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Empyema Empyema is usually caused by an infection that spreads from the lung. It leads to a buildup of pus in the pleural space. There can be a pint or more of infected fluid. This fluid puts pressure on the lungs.
Empyema Risk factors include pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma or injury to the chest.
Phosphotidylglycerol (PG) obtained by amniocentesis, when it is present, it indicates that the baby’s lungs are mature
“Thorpe Tube” standard oxygen flowmeter, plugs into wall outlet
“Bourdon Gauge” regulator
“Eupnea” normal breathing, no distress “Eu”
BiPAP is called NPPV (Noninvasive Positive Pressure Ventilation) for testing purposes
“Marked” means very severe – so do something quickly
“Oscilloscope” an older term for a cardiac monitor or other monitoring electronic monitoring device.
Cardiac Output – what formula is used? Fick Equation Normal Range for Cardiac Output – 4-8 LPM
Cardiac Index – what are the units? (L/min/m2) liters per minute per square meter. That is because Cardiac Index is Cardiac Output (L/min) divided by Body Surface Area (m2)
Cardiac Index Normal Range Since Body Surface area is about 2 for most patients, the Normal Range for Cardiac Index is about 2-4 L/min/m2
Patient is having bleeding during bronchoscopy, what do you do? Administer Epinephrine down the scope.
Patient coughing during bronchoscopy, what do you do? Administer Lidocaine down the scope.
PFT’s – what volumes add up to various capacities. Ex. ERV + RV = FRC
PFT’s. Which volumes and capacities are increased or decreased in obstruction/restriction Ex. TLC and VC decreased in restriction (less than 80% of predicted), FEV1/FVC ratio decreased in obstruction, less than 70%, so the patient exhales less than 70% of VC in the first second.
Obstruction CBABE diseases Cystic Fibrosis, Bronchitis, Asthma, Bronchiectasis, Emphysema
What does PEEP really do to improve oxygenation? it decreases PA-aO2, meaning A-a gradient, Alveolar to arterial gradient. It also increases the FRC
Acute Asthma in the ER – albuterol and prednisone are best (versus long acting agents, not Brovana, Symbicort, etc)
Infant with Stridor in the ER Racemic Epinephrine is best (will talk later about croup versus epiglottitis)
TcO2 – transcutaneous oxygen – sensor temp should be 44 degrees C. If the sensor is burning the infant, move it more often! 2-3 hours in one place, and then move it
Heliox – when used (severe bronchospasm or airway obstruction), how to determine actual flow when using standard oxygen flowmeter (you will be using a nonrebreather mask)
For 80/20 mixture, the ratio is 1.8. So multiply the oxygen flowmeter reading times 1.8 to get the true flowrate
If the patient is on 80/20 Heliox and the oxygen flowmeter reads 10 LPM, then the actual flow is 18 LPM
14. For Pediatrics – review setting oscillator - HFOV, Mean Airway Pressure, Amplitude
1. Know all the Ventilator Waveforms and what they mean – the “beak” is overdistension, so you would decrease tidal volume or PIP. Also review air leak, reduced compliance, increased resistance, inadequate flow.
11. Know PEEP and its effects on venous return, cardiac output, blood pressure, lung compliance, etc. deryl.gulliford@independence.edu
1. Know Capnography waveforms and what they mean. Like the sharkfin for bronchospasm, or hypoventilation.
Tylenol (Acetaminophen) Overdose - Acetaminophen (APAP) poisoning is most common causes of medication-related poisoning and death. The duration of N-acetylcysteine treatment is determined by the type of ingestion and the presence or absence of elevated serum alanine aminotransferase (ALT) concentrations.
Tylenol (Acetaminophen) Overdose- Mangement The management of the acetaminophen-poisoned patient may include stabilization, decontamination, and administration of Mucomyst - N-acetylcysteine, a specific antidote.
Tylenol (Acetaminophen) Overdose Acetaminophen poisoning may occur following a single acute ingestion or through the repeated ingestion of supratherapeutic amounts.
15. Capillary Blood Gases – know how they compare to ABG’s, know the normal values For example, the pH and PCO2 will be similar to arterial blood gases, but the PO2 will be much lower, more like 50-60.
1. Modifying therapy based upon blood gases. Especially know when to raise FIO2, when to add PEEP, when to increase or decrease tidal volume. Raise FIO2 to 60%, and then start adding PEEP. Any FIO2 over 60% is considered toxic!
Hemoximetry – know why important – carboxyhemoglobin, methemoglobin – know what it means if Pulse Oximeter reads different from true oxygen saturation. If the Hemoximeter and Pulse Oximeter disagree, there is probably Carboxyhemoglobin, as in CO poisoning
Created by: Cam1228