crt

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lisad
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141167
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crt
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2012-12-08 09:32:10
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crt
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crt
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  1. Acute epiglottits
    thumb sign
  2. Laryngotracheobrachitis (croup)
    steeple sign
  3. pleural effusion
    • x-ray = concave shape free fluid with a menisus
    • concave superior interface border
    • dull to percussion
  4. atelectasis
    • xray = diffused scattered throughout ,patchy infiltrates, plate like infiltrates
    • flat to percussion
  5. chf and pulmonary edema
    • fine rales
    • pink suptum
    • xray= opaque, enlarged heart, batwing, fluff infiltrates
    • orthopnea
  6. Pulmonary embolus
    • Sudden onset of shortness of breath
    • xray wedge shaped infiltrates
  7. ARDS
    • increased plateau and pip
    • xray= reticulogranular, honeycomb, ground glass
  8. pneumothorax
    • hyperresonant to percussion
    • hyperlucency
    • sudden onset of tachypnea
  9. asthma
    • air entrainment mask
    • elevated eosinophil count
  10. bronchiectasis
    tree in winter problem
  11. COPD
    hyperresonat
  12. defibilation
    • 360 joules
    • pulseless v-tech
    • ventricular flutter
    • ventricular fibillation
  13. pulseless v-tech
    • cpr
    • epinephrine,amiodarone, lidocain
  14. Asystole
    • confrim in 2 leads
    • epinephrine and atropine
    • do not defib
  15. Bipap
    • Ipap most exceed EP
    • increase ipap only to blow of co2
    • increase both ipap and epap to improve o2
  16. optium peep
    • inflection point of a volume-press loop graph
    • acceptable oxygen with no cardovascular
    • increase static compliance with acceptable o2
  17. amplitude
    • = press
    • incraese with high co2
  18. low pressure alarm
    • leak in the vent circuit
    • insufficent flow
    • endotracheal/tracheostomy tube cuff
  19. low exhaled volume alarm
    • equipment disconnect
    • low spontaneous tidal volume
  20. High pressure alarm
    • secretions
    • hernated cuff
    • coughing
    • decressed compliance
    • pneumothorax
    • pinched circuit
    • water in circuit
    • clogged hme
  21. weaning
    • rr- 20
    • vt- 300-500 ml
    • mip/nif-25
    • vc- 10-15ml
    • V.E- <10 l/min
  22. low co2
    • increase dead space
    • decrease rate or vt
  23. high co2
    • decrease or remove deadspace
    • increase vt and rate
  24. pulmonary capillary wedge pressure
    • 4-12
    • high = cardiac
    • normal pulmonary
    • left heart
  25. central venous pressure
    • 2-6
    • when high fluid overload
    • when low dehydration or vasodilation
  26. decreased volumes
    decreased compliance and increased airway resistance
  27. Increased volumes
    increased compliance and decreased airway resistance
  28. elevated s-t segment
    current mi
  29. Spiked t wave
    hyperkalemia
  30. pronounced q wave
    previous MI
  31. icp
    • 5-10
    • treat >20 mmhg
    • hyperventilated untill paco2 is 25-30 mm hg
  32. central sleep apnea
    No chest movement
  33. obstructive sleep apnea
    chest movement
  34. treat decreased static compliance
    • inverse positive pressure ventilation optium peep therapy
    • press control ventilation
  35. air/o2 ratio
    • 28% 10:1
    • 40% 3:1
    • 60% 1:1
  36. miller blade
    • under the epiglottis
    • infants
    • straight
  37. macintosh
    • vallecula
    • curved
  38. data
    • Subject- what the pt tells you
    • objective - actual fact
  39. breath sounds
    • wheezing
    • bronchoconsteiction
    • rhonchi (coarse rales )
    • secreations in the large airways
    • rales (crackles)
    • secrations in the middle-sized airways
    • treat with chest pt
    • Stridor
    • upper airway obstruction
    • mild-cool mist
    • moderate- racemic epi
    • severe - intubate
  40. increased pip
    • secrations in the airway
    • kinked et tube
    • excess water in the vent circuit
    • bronchoconstrion
  41. increased platau
    • ARDS
    • plumonary fibrosis
    • plumonary edema
  42. Pulmonary arterial pressure (pap)
    • 25/10
    • increased equals pulmonary hypertention, left ventricular failure, fluid overload
    • decreased equals pulmonary hypotenstion, hypovolemia,cardiovascular collapse
  43. decrease auto
    • incease flow
    • add exoiratory retard
  44. maximal expiratory flow volume loop
    test upper airway obstrucation
  45. obstructive lung disease
    • low flows
    • increase rv and tlc
  46. mean arterial pressure
    85-100 mmg
  47. high frequency jet
    rates of 100 to 600 per/min
  48. high frquency oscillatory
    15 hz or 900 per/min
  49. chest tube
    • suction control and water seal bubble
    • should be located in the pleural space surrounding the lung
  50. dead space/ tidalvoulme (vd/vt)
    • 20-40%
    • if high relates to pulmonry embouls
  51. ap xray
    use when determining placement of et tube
  52. lateral xray
    lungs in 3- demensional body
  53. oblicque xray
    increase the 3 demensionality of the lung, helpful in spotting internal issues such as masses, blebs, or leasions
  54. lateral neck xray
    defferenting between croup and acute epiglottitis
  55. mri
    masses, lesions, or nodules
  56. broncogram
    primary dignostic tool for bronchtiectasis
  57. percussion
    • hyperresonant- copd or pneumothorax
    • dull- pneumonia
    • flat-atelectasis
  58. tracheal palpation - devation toward
    • pulmonary fibrosis
    • atelectasis
    • lobectomy
    • pneumothorax
  59. tracheal palpation away
    tension pneumothorax
  60. slow vital capacity (svc)
    • good test to measure for restrictive lung diesase
    • should be hogher then fvc
  61. forced vital capacity
    • best indicator of obstrucation
    • normal is 85% minimum 75%
    • obstructive imparirment is consider present if less then 75%
  62. maximum volutary ventilation (mvv)
    • 12 to 15 sec
    • relates to muscle endurance and general function
  63. flow volume loop
    • use to evaluate vocal cord dysfunction and paralysis as well as cancerous masses in the upper airway
    • tall and skinny loop- restritive
    • short and fat loop- obstritive
    • round loop- large fixed airway obstrtion
  64. oxygen tent
    fio2 40-50%
  65. oxygen hood
    • minimum flow is 7lpm
    • max 100%
  66. cascade humidifier (heated)
    most efficient device
  67. oral airway
    inser 180o from final postion the twist
  68. cather size
    should not exceed 1/2 of the internal diameter of the et or trach tube
  69. pasteurization
    best to use with equipment used on patients with infections disease such as hepatits
  70. alcohol
    • ethyl and isopropyl are effective
    • 70-90%
  71. ethylene oxide (eto)
    • gas sterilization
    • good for devices that have electical componets
  72. cidex (alkaine gluteraldehydo)
    • not good for elecraical componets
    • will kill all bactera in 10 min
    • will kill everything in 10 hr
    • will kill tb in 20 min
  73. ippb
    • decrease work of breathing
    • prevent atelectasis
    • improve cough effectivness
    • provide brocodaitlaion
    • moblize secrtions
    • tread/prevent pulmonary edema
  74. is
    • done hourly
    • 8-10 breaths
    • post-op goal should be half of pre-op
  75. intiation of mechanical ventilation
    • rate 8-12
    • vt 8- 12
    • 100% im emergency
    • simv/imv- a/c- comtrol
  76. pressure control ventilation
    • no vt- only inspiratory pressure and i time
    • must set exhaled vt alarms
    • only use to modify therpy
  77. cuff pressure
    20-25 mmhg
  78. anxiety/pain reliver
    • morphine sulfate
    • valuim
    • versed
  79. lidocain
    treat pvc, v-teac,v-fib
  80. sedation
    • narcotic analgesies
    • meperidine
    • morphine
  81. supine postion
    • lying flat on back
    • drain upper lobes, anterior segment
    • good for post neuro surgical patitnets
  82. prone postion
    • lying face down
    • drains lower lobed, posterior basal segment
    • superior segments
  83. trendelenburg ( head down 15o)
    • manage hypotension
    • contraindicated for head trauma
    • drain lingular, lateral , and medial segments
  84. head down 30 o
    used to drain the lower lobes, basal segments, anterior basal ,lateral basal, posterior basal segments
  85. postive expiratory pressure (pep)
    • use 3-4 times per day
    • 15- 20 min
    • expiratory pressure from 10-20 cm H2O
    • rhonchi that clears with coughing is evidence it tis working
  86. Minimal concluding volume 
    • Use
    • Inflate cuff till leak is not heard during positive pressure breath 
  87. Apgar score
    • Color, pulse, reflex,movement,resp
    • Less then 3 cpr
    • 4-6 preventive measurement 
    • 7-10 good 
  88. Neonate vs
    • Rr & hr double adults 
    • Bp half of adults 
  89. Sputum 
    • Mucoid - clear and thick 
    • Fetid- foul smelling 
    • Purulent- contains pus 
    • Copious- large amounts 
  90. Hemoptysis
    Spitting up blood from the teacheobronchial tree lungs 
  91. Hepatomegaly 
    Enlarged liver 
  92. Dyspnea
    Shortness of breath as perceived by the pt 
  93. Orthopnea
    Pt can't breath lying down
  94. T-pieace weaning 
    Placing pt on blow by at anappropriate fio2
  95. General Malaise
    Electrolye imbalance
  96. Clubbing
    Chronic Hypoxemia
  97. increasded venous distention
    chf
  98. Diaphoresis
    Heavey sweating, heart failure, fever, infection, anxiety, nervouness
  99. chest configuration
    • kyphosis- leaning foward
    • scoliosis- side to side
    • pectus carinatum- anterior protrusion of the sternum
    • pectus Excauatum- depression of part of all the sternum
    • Kyphosis- hunchback
    • barrel chest- air trapping, copd 
  100. Eupnea
    normal rr, depth and rhythm
  101. tachypnea
    increased rr (20bpm)
  102. Bradypnea
    decreased rr (less then 8 bpm)
  103. cheyne- strokes
    gradually incrase then decrease rate and depth in a cycle lasting from 30-18- seconds with periods of apnea
  104. hyperpnea
    increased rate, depth and regular rhythem
  105. biots
    increased rr and depth with irregular periods of apnea
  106. kussmauls
    increased rate depth, irregular rhythm breath sounds labored
  107. apneustic
    prolonged gasping inspiration followed by extremely short, insufficient expiration
  108. atrophy
    loss of muscle tone and occurs in paralysis
  109. hypertrophy
    increased muscle size - copd
  110. dry or nonproductive cough
    may indicate a tumor in the lung
  111. productive cough
    indicate an infection
  112. pleura friction rub
    • pleurisy, tb pneumonia, pulmonary infarction, cancer
    •  treat with steriods and antibottics
  113. heart sounds
    • s1- normal
    • s2- normal
    • s3- may suggest chf
    • s4- cardic abnormality such as mi or cardiomegaly
  114. pulmonary artery catheter
    should appear in the right lower lung field
  115. pacemaker
    should normally be in the right ventricle
  116. central venous catheter
    placed in the right or left subclavin or jugular vein and should rest in the vena cava of the right atrium of the heart
  117. ischemia
    reduced blood flow to tissue injury- acute damage to tissue
  118. infarction
    necrosis or death of tissue may be recent  (acute) or old
  119. patent airway
    • head-tilt/chin lift
    • jaw thrust/modified jaw thrust (broken neck)
  120. intubation
    • oral - 21-25 cm mark
    • nasal- 26-29 cm mark

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