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CSE TIPS

QuestionAnswer
NEVER PICK or ALWAYS PICK: Sensorium ALWAYS!!
NEVER PICK or ALWAYS PICK: Closing Volume NEVER!!
NEVER PICK or ALWAYS PICK: Breath Sounds ALWAYS!!
NEVER PICK or ALWAYS PICK: Shunt Study NEVER!!
NEVER PICK or ALWAYS PICK: Blood Pressure ALWAYS!!
NEVER PICK or ALWAYS PICK: measure % Shunt NEVER!!
NEVER PICK or ALWAYS PICK: Heart Rate ALWAYS!!
NEVER PICK or ALWAYS PICK: Gag Reflex NEVER!!
NEVER PICK or ALWAYS PICK: SpO2 ALWAYS!!
NEVER PICK or ALWAYS PICK: Maximum Voluntary Ventilation NEVER!!
NEVER PICK or ALWAYS PICK: Skin Color ALWAYS!!
NEVER PICK or ALWAYS PICK: Hypoxic Drive NEVER!!
NEVER PICK or ALWAYS PICK: ECG via Cardiac Monitor ALWAYS!!
NEVER PICK or ALWAYS PICK: P50 NEVER!!
NEVER PICK or ALWAYS PICK: Respiratory Rate & Pattern ALWAYS!!
NEVER PICK or ALWAYS PICK: Resting CO2 Production NEVER!!
NEVER PICK or ALWAYS PICK: Vital Signs ALWAYS!!
NEVER PICK or ALWAYS PICK: Check O2 & Airline Pressure NEVER!!
NEVER PICK or ALWAYS PICK: General Appearance ALWAYS!!
NEVER PICK or ALWAYS PICK: Circuit Compliance NEVER!!
NEVER PICK or ALWAYS PICK: Chest Inspection ALWAYS!!
NEVER PICK or ALWAYS PICK: Vent Tube compliance NEVER!!
NEVER PICK or ALWAYS PICK: Diagnostic Chest Percussion ALWAYS!!
NEVER PICK or ALWAYS PICK: pH tracheal aspirate NEVER!!
NEVER PICK or ALWAYS PICK: SIMV/VC or VC/AC (if settings are the same) ALWAYS!!
NEVER PICK or ALWAYS PICK: Thoracic Compliance NEVER!!
NEVER PICK or ALWAYS PICK: Appearance of Extremities ALWAYS!!
NEVER PICK or ALWAYS PICK: Respiratory exchange ration NEVER!!
NEVER PICK or ALWAYS PICK: Titrate ALWAYS!!
NEVER PICK or ALWAYS PICK: Metabolic Rate NEVER!!
NEVER PICK or ALWAYS PICK: Pedal Edema ALWAYS!!
NEVER PICK or ALWAYS PICK: Range of motion of neck NEVER!!
NEVER PICK or ALWAYS PICK: APGAR score fro neonates (Delivery) ALWAYS!!
NEVER PICK or ALWAYS PICK: Cervical Flexibility NEVER!!
NEVER PICK or ALWAYS PICK: O2 Consumption NEVER!!
NEVER PICK or ALWAYS PICK: Moro reflexes NEVER!!
NEVER PICK or ALWAYS PICK: Intraocular Pressure NEVER!!
NEVER PICK or ALWAYS PICK: Electroencephalogram (EEG) NEVER!!
NEVER PICK or ALWAYS PICK: CO2 response curve NEVER!!
NEVER PICK or ALWAYS PICK: Mueller Maneuver NEVER!!
NEVER PICK or ALWAYS PICK: Bilirubin NEVER!!
NEVER PICK or ALWAYS PICK: IVP NEVER!!
NEVER PICK or ALWAYS PICK: Doll Eyes NEVER!!
NEVER PICK or ALWAYS PICK: 24 hour Holter monitoring NEVER!!
NEVER PICK or ALWAYS PICK: History of foreign travel NEVER!!
NEVER PICK or ALWAYS PICK: Visual Acuity NEVER!!
NEVER PICK or ALWAYS PICK: Gallium lung scan NEVER!!
NEVER PICK or ALWAYS PICK: Bedside thoracic ultrasound NEVER!!
NEVER PICK or ALWAYS PICK: Antinuclear antibody test NEVER!!
NEVER PICK or ALWAYS PICK: Discontinue PEEP NEVER!!
NEVER PICK or ALWAYS PICK: Coomb's Test NEVER!!
NEVER PICK or ALWAYS PICK: Peripheral pulses NEVER!!
NEVER PICK or ALWAYS PICK: Dead Space NEVER!!
NEVER PICK or ALWAYS PICK: Analyze the Delivered FiO2 NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER PICK or ALWAYS PICK: NEVER!!
NEVER Pick _________ Unless Baby. Heart Sounds
NEVER Pick _________ Unless Baby has murmur. Echocardiogram
NEVER Pick _________ Unless Suspected Diaphragmatic hernia. Bowel Sounds
NEVER Pick _________ Unless Neonates/ Neuromuscular . Muscle Tone
NEVER Pick _________ Unless "NMS" (neuromuscular). EMG
NEVER Pick _________ Unless "NMS"/ Apnea Testing/ Brain Dead/ Trauma. Deep Tendon Reflexes
NEVER Pick _________ Unless "NMS"/ Weaning. VC and MIP
NEVER Pick _________ Unless "NMS"/ Stroke. Ability to swallow
NEVER Pick _________ Unless Stroke/Head Trauma. Pupillary Response
NEVER Pick _________ Unless Stroke/Head Trauma. Respond to painful stimuli
NEVER Pick _________ Unless stroke/ Trauma/ PE coming in. CT
NEVER Pick _________ Unless Trauma. Urinalysis
NEVER Pick _________ Unless PE V/Q Scan
NEVER Pick _________ Unless ARDS. QS/QT Pulmonary shunt fraction
NEVER Pick _________ Unless Sepsis. Blood Culture
NEVER Pick _________ Unless Sepsis. Lactic Acid
NEVER Pick _________ Unless "MI". Cardiac Enzymes
NEVER Pick _________ Unless "MI". Troponin
NEVER Pick _________ Unless Diagnosed CF. Sweat Test
NEVER Pick _________ Unless Asthma. Methacholine challenge/ Inhalation challenge/ Bronchoprovocation
NEVER Pick _________ Unless Asthma. PEFR
NEVER Pick _________ Unless Smoke Inhalation. CoHb
NEVER Pick _________ Unless Burn Pt. Condition of oral & nasal mucosa
NEVER Pick _________ Unless Neonates & Found Down. Glucose
NEVER Pick _________ Unless MVA or Found Down. Blood Alcohol Level
NEVER Pick _________ Unless FiO2 goes Off. O2 gas connection
NEVER Pick _________ Unless bronchiectasis. Bronchogram
NEVER Pick _________ Unless CHF. Color of Urine
NEVER Pick _________ Unless CHF or looking at kidneys, Liver. Blood Chemistry
NEVER Pick _________ Unless Croup or Epiglottitis Upper airway xray/ lateral neck xray
Things to Remember: Trach Patients CANNOT do: PFT's
Things to Remember: ONLY select hemodynamic values when: hemodynamic lines are in place
Things to Remember: Laryngeal Edema will NEED: immediate intubation
Things to Remember: If the BABY has GRUNTING or RETRACTIONS give: CPAP
Things to Remember: CT is NOT the first line of testing UNLESS: it is trauma or stroke
Things to Remember: STABLE pneumothorax needs a : Chest Tube
Treating a patient with Head Trauma: Hyperventilate to keep PaCO2 between 25-30 for first 48 hours. If ABG's have normal CO2- increase rate, low CO2, maintain settings.
You WANT to INTUBATE to NOT _____: Aspirate
Staging severity of lung disease using ATS standards: MILD: 70-79%, MODERATE: 60-69%, SEVERE: 50-59%, VERY SEVERE: < 50%
MIP/NIF, VC and VT are only for neuromuscular patients who are not at the vent yet. Otherwise, only pick these tests for: weaning from mechanical ventilation.
VfIb= Defib
PaO2 = 60-70 means maintain FiO2 (unless ____), PaO2 less than 60- then increase ____ OR ____ depending on settings, PaO2 >80, ____ FiO2 or PEEP depending on the settings. Child; FiO2 or PEEP; Decrease
Spinal Tap for _____ Patients. Antibodies Test/ Tensilon Test for ____. GB Patients; MG patients.
No matter what the PaO2 is don't decrease the FiO2 on burn patients until the: CO level is back to normal.
25-28% venti-mask OR 2 lpm for ____ Patients. COPD
If you are using a BVM and you feel NO resistance what would you do? The bag needs to be replaced.
Toxicology for (THESE types of patients) ______. Unconscious Patients, Patients with altered level of consciousness "ALOC", & Traumas
Patient is UNSTABLE (hypotensive, chest pain, ALOC) and ECG presents with VTACH with a Pulse or SVT = cardiovert
Patient is STABLE and ECG presents with VTACH with a Pulse= Amiodarone
Patient is STABLE and ECG presents with SVT with a Pulse= Adenosine
Thoracic ultrasound- detect fluid in thorax, pneumothroax, or chest traumas; guided thoracentesis
PET scan- identify malignant tumors
V/Q perfusion scan- help diagnose or rule out a pulmonary embolism
CT angiography- identify the presence and extent of pulmonary embolism
CT/MRI- Thoracic: detect tumors, aortic aneurysm, effusions, and chest trauma.
CT/MRI--head/neck- evaluate for traumatic brain, neck, spine injury
Neck Xray- differentiate causes of stridor (croup vs epiglottitis) to help detect foreign body aspirations (only for radiopaque objects)
CXR- assess for atelectasis, consolidation, pneumothorax, and tube/catheter positions
Exercise testing- evaluate tolerance for exertion
Diffusing Capacity (DLCO)- identify the cause of restrictive disorders, assess the feasibility of lung reduction surgery
Bronchoprovocation- assess for airway hyperresponsiveness and inflammation
Functional residual capacity (FVC), Residual volume (RV), total lung capacity (TLC)= differentiate between obstructive and restrictive conditions
Spirometry (FEV)- assess for surgical risk; detect obstruction/reversibility
Ve, RR, RSBI- evaluate the adequacy of ventilation
VC (vital capacity)- assess inspiratory/expiratory muscle function
MIP/NIF- asses respiratory muscle strength (weaning and neuromuscular)
Percussion- identify pneumothorax (hyperresonant note) or consolidation/pneumonia (dull note)
Tracheal position identify pneumothorax (shift away) or atelectasis (shift toward)
Cardiac enzymes (CK, troponin, BNP)- assess for myocardial damage or CHF
BUN (blood urea nitrogen), Creatinine- assess renal function and metabolic acid-base imbalances
Electrolytes- determine the type of metabolic acid-base imbalance (anion gap) identify causes of selected cardiac arrhythmias and neuromuscular abnormalities
Platelets, INR, PT (prothrombin time)- evaluate blood clotting and bleeding abnormalities
WBC's- assess for presence of bacterial/viral infections
Hb, Hct, RBC evaluate O2 carrying capacity, assess for anemia
Newborn PHN VS RDS- pre-postductal SpO2, chest xray
CO poisoning VS alcohol/drug overdose- History (CO exposure), HbCO
CHF VS ARDS- history; PWCP, echo
Reversible obstruction (asthma) VS. Irreversible (emphysema)= pre/post bronchodilator results
Myasthenia Gravis VS. Guillan Barre- Tensilon test, AChR, CSF Fluid
Weak Cough= poor secretion clearance. Give bronchial hygiene therapy, suction
RHONCHI/tactile fremitus= secretions in large airways. Give bronchial hygiene therapy, suction
tumor/mass- bronchoscopy
Foreign body- laryngoscopy
STRIDOR= laryngeal edema- give cool mist/racemic epinephrine
Foreign body (Child)- bronchoscopy
CHF - give diuretics, positive inotropes
Wheezing= bronchospasm- give bronchodilator therapy
PFT Calibration syringe= 3.0 liters (+- 3.5%)
NEWBORN ABG- pH >7.30, PaO2 >60torr, PaCO2 <50 torr
COHb- Carboxyhemoglobin= O% to 1%
ET tube markings: Oral 21-25 cm at lips, Nasal 26-29 cm at nares
Cuff pressure- 20 to 25 mmHg, 25-35 cmH20
Exhaled Carbon Monoxide "FeCO" < 7 for non smokers
Urine output- 40 mL/hr
ICP- (>20) hyperventilate, mannitol
MRSA =Precautions Contact precautions
V Fib & PULSELESS V Tach = Defibrillation (Amiodarone)
Drug overdose- pupillary reflexes
CSE TIPS:CHF assess BNP, give lasix and place on CPAP with 100%. Watch for bilateral fluffy infiltrates, batwing appearance, or Kerley b lines on cxr.
CSE TIPS: PE assess d-dimer and INR and give a clot buster, such as streptokinase or tPA and an anticoagulant (heparin) Watch for wedge shaped atelectasis on cxr and decreasing etco2.
CSE TIPS: COPD assess FEV1%...will be less than 70% which supports COPD. Also, if asked for lung volumes study...don't choose nitrogen washout because it gives 100% oxygen to your patient which you don't want to do for a COPD patient.
CSE TIPS: Asthma assess FeNO...this is expired nitric oxide which increases with asthma. Also, watch for air trapping during mech vent.
CSE TIPS: ARDS ground glass appearance in cxr. Use lower tidal volumes (4ml/kg minimum) with higher peep. PaO2 range is 55-80.
CSE TIPS: Increased Troponin will indicate an acute myocardial infarction vs increased BNP with CHF.
CSE TIPS: CF digital clubbing at an early age with barrel chest. Think bronchodilator, CPT, pulmozyme (not mucomyst) and inhaled TOBI (antibiotic for pseudomonas).
CSE TIPS: VAP perform BAL to get sputum sample to isolate causitive organism. Evident by spike in temperature and change to thick yellow sputum.
CSE TIPS: MG & GB ransient improvement of muscle weakness = MG. GB typically follows an acute infection. GB assess CSF protein count. MG = give cholinesterase inhibitor (edrophonium or neostigmine) to see reverse of muscle weakness.
CSE TIPS: Pediatrics thumbnail sign on cxr = epiglottitis = go to OR and perform controlled intubation
CSE TIPS: Steeple Sign = croup = cool most aerosol and maybe racemic epinephrine.
CSE TIPS: Neonates premature baby with high ventilating pressures and low tidal volumes= RDS = give surfactant = increased tidal volumes in pressure control ventilation.
CSE TIPS: COPD continued Choose either helium dilution or body plethysmography to assess lung volumes. Watch for air trapping during mech vent.
CSE TIPS: MG & GB continued If MG and not reversal of muscle weakness following cholinesterase inhibitor, then consider cholinergic crisis, which is the result of excessive cholinesterase inhibitor administration.
CSE TIPS: Neonates continued This may lead to resp alkalosis = decrease insp pressure to decrease delivered tidal volume to reduce overall minute ventilation and correct resp alkalosis.
Created by: tumi6472
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