My Flash: Pulmonary
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| What are the four accessory muscles of inspiration? | Scalenes, SCM, Levator Costarum and Serratus
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| What are the four accessory muscles of expiration? | Abdominals, Quadratus lumborum, Triangularis Sterni and Internal Intercostals
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| What are the three muscles that become muscles of inspiration with the girdle fixed? | Trapezius, Pectorals and Serratus
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| The more upright the body position, the lower is the diaphragm therefore the lower is the | Inspiratory reserve
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| This can be helpful in providing support to abdominal viscera thereby assisting ventilation | Abdominal binder
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| This covers the inner surface of the thoracic cage, diaphragm and mediastinal border | Parietal pleura
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| It wraps the outer surface of the lung including the fissure lines | Visceral pleura
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| It is the point of equilibrium where forces are balanced and occurs at the end tidal expiration? | REEP (resting end expiratory pressure)
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| It is the volume of gas inhaled (or exhaled) during a normal resting breath | Tidal volume
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| It is the volume of gas that can be inhaled beyond a normal resting tidal inhalation | Inspiratory reserve volume
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| It is the volume of gas that can be exhaled beyond the normal resting tidal exhalation | Expiratory reserve volume
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| It is the volume of gas that remains in the lungs after ERV has been exhaled | Residual volume
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| It is the amount of air that can be inhaled from REEP | Inspiratory capacity (IRV + TV)
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| It is the amount of air that is under volitional control; conventionally measured as the forced expiratory tidal capacity (FVC) | Vital capacity (IRV + TV + ERV)
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| It is the amount of air that resides in the lungs after a normal resting tidal exhalation | Functional residual capacity (ERV + RV)
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| It is the total amount of air that contained within the thorax during a maximum inspiratory effort | Total lung capacity (IRV + TV + ERV + RV)
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| The ability of the arterial blood to carry oxygen | Arterial oxygenation
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| The ability to remove carbon dioxide from the pulmonary circulation and maintain pH | Alveolar ventilation
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| Normal range of partial pressure of oxygen (PaO2) | 80-100mmHg
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| Normal range of partial pressure of carbon dioxide (PaCO2) | 35-45mmHg
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| Normal range of bicarbonate ions (HCO3) | 22-28 mEq/mL
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| Relationship of pH and PaCO2 | Inverse
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| Relationship of pH and HCO3 | Direct
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| Anatomical or physiological space that is well ventilated but with no gas exchange | Dead space
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| In gravity dependent, there is more blood than air, therefore V/Q ratio is | Low
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| In gravity independent, there is more air than blood, therefore V/Q ratio is | High
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| Normal value (adult and infant): HR | A: 60-100bpm I: 120bpm
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| Normal value (adult and infant): RR | A: 12-20br/min I: 40br/min
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| Normal value (adult and infant):BP | A: <120/80mmHg I: 75/50mmHg
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| Normal value (adult and infant): PaO2 | A: 80-100mmHg I: 75-80mmHg
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| Normal value (adult and infant): Tidal Volume | A: 500ml I: 20ml
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| A sign of chronic hypoxemia | Digital clubbing
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| How many inches is the thoracic excursion of the normal individual | 2-3inches
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| Normal breath sound; soft rustling sound heard throughout inspiration and start of expiration | Vesicular sound
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| A more hollow echoing sound normally found over the right superior anterior thorax. Heard in all of inspiration and most of inspiration | Bronchial breath sound
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| A very distant sound not normally heard over a healthy thorax. Associated with obstructive lung disease | Decreased breath sound
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| Two adventitious sounds | Crackles and wheezes
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| Also termed as rales or crepitations | Crackles
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| A crackling sound heard usually during inspiration that indicates pathology (atelectasis, fibrosis, pulmonary edema) | Crackles
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| A musical pitched sound usually heard during expiration caused by airway obstruction | Wheezes
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| As with normal breath sounds, vocal transmission is loudest in what areas | Trachea and main bronchi
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| Normally, words should be intelligible though soft and clear at what area | At more distal areas of the lungs
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| Is a nasal or bleating sound heard during auscultation. E is heard as A. | Egophony
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| Intense, clear sound during auscultation, even at lung bases | Bronchophony
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| Occurs when whispered sounds are heard clearly during auscultation | Whispered pectoriloquy
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| A radiographic examination that identifies the presence of pulmonary emboli | Ventilation perfusion scan
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| Continuous xray beam that allows observation of diaphragmatic excursion | Flouroscopy
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| Causes and SSx: Respiratory alkalosis | Alveolar hyperventilation;
Dizziness, syncope, tingling, numbness and early tetany
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| Causes and SSx: Respiratory acidosis | Alveolar hypoventilation;
Early: anxiety, restlessness, dyspnea and headache
Late: Confusion, somnolence, coma
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| Causes and SSx: Metabolic alkalosis | Bicarbonate ingestion, vomiting, diuretics, steroids and adrenal disease;
Vague symptoms: weakness, mental confusion and possible tetany
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| Causes and SSx: Metabolic acidosis | Diabetic, lactic, uremic acidosis and prolonged diarrhea;
Secondary hyperventilation (Kaussmall breathing), nausea, lethargy and coma
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| Normal WBC | 5000-10000
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| Normal Hematocrit | 35-48%
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| Normal Hemoglobin | 12-16g/dL
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| 10 Criterion for Termination of ETT | Max SOB
Fall in PaO2 of >20 or PaO2 of <55mmHg
Rise in PaCO2 of >10 or PaCO2 of >65mmHG
Cardiac ischemia/arrythmia
Sx of fatigue
10mmHg inc DBP, SBP of 250, or dec'g BP c inc'g workload
Leg pain
Total fatigue
Signs of insufficient CO
Reach ventil
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| An intra-alveolar bacterial infection of the lungs | Bacterial pneumonia
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| Most common type of gram positive pneumonia | Pneumococcal pneumonia
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| WBC in TB shows | Increased lymphocytes
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| CBC count in Pneumocystis pneumonia shows | No evidence of infection
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| GOLD Stage 1 for COPD | Mild
FeV1 >=80%
With or without complications
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| GOLD Stage 2 for COPD | Moderate
FeV1 <80%
SOB with exertion
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| GOLD Stage 3 for COPD | Severe
FeV1 <50%
Greater SOB, decreased exercise capacity and exacerbation of disease
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| GOLD Stage 4 for COPD | Very Severe
FeV1 <30%
Impaired quality of life, exacerbation of the disease may be life threatening
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| PFTs in COPD shows | Decreased FeV1, decreased FVC, decreased FeV1/FVC ratio, increased FRC and RV
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| Increased reactivity of the trachea to various stimuli with narrowing of the airways due to inflammation | Asthma
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| Cystic Fibrosis: 4 | Genetic, there is thickening of secretions of the exocrine glands, may present as obstructive, restrictive or both, onset of symptoms usually in early childhood
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| 3 Clinical signs of CF | Meconeum ileus, frequent respiratory infections, inability to gain weight despite adequate caloric intake
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| Diagnosis of CF | (+) Trypsinogen, (+) Sweat electrolyte test
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| It is congenital or acquired, characterized by abnormal dilatation of the bronchi and excessive mucus production | Bronchiectasis
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| Characterized by alveolar collapse in a premature infant due to lung immaturity and inadequate level of pulmonary surfactant | Respiratory Distress Syndrome /Hyaline Membrane Disease
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| Air in the pleural space due to a lacerated visceral pleura from a rib fracture or ruptured bullae | Pneumothorax
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| Blood in the pleural space due to laceration of the pleural space | Hemothorax
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| Blood and edema within the alveoli and interstitial space | Lung contusion
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| Cough with pink frothy secretion | Pulmonary edema
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| CXR of Pulmonary edema | Shows typical butterfly pattern
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| A thrombus from the peripheral venous circulation becomes embolic and lodges in the pulmonary circulation | Pulmonary emboli
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| Excessive fluid between the visceral and parietal pleura due to increased pleural permeability to proteins from inflammatory disease | Pleural effusion
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| Collapsed or airless alveolar unit caused by hypoventilation secondary to pain during the ventilatory cycle | Atelectasis
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| CXR of Atelectasis shows | Platelet streaks
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| Indications of pulmonary drainage, percussion and shaking | Increased pulmonary secretions
Aspiration
Atelectasis
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| Duration of the pulmonary drainage | 20 minutes per postural drainage position
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| Postural drainage: Upper lobe apical segments | Bed flat
Px leans backward at 30 deg angle against the patient
PT percusses at area between the clavicle and scapula
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| Postural drainage: Upper lobe posterior segments | Bed flat
Px leans forward at a pillow at 30 deg angle
PT percusses at the upper back
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| Postural drainage: Upper lobe anterior segments | Bed flat
Px lies flat with pillows under the knees
PT percusses between the clavicle and nipples
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| Postural drainage: Right Middle lobe | Foot of bed elevated at 16 inches
Pt lies on his left side, turns 1/4 backward. Shoulder and hip with pillows and knees flexed.
PT percusses at the right nipple area.
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| Postural drainage: Left Lingular lobe | Foot of bed elevated at 16 inches
Px lies on his right, turn 1/4 backward. Shoulder and hip with pillow, knees flexed.
PT percusses at the left nipple area.
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| Postural drainage: Lower lobe anterior segments | Foot of bed elevated at 20 inches.
Px lies on one side.
PT percusses at the lower rib area.
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| Postural drainage: Lower lobe superior segments | Bed flat.
Px lies on abdomen with 2 pillows under the hips.
PT percusses the middle back at the tip of the scapula.
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| Postural drainage: Lower lobe posterior segments | Foot of bed elevated at 20 inches.
Px lies on abdomen with a pillow under the hips.
PT percusses at the lower ribs near the spine
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| Postural drainage: Lower lobe lateral segments | Foot of bed elevated at 20 inches.
Px lies on abdomen, turns 1/4 upwards with pillows on flexed knee for support.
PT percusses the uppermost portion of the lower ribs.
PT
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| Bouncing maneuver applied after percussion | Shaking
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| Duration for shaking | 5-10 deep inhallations
Less than 5 is ineffective
More than 10 can cause hyperventilation
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| Effective in clearing secretions on major central airways | Cough
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| Used in COPD patients. Prevents high intrathoracic pressure which causes premature airway closing | Huff
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| Used for patients who cannot cough on command | Tracheal stimulation
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| Used when all other forms of airway clearance fails | Endotracheal suctioning
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| Endotracheal suctioning is set at | 120 mmHg of suction
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| Usual suctioning time | 10-15 seconds
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| Complications associated with suctioning (7) | Hypoxemia
Bradycardia or tachycardia
Hypotension or hypertension
Increased intracranial pressure
Atelectasis
Tracheal damage
Infections
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| Segmental breathing is inappropriate in intractable hypoventilation until medical situation is resolved | True
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| Pursed lip breathing is used to (6) | Reduce respiratory rate
Increase tidal volume
Reduce dyspnea
Improve gas mixing at rest for COPD pxs
Decrease the mechanical disadvantage of impaired ventilatory pump
Facilitate relaxation
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| Patients with severe and very severe pulmonary disorders will likely reach a pulmonary endpoint before a cardiovascular endpoint | True
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| How and where is paced breathing or activity pacing used? | Used to spread out the metabolic demands of an activity, used with patients who become dyspneic during performance of an activity
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| Beta 2 agonists drugs | Are sympatomimetic drugs that causes bronchodilation, increase HR and BP
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| 3 examples of short acting beta 2 agonists | Ventolin (albuterol)
Alupent (metaproterenol)
Maxair (pirbuterol)
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| Example of long acting beta 2 agonists for maintenance | Serevent (salmeterol xinafoate)
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| Anticholinergics | inhibits PNS therefore causes bronchodilation, increase HR and BP
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| Side effects of anticholinergics | Lack of sweating, dry mouth and delusions
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| Example of anticholinergics | Atrovent (ipratropium)
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| Methylxantines | Produces smooth muscle relaxation
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| Examples of methylxantines | Aminophylline
Theophylline
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| If tube of mechanical ventilator is moved, a nurse or respiratory therapist should check the placement of the tube | Correct
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| If tube of the mechanical ventilator is dislodged, a physician or anesthesiologist needs to replace the tube | Correct
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| Used to evacuate air or fluid trapped in the intrapleural space | Chest tubes
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| If the chest tube is dislodged during treatment, cover the defect and seek assistance | Correct
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| For IVs, the UE should not be raised above the level of the IV medication for any length of time or backflow of blood will occur | Correct
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| Artery usually used for arterial line | Radial artery
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| If arterial line is dislodged, immediate firm pressure needs to be applied to or above the arterial insertion site to stop bleeding | Correct
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| Supplemental oxygen is indicated for (SaO2 and PaO2) | SaO2 of <88% or PaO2 <55mmHg
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