoglobin (Met Hb) levels may increase

what is a thoracentesis? what condition is it most commonly used?

diagnostic or therapeutic procedure that in which a needle is inserted into the chest to remove fluid from the pleural space

pleural effusion

in a thoracentesis where is the needle inserted?

7th or 8th intercostal space

An AHI of what is considered mild sleep apnea? moderate? severe?

mild: 5-15

moderate: 16-30

severe: >30

on CPAP what should the starting pressure be for a peds patient > 12 yrs. and adults? when should you initiate NPPV?

3-5

initiate NPPV if:

• pt can’t tolerate high pressures on CPAP

• continues obstructive respiratory events when pt reaches CPAP of 15

what is the initial settings on NPPV for peds pt. > 12 yrs. and adults?

IPAP: 8-10

EPAP: 3-5

when should supplemental oxygen be added?

when patient has an SpO2 of < 88% on room air while in supine position

what king of pneumothorax reqyire a chest tube?

> 20% pneumothorax

where is a the chest tube placed to drain air? where is it placed to drain fluid?

AIR: 2nd intercostal space mid clavicular

FLUID: 5th- 2nd intercostal space mid axillary

what is the purpose of the collection bottle with chest tubes? where should the bottle be positioned?

collects fluid from the pleural space by using gravity

bottle should be below patient

in the water seal bottle where should the water level be? what is seen in this chamber when there is a pneumothorax present?

2 cm

bubbling

in the water seal bottle a patient who is spontaneously breathing should have bubbles when? when patient is on positive pressure? what does continuous bubbling mean?

spont.: bubbling during exhalation

positive pressure: bubbling during inspiration

continuous: should be reported indicates air leak

what does the water in the suction control bottle determine? what does continuous bubbling indicate?

water height determines the amount of negative pressure

continuous bubbling indicates proper suctioning pressure set on vacuum

what should you do if chest tube becomes disconnected or breaks and the patient is spontaneously breathing? if the patient is on positive pressure?

spont: submerge chest tube in a glass of water

positive pressure vent: leave the tube open to air until new system can be set up

when removing chest tube what must be done first? when removing what must the patient do?

tube must be clamped for 24 hours prior to removal

when removing pt. takes a deep breath, exhales and preforms a valsalva maneuver (exhale against closed airway)

for cardiopulmonary stress testing what must be done before the test? what is teh formula for maximum heart rate?

history and physical exam

resting ECG

determine pt maximum heart rate

220 - age in years

when is infant apnea monitoring indicated?

pt. at risk for periods of significant apnea (> 20 sec)

pt at risk for SIDS

what are teh risk factors for SIDS?

• one or more apparent life- threatening episodes

• sibling of a SIDS baby

• preterm infant with significant apnea

• snoring in infants

when is cardioversion indicated?

non life threatening arrythmias:

unstable atrial fibrillation

unstable atrial flutter

stable ventricular tachycardia

with cardioversion is synchronization on or off? when is the electric shock delivered?

ON

shock delivered on the R wave of ECG

what shoudl you do if ventricular fibrilation occurs with cardioversion?

• check pt pulse

• turn off synchronization

• immediately defibrillate

what medication is given before cardioversion?

midazolam (versed) strong short acting sedative

when is defibrillation indicated? is synchronization on or off?

pulseless ventricular tachycardia

ventricular fibrillation

synch is OFF

intrahospital vs interhospital transport

intra: within hospital

inter moves pt from one facility to another

what is the most important equipment needed for transport? what should be considered when using air or oxygen cylinders to power vents?

• intubation equipment

• portable oxygen

• transport vent if pt if on mechanical ventilation

duration of flow must be considered for cylinders

what distance in miles is an ambulance used to transport? helicopter? airplane?

ambulance: 0-80 miles

helicopter: 81- 150 miles

airplane: > 150 miles

cuff pressure varies with altitude as you go up you should? as you go down?

going up: decrease cuff pressure

going down: increase cuff pressure

how is apnea testing done for brain death determination? how is diagnosis confirmed?

1) disconnect pt form vent while administering 100% O2 and monitoring SpO2

2) observe pt for any chest or abdominal movements that produce adequate tidal volume

3) absense of respiratory movements indicates positive test and supports diagnosis of brain death

confirmation of diagnosis is done by cerebral perfusion scan (cerebral angiogram)