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# Fund Final

### Fundamentals Final

Joseph Black Discovers carbon dioxide
Joseph Priestly Credited with the discovery of oxygen
Thomas Beddoes Uses oxygen to treat various disorders
AARC Promote profession & practice
NBRC Testing & credentialing organization
CoArc Program accreditation organization
Service Areas General Therapeutics, Critical Care, Emergency Care, Diagnostics, Pulmonary Rehabilitation
Boyle's Law Volume of gas varies inversely with its pressure P1V1 = P2V2
Charles' Law Volume of gas varies directly with changes in its temperature V1/T1 = V2/T2
Gay-Lussac's Law Pressure exerted by a gas varies directly with its absolute temperature P1/T1 = P2/T2
Combined Gas Law (P1xV1)/T1 = (P2xV2)/T2
Minute Ventilation calculation VE = VT x f
Alveolar Ventilation calculation VA = (VT - VD) x f
Shunt Perfusion without ventilation
Oxygen Content equation (1.34 x Hb x SaO2) + (PaO2 x 0.003)
ABG ranges pH:7.35–7.45, PaCO2(Resp):35 – 45 mmHg, HCO3(BiCarb):22 – 26 mEq/L, Base Excess: -2 to +2
Cylinder Volumes E = 22cu.ft. / 623L G = 187cu.ft. / 5292L H = 244cu.ft. / 6905L K = 275cu.ft. / 7783L
Cylinder Duration equation (Tank Pressure x Tank Factor) / Flow
Tank Factors E = .28, G = 2.41, H = 3.14
NFPA Regulates storage & handling of cylinders, as well as central supply gas & piping systems.
DOT Regulates cylinder construction, testing, & transport.
CGA Sets all safety standards (ASSS, DISS, &PISS)
FDA Sets medical gas purity standards.
Liquid to Gas conversion 1cu.ft. liquid O2 = 860cu.ft. gaseous O2
Cubic Feet to Liters conversion 1cu.ft. gaseous O2 = 28.3L gaseous O2
Refractory Hypoxemia Low levels of O2 in blood that cannot be corrected with add'l O2. Use PEEP or CPAP.
Responsive Hypoxemia Low levels of O2 in blood that can be corrected w/ add'l O2 - Significant increase in PaO2 w/ increase in FiO2 due to V/Q mismatch or diffusion defect. Use low or high flow O2 device.
Manifestations of Hypoxemia Tachycardia – high heart rate > 100bpm Tachypnea – high rate of breathing > 20L/m Restlessness / confusion (nasty, mean) Pulmonary Hypertension
Alveolar Air equation PAO2 = FiO2(760 – 47) – PaCO2 / 0.8 *If FiO2<60% don't / by 0.8
AARC CPGs for Hypoxemia Documented: PaO2 < 60mmHg SaO2 < 90% Suspected: Acute M/I Severe trauma
High Flow Devices Will meet pt’s inspiratory flow needs, Air Entrainment Mask < .40, AE Nebs – high flow or < .40
Low Flow Devices Will not meet pt’s inspiratory flow needs, Nasal / reservoir cannulas, transtracheal O2 catheter, simple, O2 mask, partial & non-rebreather masks, Total Flow Question
Polorgraphic Oxygen Analyzer Components: silver anode, platinum cathode, KCI electrolyte soltn, polypropylene or Teflon membrane battery. Quick response time: <30 sec.
Galvonic Fuel Cell Oxygen Analyzer Components: Lead anode, gold cathode, KOH(potassium hydroxide) or CsOH(cesium hydroxide) electrolyte solution Longer response time: up to 60 sec.
HeOx Therapy Low density gases will decrease turbulence and WOB, helps O2 move better into airways. Tx of: stridor croup, foreign body aspiration, upper airway masses
HeOx Gas Densities Air 1.29g/L & O2 1.43g/L *80/20 He/Ox – 0.43g/L = flow x 1.8 *70/30 He/Ox – 0.55g/L = flow x 1.6
Spectrophotometry Red & Infrared light absorption on finger or earlobe to calculate HbO2
Photoplethysmography Light transmission to determine pulse
Pulse Oximetry *Red light is absorbed by deoxyHb *Infrared is absorbed by oxyHb *Low R/IR, ½ = High SpO2, 98% *High R/IR, 2/1 = Low SpO2, 60%
Adrenergic meds Sympathetic, Catecholamines & Non-Catecoholamines, Side effects: tachycardia, tremor, headache, insomnia, nervousness
Catecholamines Rapid onset < 10 min, Short duration < 3hrs Epinephrine: Alpha 1, Beta 1 & 2 Racemic Epinephrine: Neb, Alpha 1, Beta 1 & 2
Non-Catecholamines (4-6hr duration) *Onset 15 – 20min, Peak 30 min, Metaproterenol – Neb/MDI/Tab, Pirbuterol – MDI, Albuterol – Q4 @ 2.5mg, Neb/MDI/TB/DPI, Levalbuterol – Q6 @ 1.25mg
Non-Catecholamines (Up to 12hr duration) Formoterol – Onset 3 min, Peak 30 – 60, DPI, Salmeterol – Onset 15 – 20, MDI/DPI, Arformoterole Tartrate – Onset 15 min, Neb
Anticholinergics Onset 15 min, duration 4 – 6 hrs, Ipratropium Bromide (Atrovent) – MDI/Neb, Q6 - 8, Tiotropoim Bromide (Spiriva) – DPI, QDay, *Side effects – increased heart rate & blood pressure, decreased secretions
Asthma Maintenance Drugs Mast Cell Stabilizers & Leukotriene Receptor Agonists
Mast Cell Stabilizers Intal & Tilade (Not avail. In US)
Leukotriene Receptor Agonists Accolate, Zyflo, Singulair – all 3 are mtce drugs
Proteolytic Agent Pulmozyme (dornase alpha) – neb, 0.1% solution, commonly used with CF pts, can’t be mixed. *Side effects: pharyngitis, laryngitis, conjunctivitis
Henry's Gas Law Directly proportional to partial pressure
Graham's Gas Law Inverseley proportional to the square root of the gases GMW
3 Major Cartilages Epiglottis, Thyroid, Crycoid
Glottis The space between the vocal cords
Trachea 16-20 C Shaped cartilages, bifurcates at the carina into the R & L mainstem bronchi
Bronchi order Mainstem, Lobar, Segmental, Sub-Segmental
Bronchioles Thousands, terminal bronchioles are the last of the conducting airways.
Pleurae Parietal: membrane that lines the ribcage, diaphragm, & mediastinum. Visceral: membrane that surrounds the lungs.
Diaphragm Major muscle of inspiration, R & L, innervated by phrenic nerve
Inspiratory Accessory Muscles Neck, shoulders
Expiratory Accessory Muscles Stomach
Pericardium Fibrous, Parietal, Visceral (from outer most to inner most)
Heart Layers Epi-, Myo-, Endo- (from outer most to inner most)
Apnea Not Breathing
Dyspnea Short of Breath
Eupnea Normal Breathing
Hyperventilation Blowing off CO2 < 35
Hypoventilation CO2 level > 45
Orthopnea Ability to breathe only while sitting up
Hyperpnea Tidal volume > 10L/m
Hypopnea Tidal volume < 5L/m
Tachypnea Rate > 20L/m
Causes of Respiratory ACIDOSIS Anesthesia, sedatives, narcotics Poliomyelitis, Myasthenia Gravis, Guillain-Barre Syndrome Sever obesity, COPD
Causes of Respiratory ALKALOSIS Anxiety, fever, stimulant drugs, pain, hypobarism(high altitude) Acute asthma, Pulmonary Vascular Disease
Causes of Metabolic ACIDOSIS Loss of BiCarb, Diarrhea, renal tubular acidosis, chloride administration, Diabetic ketoacidosis, alcoholic ketoacidosis, lactic acidosis, Drug or chemical induced = salicylate intoxication
Causes of Metabolic ALKALOSIS Admin/Ingestion of BiCarb, hypochloremia, diuretic therapy, Severe vomiting, nasogastric suction, corticosteroids
Humidifiers Bubble, Passover, HME
Nebulizers Pneumatic: Jet,SVN,LVN,DPI,MDI. Electric: Ultrasonic,Mesh
Autoclaving Uses steam under pressure. Rubber & plastic are easily damaged. Thermal indicators – temperature exposure. Biological indicators – sterilization
Ionizing Radiation x-rays/gamma rays. Limited use due to high cost, & the creation of toxic bi-products, long exposure time 48-72hrs
Disinfection Destroys the vegetative form of pathogens but NOT spores
Low Level Disinfection Will not kill resistant microorganisms
Acetic Acid Basically vinegar & water, used in homes to clean SVNS & tubes
Quaternary ammonium compounds Used to clean ventilators
Intermediate Level Disinfection Kill all vegetative bacteria & fungi, but not certain viruses
Ethyl & Isopropyl Alcohol Good surface disinfectants
Phenolics Limited use surface disinfectants
Iodophors Used primarily as an antiseptic agent (skin/tissue application – think IODINE)
High Level Disinfection Kills ALL vegetative microorganisms
Glutaraldehyde True sterilizing agent – kills SPORES w/ 3hr exposure time. Most widely use HIGH LEVEL disinfectant in Respiratory. Used w/ ventilator tubing, bronchoscopes, airways, & resuscitation bags.
Hydrogen peroxide Popular wound antiseptic, 6hr exposure time.
Sodium hypochlorite (bleach) Excellent surface disinfectant
Peracetic Acid w/ buffers is an excellent sporicidal agent
Ethylene Oxide Good for heat sensitive equipment. Chemical indicators – ETO exposure. Bio indicators – sterilization
Created by: vgflgirl