PFT, Chest X-Ray, and EKG exam

What are the four Volumes of the lungs? page. 166

Residual volume (RV)

Inspiratory reserve volume (IRV)

Expiratory reserve volume (ERV)

tidal volume (Vt)

What are the four capacities of the lungs? page. 166

Total lung capacity (TLC)

Vital capacity (VC)

Functional residual capacity (FRC)

Inspiratory capacity (IC)

What is tidal volume (Vt)? page. 167

volume of air inhaled or exhaled during each normal breath

What is inspiratory reserve volume (IRV)? page. 167

maximal volume of air that can be inhaled over and above the inspired tidal volume

What is expiratory reserve volume (ERV)? page. 167

maximal volume of air that can be exhaled after exhaling a normal tidal breath

What is residual volume (RV)? page. 167

volume of air remaining in the lungs after a maximal exhalation

What is total lung capacity (TLC)? page. 167

maximal volume of air in the lungs at the end of a maximal inhalation

What volumes is TLC a sum of? page. 167

RV + Vt + ERV + IRV

What is functional residual capacity (FRC)? page. 167

volume of air present in the lung at end-expiration during tidal breathing

What volumes is FRC a sum of? page. 167

RV + ERV

What is inspiratory capacity (IC)? page. 167

maximal volume of air that can be inhaled from the resting end-expiratory level

What volumes is IC a sum of? page. 167

Vt + IRV

What is vital capacity (VC)? page. 167

maximal volume of air that can be exhaled after a maximal inhalation

What volumes is VC a sum of? page. 167

IRV + Vt + ERV

STUDY THIS!!!

know all of the volumes and capacities as well as their normal values.

What are the normal values of the volumes of the lungs? page. 166

IRV- 3100 ml

Vt- 500 ml

ERV- 1200 ml

RV- 1200 ml

What are the normal values of the capacities of the lungs? page. 167

TLC- 6000 ml

VC- 4800 ml

IC- 3600 ml

FRC- 2400 ml

What is Forced vital capacity (FVC)? page. 168

total volume of air that can be exhaled during a maximal forced expiration effort

What is Forced expiratory volume (FEV1)? page. 168

volume of air exhaled in the first second after a maximal forced inhalation

What is FEV1/FVC? page. 168

proportion or percentage of the FVC expired during the first second of the maneuver

What is FEF25%-75%? page. 168

average flow occurring between 25% and 75% of the FVC

What does FEF25%-75% measure?

It measures the function of the small airways, which are crucial for airflow resistance in obstructive lung disease.

What does the X-axis on a flow volume loop show? page. 169

Volume

What does the Y-axis on a flow volume loop show? page. 169

Flow

What is true during an FVC vs. SVC measurement?

In an obstructive disease pattern, the SVC will be greater than the FVC

What are the normal values for a PFT?

Normal: 80-100%

Mild: 60-79%

Moderate: 40-59%

Severe: less than 40%

In restrictive lung patterns are volumes increased or decreased? page. 173

Decreased

In obstructive lung patterns is flow increased or decreased? page. 173

Decreased

Can FRC be directly measured? page. 174

No, they cannot be directly measured

What are the three ways that FRC can be measured? pages. 174-176

Closed-Circuit Helium Dilution

Open-Circuit Nitrogen Washout

Body Plethysmography

What is Boyles law?

at constant temperature, pressure and volume of a gas are inversely related

What is Charles law?

at constant pressure, the volume of a gas varies directly with its temperature

What is Gay-Lussac's law?

at constant volume, the pressure of a gas varies directly with its temperature

Changes in lung volumes and capacities

Understand how restrictive, normal and obstructive are impacted

What is the normal airway resistance in healthy adults?

0.5 to 2.5 cm H20/L/S

What is a normal DLCO?

80-120%

How do you calculate airway resistance? page. 179

PIP - Pplat/flow

What is the minimum compliance a patient can have in order to wean?

20 ml/cm H2O

What is bronchoprovocation test? page. 181

A test that uses a methacholine to try and trigger a bronchospasm that helps determine the level at which airway response occurs

What does bronchoprovocation testing help with? page. 181

rule out a diagnosis of asthma

assess the severity of airway hyperresponsiveness (AHR)

evaluate for occupational asthma

assess response to airway hyperresponsiveness (AHR) treatment

What is a common test done for asthma patients?

Peak flow

Which volumes can be directly measured?

Tidal volume

Expiratory reserve volume

Inspiratory reserve volume

Which capacities can be directly measured?

Inspiratory capacity

Vital capacity

Which volumes/capacities are indirectly measured?

Residual volume

Total lung capacity

Functional residual capacity

What quality control must be done for a Levey Jennings chart?

If there is an outlier outside of the lines, the machine must be recalabrated

What is the most important factor of PFT?

A well-trained energetic therapist

What are the factors that affect PFT results?

Age

Gender

Height

Weight

What are the four patterns for a PFT?

Normal

Obstructive

Restrictive

Mixed

What happens when doing a methacholine challenge test?

The therapist gives a dose then records FEV1, then gives a bigger dose then records FEV1 and continues to do so until the capacities drop 12%, if they drop 12% a bronchodilator is given to bring the patient back to their baseline.

How is a calibration test done for volume? page. 170

calibration check with a calibrated 3-L syringe

When looking at a chest X-Ray what are the five things we look at?

A: Airway

B: Bones

C: Cardiac

D: Diaphragm

E: Everything else (that's important)

What are the angles of the diaphragm called?

costophrenic angles

What is the notch above the heart called?

cardiac notch

What side does the trachea shift to if the patient has a pneumothorax?

The trachea shifts away from the affected side

What side does the trachea shift to if the patient has atelectasis?

The trachea shifts towards the affected side

How many ribs should be able to be counted on a chest X-ray?

8-10 Ribs

If a patient has a visible artificial airway on a chest X-Ray how far above the carina should it be?

3-5 cm

What is an enlarged heart on a chest X-Ray called?

cardiomegaly

How can we determine if the heart is enlarged on a chest X-Ray?

More than half the diameter of the chest

If the diaphragm on a chest X-Ray looks flattened what is that indicative of?

Air trapping, hyperinflated lungs

What are five findings on a chest X-Ray of someone who has COPD that someone else may not have if they don't have COPD

flattened diaphragm

less curved ribs

can count more than 8-10 ribs

hyperinflated lungs

Increased intercostal space

Heart becomes more narrow due to hyperactivity inflation

On a normal ECG rhythm, what are the events that occur for the P, QRS, and T waves?

P wave: atrial depolarization (contraction)

QRS: ventricular depolarization (contraction)

T: ventricular repolarization (relaxation)

What is happening between the PR intervals on a normal ECG?

period between atrial depolarization (contraction) and ventricular depolarization (contraction)

What is happening between the ST segment on a normal ECG?

period between ventricular depolarization (contraction) and ventricular repolarization (relaxation)

When should an ECG be obtained?

physicians order or protocol

known or suspected cardiac patient

known or suspected overdose on a tricyclic medication

electrical injuries

drop in blood pressure (Syncope)

What is PEA?

Pulseless electrical activity (looks normal on an ECG, but there is no heart activity going on)

What is septal infarct?

Tissue of the heart is dead and can't contract

What is angina pectores?

chest pain caused by decreased consistent low oxygenation to the heart (caused by ischemia)

What is Ischemia?

decreased oxygenation to the heart

What is infarction?

death of myocardial tissue. tissue is dead and cannot come back.

What happens first infarction or ischemia?

Ischemia will happen before infarction; can be long before infarction or just shortly before.

What are pacemaker cells?

specialized cells that can generate their own electrical activity

Where are pacemaker cells located?

They are mostly consolidated in the SA node but there are some in the AV node as well

What are conducting cells?

They are cells that conduct the electrical impulses throughout the heart

What is the pattern of electrical conduction of the heart?

SA node -> Internodal pathways -> AV node -> Bundle of His-> right and left bundle branches-> Purkinje fibers

What is the most important lead to respiratory therapists?

Lead II (2)

What is important of the ST segment?

very important in determining a STEMI

In terms of electrical impulse, what is important about the PR interval?

It is the time that it takes the SA node impulse to get to the AV node

How many seconds is each box on an ECG?

0.04 seconds

What are five important steps when interpreting an ECG?

looking at the rate

looking at the rhythm

looking at the shape of the QRS

looking at the PR interval

looking at the ST segment

What is a uni-focal PVC vs. a multi-focal PVC

uni=1 pvc

multi= multiple PVC's

What is cardioversion?

treatment that sends shock during R wave.

What is defibrillation?

shocking to stop fibrillation

Can asystole be shocked?

NO