Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
PAAM
| Question | Answer |
|---|---|
| most common place for a nose bleed? | kiesselbach's plexus |
| what is jones dye test used for? | to see if nasolacrimal ducts are obstructed |
| what do type 2 cells in the lungs produce? | surfactant |
| how much air do adult lungs hold and what is the average tidal volume? | 3L/lung total of 6 with average tidal volume of 500mL |
| where does the bronchi and branching divisions of the tung tissue get their blood supply? what about the alveoli? | bronchi/branching = bronchiole arteries, alveoli from pulmonary circulation |
| how much fluid can the pericardial sac hold | 30mL |
| how much air do pediatric lungs hold? | 5-7mL/kg |
| SA node of the respiratory drive? | pre-botzinger complex |
| which respiratory group transmits signals via the phrenic nerve and intercostal nerves stimulating diaphragm and IC muscles to contract | Ventral (VRG) |
| which respiratory group receives input from the peripheral chemoreceptors and communicates with VRG telling it to chill (herig-bruere reflex) | dorsal respiratory group (DRG) |
| what does the pontine respiratory center do? | communicates with VRG to smooth out transition from inspiration to expiration |
| what 3 things does pulmonary perfusion depend on? | adequate blood volume, intact pulmonary capillaries, and efficient pumping of blood by heart |
| increases in CO2, temp, 2,3-BPG, and decreased pH, shifts chart to the right | Bohr effect |
| decreased CO2, temp, 2,3-BPG(byproduct of glycolysis = need energy), and increased pH, shifts chart to left | Haldane effect |
| CO2 transported from cells to the lungs via what 3 ways and percentages | bicarbonate 70%, hemoglobin 23%, plasma 7% |
| What is the equation for nasal cannula FiO2 given? what range of rates do you set it at? | (lpm x 4) +20%; 1-6 L/min |
| what are the suction limits for adults, children, infants, and ET/Trach tubes? | adults: 15sec, child: 10sec, infant: 5sec; ET: 5-10 |
| what are the 4 ways to ventilate and what is best for one person? | mouth to pocket mask (best), 2 person BVM, demand valve, 1 person BVM |
| what are the ventilation rates for adults and infant/child with/without pulse? | adult 1 every 5-6sec, infant/child with pulse 1 every 3-5, without 1 every 2-3 |
| how do you size for pedi ETT? | (age/4)+4; (Age+16)/4 for uncuffed (age/4)+3.5 cuffed |
| what is the appropriate way to size for suction when it comes to ETT? what should the depth be? | size = 2x tube used depth = 3x tube used +/- 1 |
| what does DOPES stand for and what is it used for? | ET intubation troubleshooting: Displacement, Obstruction, Pneumothorax, Equipment, Stacking |
| what does LEMONS stand for in regards to difficult airway assessment? | Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck Mobility, Saturations |
| what is the Cormack/LeHane Classification system? | used to evaluate glottic opening from grad 1-4: 1 entire glottic opening and vocal cords seen, 2 epiglottis and posterior portion of glottic opening and partial vocal cords, grade 3 only epiglottis sometimes posterior cartilages, grade 4 neither |
| indications for nasotracheal intubation and what kind of tube do you use? what can you connect to help with placement since it is a blind procedure? | requires cooperative/unresponsive spontaneous breathing patient using an endotrol tube 7.0 attach a BAAM device that whistles on inhalation = placement |
| what is the likely cause of "shark fin" waveform on capnography? | bronchospasm |
| what is a curare cleft seen in a capnography waveform? | appears when NMBA's begin to wear off and depth of cleft inversely proportional to degree of blockade |
| what size ETT or Shiley tube should be used in a cricothyrotomy? | ETT 6.0 or 7.0 Shiley 6.0 or 8.0 |
| where do you perform a digital thoracostomy? | between the 4th-5th ICS mid axillary |
| needle decompression (NDC)/thoracentesis sites? size of catheter minimum? | 2nd ICS midclavicular over the 3rd rib or 4-5th ICS anterior axillary line over the 5th/6th rib minimum size catheter 3.25IN |
| what action should you take if a patient starts to crash on a ventilator? | take them off and bag them |
| Diameter-Index Safety System (DISS) fitting for O2 tanks number? | 2:5 |
| how much pleural fluid is normally present and what pressure is our negative pressure breathing normally at? | 5-10mL and -2cmH2O pressure |
| what is the normal inspiration to expiration ratio? | 1:2 |
| Positive pressure ventilation that is controlled by preset rate, delivers a preset tidal volume | Time-cycled |
| Positive pressure ventilation: air pushed until preset tidal volume delivered, Time taken to deliver breath and pressure required to deliver tidal vol are adjustable. what must be set in place to prevent excess pressure | Volume-cycled (VC); high pressure limit needed |
| volume-cycled ventilation that gives breath no matter what, used in unconscious; pt RR and Vt is set, delivered by vent, any attempt by pt to breathe is blocked | Controlled mechanical ventilation (CMV) |
| VC ventilation that sets pt RR and Vt, if pt attempts to breathe, vent recognizes and will assist pt in delivering breath w/preset volume…. This can create breath stacking and hyperventilation. | Assist Control Ventilation (AC) |
| VC ventilation where RR and Vt set, but pt tries to breathe won't force set volume and will adjust pattern of set breaths around spontaneous breaths volume. Have to watch for hypoventilation | Synchronized Intermittent Mandatory Ventilation (SIMV) |
| VC ventilation where pt have to be breathing on your own, cannot have pneumo or hypotensive; positive pressure throughout entire respiratory cycle, can be used alone or as weaning mode (helps end pt need to be on a vent) | Continuous Positive Airway Pressure (CPAP) |
| Positive pressure ventilation where air pushed until preset pressure achieved, volume and time to give breath is variable, often used in noncompliant lungs/stiff (pt with ARDS | Pressure cycled |
| How do you calculate the tidal volume for a ventilated patient? | (height in feet - 1.5)x100 |
| what is normal PEEP created by and what is the natural pressure? where is the PEEP connected to on the vent circuit and BVM? How high can you go before needing consult? | natural PEEP is created by 1 nostril that is smaller in comparrison to trachea and epiglottis; normal is 5cmH2O; attach device to exhalation port/valve; can go from 5-10cmH2O without consult |
| When inserting ETT how far past vocal cords do you go? into stoma? | ETT 2-3cm, stoma 1-2cm |
| difference between sedation-facilitated intubation (SFI) and rapid/delayed sequence intubation (R/DSI)? | SFI given sedation but no paralytics, DSI potent induction agent followed by NMBA paralytics |
| absolute contraindications for RSI/DSI? | patient already in cardiac arrest |
| what medications for RSI/DSI should be based on ideal body weight? | ketamine and vecuronium |
| How do you calculate ideal body weight(IBW)? | Men: 50kg + 2.3kg x (height (in) - 60) Women: 45.5kg + 2.3kg x (height(in) - 60) |
| how do we prevent air and fluid reentering the chest cavity during chest tube care? | underwater seal by submerging distal tube in 2cmH2O at least |
| how far below the patient should we keep the chest tube system? | 2-3ft below chest |
| what gas law states: volume of gas is inversely proportional to pressure of it = more pressure, less volume, and the less pressure the more volume; every 33ft under water adds another atm | Boyles law |
| what gas law states: amount of dissolved gas in given amount of fluid is directly proportional to amount of pressure on top of that gas | Henry's law |
| what gas law states: at constant temp, volume of gas is directly proportional to absolute temperature of gas; if temp increases volume increases, temp decrease means volume decrease | Charles law |
| what gas law states: as you heat volume of gas the pressure is going to go up, cooling decreases | Gay-Lussac's |
| what gas law states: total pressure of a mixture of gases = sum of partial pressure of individual gases; air we breathe is 78% nitrogen, 21% oxygen, 1% other (CO2, helium, argon, others) | Dalton's law |
| What is the average PaO2 and PaCO2 | O2 avg PaO2 80-100, CO2 avg PaCO2 35-45mmHg |
| talking in a manner that achieves positive relationship is known as what kind of communication? | therapeutic |
| what is the 50/70 rule when communicating with someone? | 50% looking in eyes when talking and 70% when listening |
| what is the intimate zone distance, personal space, social space, and public space | intimate: <1.5ft, personal 1.5-4ft, social 4-12ft, public 12+ft |
| AEIOU-TIPS for altered mental status | Alcohol/acidosis/arrhythmias, Endocrine/epilepsy/electrolytes/encephalopathy, Infection, Oxygen/Overdose/opiates, Uremia, Trauma/temp/toxins/tables, Insulin (hypo/hyperglycemia), Poisoning/psychosis, Stroke/seizure/syncope |
| what is the first-4th step when it comes to assessment techniques? | 1: visual inspection, 2: palpation, 3: percussion, 4: auscultation |
| exaggerated drop in BP during inspiration >10mmHG | pulses paradoxus |
| strong and weak heartbeats alternate despite regular rhythm | pulsus alternans |
| appropriate size of BP cuff width, length, and overall distance on upper arm | width 40-50% mid arm, length 80-100%, overall 2/3 |
| what are the korotkoff sounds in words | first snapping, 2 swooshing, 3 tapping, 4 thumping, 5 silence |
| what heart sound : lub = closure of mitral/tricuspid valves during systole | S1 |
| what heart sound: dub = closure of aortic/pulmonary valves end systole beginning of diastole | S2 |
| what heart sound: systolic heart failure heard in early diastole directly after S2 "gallop" | S3 |
| What heart sound: diastolic failure; heard before S1 as atria force blood through stiff valves | S4 |
| what sign is being described: paradoxical rise in Jugular venous pressure during inspiration instead of normal decrease | Kussmauls sign |
| where are the heart sounds located? Aortic, Pulmonic, Erb's, Tricuspid, Mitral | A: 2nd ICS right, P: 2nd ICS left sternum, E: 3rd ICS left sternum, T: 4th ICS left, M: 5th ICS |
| where do you hear Hamman's crunch? | substernal after chest trauma |
| rovsing's sign | RLQ pain with palpation to LLQ |
| where is McBurney's point located | 2/3 from umbilicus to ASIS |
| cranial nerve action: smell | Olfactory (1) |
| cranial nerve allowing sight and vision | Optic (2) |
| cranial nerve in control of pupils, superior/inferior rectus and inferior oblique eye movement | Oculomotor (3) |
| Cranial nerve in control of superior oblique ocular muscles and down/inwards motion of the eye | Trochlear (4) |
| Cranial nerve in charge of ophthalmic (forehead), maxillary (cheek), Mandibular (chin) sensation and motor control of mastication | Trigeminal (5) |
| Cranial nerve in charge of lateral rectus muscle ocular movement | Abducens (6) |
| Cranial nerve in charge of sensory to the anterior 2/3 of the tongue, motor to the facial muscles of expression | Facial (7) |
| Cranial nerve in charge of hearing and balance | Vestibulocochlear (8) |
| Cranial nerve in charge of posterior pharynx sensation and taste posterior 1/3 tongue, posterior palate and tongue swallowing | Glossopharyngeal (9) |
| Cranial nerve in charge of sensory to the taste to posterior tongue, motor to posterior palate and pharynx swallowing ans speech, major parasympathetic nerve touching every organ down to the rectum | Vagus (10) |
| Cranial nerve in charge of trapezius and SCM = shrugging and head movement | Accessory (11) |
| Cranial nerve in charge of tongue movement | Hypoglossal (12) |
| where is the negative and positive electrodes in lead I of Einthoven's triangle | negative is RA positive LA |
| where is the negative and positive electrodes in lead II of Einthoven's triangle | negative RA and positive LL |
| where is the negative and positive electrodes in lead III of Einthoven's triangle | negative LA and positive LL |
| what is the view of the heart in leads I, II, III? | lead I upper left lateral, lead II and III inferior |
| what is a normal ECG speed? | 25mm/sec |
| what is 1 small horizontal box and large box measurement on an ECG? | small: 0.04sec, large: 0.20sec |
| what is 1 small vertical box and large box measurement in an ECG? | small: 1mm, 0.1mV; large: 5mm, 0.5mV |
| duration and amplitude(limb and precordial leads) of a normal p wave in ECG? PRI? | duration <0.12sec, amplitude in limb lead <2.5mm and <1.5mm in precordial PRI normally 0.12-0.20sec |
| what should a normal QRS duration be in ECGs? | 0.04-0.12sec |
| what part of the ECG is described as normally asymmetric with steeper downslope than upslope, upright except in aVR and V1 | T wave |
| what is normal amplitude of T wave in limb and precordial leads? | limb <5mm, <10mm in precordial |
| what are the 5 steps to the systematic approach to reading an ECG? | rate, rhythm, P waves, PRI, QRS complexes |
| how do you calculate duration of oxygen given type of cylinder and flow rate? | (PSI X Factor) / Flow rate = duration in minutes |
| What are the specific multiplication factors for M, D, E, H/k, and large D | M : 1.56, D: 0.16, E, 0.28, H/K: 3.14, Large D: 2.41 |
Created by:
Lindsey.George