Section 1 Review, Assessment

A Glasgow Coma Scale score of ______ indicates coma

< 8

Sputum production ______ indicates the need for airway clearance.

> 30 mL/day

An infant with an Apgar score (Appearance, Pulse, Grimace, Activity, Respirations) of ______ should be resuscitated.

< 4

.

.

Absent P waves indicate

A fib or junctional rhythm,

Widened QRS complexes indicate

Denote PVC, bundle branch block, v tach, or hyperkalemia

ST elevation or depression indicates

Myocardial ischemia, K imbalances, or digoxin effects

MIP/NIF values less negative than ________ indicate that muscle strength likely is insufficient to support spontaneous ventilation

−20 to −25 cm H2O

PAWP _______ with left ventricle failure

Increases

Indications for transthoracic ultrasound

Detect pleural effusion

Assess trauma to the diaphragm

Guide thoracentesis and percutaneous needle biopsies

CVP catheter indications

Monitor fluid volume

Monitor right heart function in unstable/ hypotensive pt

Pulmonary artery catheter indications

Frequent assessment of CO

.

.

SVC less than 80% predicted indicates what?

Mild restrictive defect

FEV1/FVC% of at least 75% or greater does not support

Obstructive defect

Normal L:S ratio

2:1

What gestational age will the L:S ratio reach 2:1?

Near week 35

What is L:S ratio use to determine?

Fetal lung maturity, which corresponds to the onset of mature surfactant production

How is L:S ratio determined?

Lab tests via amniotic fluids usually obtained via amniocentesis

What finding(s) are consistent with a CXR revealing patchy infiltrates with air bronchograms?

PN or pulmonary edema

Sinus vs ventricular tachycardia

Sinus tachycardia = 100-160

Ventricular tachycardia = 160-250

PaCO2 PETCO2 gradient in a healthy person

PETCO2 is 1-5 mmHg less than PaCO2

Restrictive disorders will have decrease ________

Volumes

Obstructive disorders will have decreased _______?

Flows

PFT, normal (no impairment) range of predicted

80-120% of predicted

PFT, mild impairment range of predicted

70-79% of predicted

PFT, moderate impairment range of predicted

50-69% of predicted PFT

PFT, severe impairment range of predicted

< 49% of predicted

An increase in flow of ________ or more after bronchodilator therapy suggests significant reversibility

12-15%

What test is done to assess if the patient has emphysema vs chronic bronchitis

DLCO

Normal reference range for DLCO

25-30 mL/min/mmHg

What can a low DLCO indicate

Emphysema, pulmonary fibrosis

What can a high DLCO indicate

Polycythemia

An FEV1/FVC% less than ______ always indicates an obstructive disorder

70%

Bronchial sounds heard over lung periphery can indicate ______

Consolidation/ PN

Increased RBCs may be associated with _________

Chronic hypoxemia (secondary polycythemia)

Hematocrit is affected by _______

fluid volume

Fluid volume and hematocrit have a _____ relationship

inverse

What is hematocrit?

The measure of the percentage of red blood cells in the total volume of blood expressed as a %

Potassium levels typically run ______ in metabolic acidosis

High

Potassium levels typically run ______ in metabolic alkalosis

Low

High lactic acid levels indicate _______

Tissue hypoxia, usually due to poor perfusion or shock

A 6 MWD < _______ indicates abnormal functional capacity

500-600 meters

CXR of a patient with ARDS typically shows

Bilateral lung opacities and infiltrates (white out) with normal heart size

CXR of a patient with emphysema typically shows

Low and flat diaphragms, decreased lung/ vascular markings, and increased retrosternal spaces

PaO2 40 torr corresponds to what SpO2?

70%

PaO2 50 torr corresponds to what SpO2?

80%

PaO2 60 torr corresponds to what SpO2?

90%

Adult normal temp, HR, RR, and BP

98.6F (37C)

60-100 bpm

12-20/min

<120/80 mmHg

Child normal temp, HR, RR, and BP

37.5C

80-120 bpm

20-25/min

94/52 mmHg

Infant normal temp, HR, RR, and BP

37.5C

90-170 bpm

35-45/min

84/52 mmHg

What does crackles/ rales indicate (late inspiratory)

Pulmonary edema, atx

What can bronchial sounds over the lung periphery indicate?

PN, consolidation

What is myoglobin?

Heme protein present in cardiac and skeletal muscle.

What does an elevated myoglobin indicate?

Significant myocardial or skeletal muscle damage. This is the first of the cardiac biomarkers to rise after a myocardial injury

Normal BNP

< 20 pg/mL

BNP values to rule out and rule in CHF

Rule out: < 100 pg/ mL

Rule in: > 500 pg/ mL

Mild hypoxemia range

60-79 torr

Moderate hypoxemia range

45-59 torr

Severe hypoxemia range

< 45 torr

Classify the ABG: pH 6.9 PaCO2 100 HCO3 10 BE -12

Combined respiratory and metabolic acidosis

What can atelectasis show on a CXR?

Increased radiopacity (whiteness), air bronchograms due to tissue collapse around the opened airways, elevated hemidiaphragms on the affected side, and tracheal shift

What would CHF show on a CXR?

Increase vascular markings, cardiomegaly (>50%), presence of pleural effusions/ Kerley B lines

COPD findings on a CXR

Low/ flattened diaphragms, decreased vascular markings, increased retrosternal air space, bullae/blebs, narrow mediastinum

What would pleural effusion show on a CXR?

Increased density, loss of sharp costophrenic angles, and meniscus sign at the fluid-air interface

What would a pneumothorax show on a CXR?

Loss of peripheral lung markings, air between lung margin and chest wall, mediastinal/ tracheal shift to the OPPOSITE side, possible depression of the diaphragm on the affected side, and sulcus sign

What would pulmonary edema show on a CXR?

Fluffy/ patchy densities in perihilar areas and in the gravity-dependent lower lung fields, can show cardiomegaly, pleural effusions, and air bronchograms

What is the gold standard for dx of a pulmonary embolism?

CT pulmonary angiography

How is a pneumothorax diagnosised via thoracic ultrasound?

Absence of gliding sign and B-lines, and presence of A-lines

What is VO2?

The measure of the maximum amount of oxygen your body can absorb and use during intense exercise, reflecting your aerobic fitness (oxygen consumption)

A higher VO2 max suggests better cardiovascular fitness and endurance.

Factors that would increase VO2 and VCO2

Fever, inflammation, sepsis, major trauma, shivering, seizures, agitation, anxiety, pain, hyperthyroidism, adrenergic drugs, ventilator weaning

What is VCO2?

Represents the rate at which CO2 is produced and eliminated

Factors that would decrease VO2 and VCO2?

Sedation/ analgesics, muscle paralysis, shock, hypovolemia, hypothermia, cooling, hypothyroidism, antipyretics, starvation, ventilatory support, dysoxia (impaired O2 extraction)

Normal ICP range

7-15 mmHg, <20 mmHg

What can decrease ICP?

Head elevation, decrease in CSF volume, severe arterial hypotension, hyperventilation/hypocapnia, lower jugular venous pressure, narcotics and benzodiazepines, mannitol (osmotic diuretic)

What can increase ICP?

Tumor, edema, infection, hypoxic/ischemic/uremic encephalopathy, increased blood volume (hemorrhage or hematoma), restricted venous outflows, CVP > ICP, right heart failure, cor pulmonale, jugular vein thrombosis, high PEEPs, hypertension, hypoventilation/hypercapnia, suctioning

What diseases can cause decreased lung compliance?

Pulmonary fibrosis, ARDS, pulmonary edema, atx, mainstem intubation, pnx, large pleural effusions, surfactant deficiency

30% FiO2 air to oxygen ratio

7:1

40% FiO2 air to oxygen ratio

3:1

50% FiO2 air to oxygen ratio

(1.7) 2:1

60% FiO2 air to oxygen ratio

1:1

How to solve for total FiO2?

(Ratio added together) flow

Spontaneous inspiratory efforts cause CVP to _______

Decrease

We are negative pressure breathers

Positive pressure breaths cause CVP to ________

Increase

What can cause an increase CVP?

Fluid overload, R/L heart failure, pulmonary hypertension, tricuspid valve stenosis, PE, and increased venous return

What can cause a decrease CVP?

Reduced circulating blood volume, vasodilation (reduced venous return), leaks in pressure system, and spontaneous inspiration

Normal CVP (central venous pressure) value

2-6 mmHg (4)

Where does the end of a CVP catheter need to be placed?

Lined up with the right atrium

Mean arterial pressure (MAP) normal value

120/ 80 (90s)

Right arterial pressure (RAP) normal value

2-6 mmHg

Pulmonary artery pressure (PAP) normal value

Systolic: 15-30 mmHg

Diastolic: 8-15 mmHg

Mean pulmonary artery pressure (MPAP/ PAP) normal value

9-18 mmHg

Pulmonary artery wedge pressure (PAWP, PCWP, or PAOP) normal value

6-12 mmHg (8)

Hgb normal value for male and females

Males: 13.5-16.5

Females: 12-15

Hct normal values for male and females

Males: 40-54%

Females: 38-47%

Normal prothrombin time (PT)

12-14 sec

What does a high PT time indicate?

Slow clotting

Normal sodium (Na) value

137-147

Normal potassium (K) value

3.5-4.8