Oxygen Delivery Systems and Pulmonary Tests

What is the most common delivery mode for oxygen?

Nasal cannula

What is the flow rate range for a facemask?

5-10 L/min

What is the FiO2 range for a trach mask/collar?

40-70%

What is the purpose of variable adaptors on a Venturi mask?

To enable selection of flow rates to influence FiO2

What is the purpose of a non-rebreather mask?

To provide high concentration of oxygen (90-100%)

What is the flow rate range for high flow nasal cannula?

25-60 L/min

What is the purpose of positive airway pressure?

To assist in splinting airways open

What is the difference between BiPAP and CPAP?

BiPAP settings can be adjusted separately for inhalation and exhalation, while CPAP settings are fixed for both

What is the purpose of mechanical ventilation?

To provide support to those with respiratory failure or in need of airway protection

What is the difference between ETT and tracheostomy?

ETT is for short term management, while tracheostomy is for long term support

What is the purpose of decubitus views in pulmonary diagnostic tests?

To confirm the presence of an air-fluid level or small pleural effusion

What is the purpose of the lordotic view in pulmonary diagnostic tests?

To visualize the apical or middle region of the lungs, or to screen for pulmonary tuberculosis

Chronic Obstructive Pulmonary Disease (COPD)

A chronic lung disease characterized by poor airflow that makes breathing difficult

Intercostal Spaces

The spaces between the ribs

Hemidiaphragms

The muscular partitions that separate the chest from the abdominal cavity

Costophrenic Angles

The angles formed by the meeting of the diaphragm and the ribcage

Rib Angles

The angles formed between the ribs and the spine

Hila

The area of the lungs where the pulmonary blood vessels, bronchi, and lymph nodes enter and exit

Vascular Markings

The pattern of blood vessels visible on a chest radiograph

Left Ventricular Failure

A condition where the heart is unable to pump enough blood to meet the body's needs

Computed Tomography (CT)

A diagnostic imaging test that uses X-rays to create detailed images of the body

High-Resolution CT

A type of computed tomography that provides high-quality images of the lungs and other organs

Pulmonary Arteriography

A test that uses X-rays and a contrast dye to visualize the blood vessels in the lungs

Emboli

Blood clots that travel through the bloodstream and can block blood vessels in the lungs or other parts of the body.

Magnetic Resonance Imaging (MRI)

A medical imaging technique that uses a strong magnetic field and radio waves to generate images of the body's internal structures.

Gradient Magnetic Field

A magnetic field produced by an MRI scanner that varies in strength across the region of the body being imaged.

Chest Wall Processes

Abnormalities in the chest wall that may involve bone, muscle, fat, or pleura.

Ventilation and Perfusion Scans

Medical tests used to measure the distribution of air and blood flow in the lungs.

Hemoglobin

The protein in red blood cells that carries oxygen throughout the body.

Hematocrit

The percentage of red blood cells in the total volume of blood.

Platelets

Small blood cells that help stop bleeding by forming clots.

Coagulation

The process by which blood clots to stop bleeding.

Arterial Blood Gases

A blood test used to measure the levels of oxygen and carbon dioxide in the blood.

Acid-Base Balance

The regulation of the pH level in the blood by the lungs and kidneys.

Henderson-Hasselbalch Equation

An equation used to calculate the pH of a solution based on the concentration of carbonic acid and bicarbonate ions.

Base Excess

A measure of the amount of excess bicarbonate in the blood.

Respiratory Acidosis

Hypoventilation, Over sedation, Head trauma, NM disorders, Cardiac arrest, Chest trauma, COPD, Pneumonia. Symptoms include tachycardia, confusion.

Metabolic Alkalosis

Loss of acid from GItract or kidney. tany, Hypertonic muscles, Numbness. Vomitting

Metabolic Acidosis

Increased production of acids (ketoacidosis) Fatigue, weakness, DOE. Renal Failure

Respiratory Alkalosis

Hyperventilation, Anxiety/fear/pain, Excessive mechanical ventilation. Pulmonary Embolism

Hypoxemia Severity

PaO2 = 60 to 80 mm Hg—mildly hypoxemic, PaO2 = 40 to 60 mm Hg—moderately hypoxemic, PaO2 = 40 mm Hg—severely hypoxemic.

Radiographic Appearance

Darker areas: radiolucent, Pneumothorax, Bullae, Air bronchograms. Lighter areas: Opacities, “infiltrates”, Blood, Pus, Water.

Diagnostic Test

Usually ordered when a pulmonary embolus is suspected.

Posterolateral Thoracotomy

A surgical procedure used for pulmonary thoracic procedures when minimally invasive approach is not an option.

Median Sternotomy

A surgical procedure used for cardiac procedures, where the great vessels and valves are sometimes approached via a thoracotomy incision.

Invasive Monitoring Arterial Line

A catheter inserted into an artery to continuously monitor blood pressure in severely ill patients with hemodynamic compromise.

Central Line

A central venous catheter inserted through the subclavian or jugular vein for continuous blood pressure management in patients on vasoactive drips.

Pulmonary Artery Catheter

A catheter inserted via a central venous access point to monitor pulmonary artery pressure and cardiac output.

Extracorporeal Membrane Oxygenation (ECMO)

A life support machine used to replace the function of the heart and lungs in people with a severe and life-threatening illness that stops their heart or lungs from working properly.

Inspiratory-focused breathing exercises

Breathing exercises that focus on inhaling air into the lungs.

Incentive spirometer

A device used to help patients improve their lung function by encouraging deep breathing.

Diaphragmatic breathing

A breathing technique that involves using the diaphragm to inhale and exhale air.

Stacked breaths (terminal exhalation)

A technique that involves taking several breaths in quick succession, with a short pause between each inhalation and exhalation.

Progressive volume breaths (intermittent exhalation)

A technique that involves gradually increasing the amount of air inhaled with each breath.

Facilitated segmental breaths

A technique that involves focusing on breathing into specific parts of the lungs.

Inspiratory hold

A technique that involves holding the breath for a brief period after inhaling.

Expiratory-focused breathing

Breathing exercises that focus on exhaling air out of the lungs.

Pursed lip breathing

A breathing technique that involves exhaling air through pursed lips to help improve lung function.

Expiratory prompts

Tools used to help patients exhale air out of their lungs, such as bubbles, kazoos, and pinwheels.

Restrictive Lung Dysfunction (RLD)

Abnormal reduction in pulmonary ventilation due to restriction of expansion by the chest wall or the lungs.

Pulmonary Function Testing (PFT)

A test performed to classify pulmonary disease into one of the two categories (obstructive vs. restrictive).

Fibrotic Disease

Focal lung lesions resulting from an inflammatory process progressing to tissue fibrosis, leading to decreased lung compliance and irregular alveolar spaces.

Sarcoidosis

Uniform, epithelioid, fibrotic granulomas within multiple organs, commonly found in lungs and lymph nodes, leading to diminished breath sounds, dry cough, and fatigue.

Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI)

Diffuse lung injury caused by inflammation, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated tissue.

Pleural Involvement

Inflammation of the pleura, leading to pleuritis, repeated small exudative pleural effusions, and pleural thickening and fibrosis, causing pain and respiratory distress.

Pneumonia

Inflammation of the parenchyma or alveoli following a lung infection, leading to increased mucous production and decreased gas exchange.

Tuberculosis

Infection caused by myobacterium tuberculosis, presenting as a primary infection or a reactivation of a prior infection.

MSK Neuromuscular Conditions

Conditions impacting the shape, strength, or flexibility of the chest wall and/or muscles of respiration, leading to diminished breath sounds, dyspnea on exertion, and decreased chest wall expansion.

Obstructive Disease

A respiratory condition that causes increased resistance to airflow, leading to expiratory impairment, increased volumes, and potentially decreased inspiratory volumes.

Asthma

A respiratory condition characterized by hyperirritability of the tracheobrachial tree, resulting in bronchospasms, inflammation of the bronchioles, and excess mucous secretion, leading to increased resistance to airflow.

Chronic Bronchitis

A respiratory condition characterized by chronic inflammation and swelling of the bronchial mucosa, leading to hypersecretion of bronchial mucous and irreversible lung damage.

Hypoxic Drive

A respiratory consideration in obstructive diseases where chronic hypercapnia blunts the sensitivity of central chemoreceptors to detect changes in CO2, leading to the body's failure to increase respiratory rate to eliminate CO2 excess.

Medical Management of Asthma

Treatment options for asthma, including bronchodilators, corticosteroids, and beta-adrenergic agonists.

Aerobic Training for Asthma

Exercise at moderate to high intensity, recommended for asthma patients for 20 minutes, 2 times a week, for a minimum of 4 weeks, but contraindicated during acute exacerbation.

Signs and Symptoms of Obstructive Disease

Tachypnea, dyspnea, decreased and/or adventitious breath sounds, chronic (potentially productive) cough, and characteristic musculoskeletal changes.

CXR in Obstructive Disease

Hyperinflation with flattened diaphragm, radiopacities revealing regions with retained secretions, and cough instruction.

Signs and Symptoms of Chronic Bronchitis

Cyanosis and barrel chest deformity, shortness of breath, dyspnea on exertion, tachypnea, and chronic productive cough.

Emphysema

Destruction of elastic fibers surrounding the alveoli given deficiency of alpha 1-antitrypsin. Decreased number of alveoli, increased size of alveolar sac and ducts, thereby reducing elastic recoil. Overall reduced surface area for gas exchange.

COPD

Chronic Obstructive Pulmonary Disease. A chronic respiratory disease that causes airflow obstruction, making it difficult to breathe. This condition is typically progressive and can lead to significant morbidity and mortality if not managed effectively.

Bronchiectasis

A chronic respiratory condition characterized by an abnormal widening and thickening of the bronchi, the airways that branch off from the trachea and lead to the lungs. This widening and thickening can cause mucus buildup, making it difficult to clear the airways and leading to recurrent infections.

RLD

Restrictive Lung Disease

PFTs

Pulmonary Function Tests

Volumes and Capacities

Measures of the amount of air in the lungs and how much can be moved in and out

Flow Rates

The speed at which air moves in and out of the lungs during breathing

Diffusion Capacity

The ability of the lungs to transfer oxygen from the air into the bloodstream

Restrictive disease

An inspiratory impairment that reduces all lung volumes, not just inspiratory volumes. Caused by decreased compliance of lung or chest wall and reduced inspiratory effort.

Compliance

The ability of the lung or chest wall to stretch and expand.