Neonatal/Pediatric Specialist Respiratory Exam

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  1. Avelor Air Equation (Alveolar PaO2)
    PAO2 = (PB-PH2O) x FIO2 - (PaCo2 x 1.25)

    short cut: the PAO2 for a child on 50% oxygen with a PaCO2 of 40 torr when the barometric pressure is 747 is

  2. Oxygen Index (OI)
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    Measures the amount of ventilatory support required to provide the level of oxygenaton obtained.

    An OI of greater than 40 is associaciated with mortality rates of 80 % and is common criteria for ECMO.

    Normal value is 380 mmHg or greater.  (As the number goes down, the patient is getting worse.)
  3. Arterial Blood Gas  (ABG)

    normal Ph for newborn
    Ph 7.25 - 7.35
  4. ABG

    PCO2 newborn
  5. ABG

    Pao2 newborn
    50-70 mm Hg
  6. ABG

    HCO2-  newborn
    17-23 mEq/L
  7. ABG

    BE newborn
    -10  to +2
  8. ABG

    Ph infant
    7.34 - 7.46
  9. ABG

    PaO2 infant
    85 - 100 mm Hg
  10. ABG

    PaCO2 infant
    30-45 mmHg
  11. ABG

    HCO3-  infant
    20-28 mEq/L
  12. ABG

    BE infant
    -4 to +2
  13. ABG

    PH child
    7.34 - 7.45
  14. ABG

    PaO2 child
  15. ABG

    PCO2 child
  16. ABG

    HCO3-  child
    22-26 mEq/L
  17. ABG

    BE child
    -2 to +2
  18. Xray:

    Hyaline Membrane Disease
    Infant Respiratory Distress Syndrome
    Acute Respiratory Distress Syndrome
    Reticulonodular, reticulogranular densities, ground glass appearance, honeycomb pattern, air bronchograms
  19. Xray:

    Bronchopulmonary Dysplasia
    Diffuse hazziness, opacification, presence of bullae, spongelike appearance.
  20. Xray:

    Patchy infiltrates, scattered densities, plate-like densities, elevated hemidiaphragm.
  21. Xray:

    Congenital Diaphragmatic Hernia
    Hypoplastic lung on affected side, mediastinal shift away from affected side, NG tube enters abdomen and passes back above diaphragm.
  22. Xray:

    Air bronchograms, consilidation, discoid shaped infiltrate.
  23. Xray:

    Hyperlucency, absent vascular markings, flattened diaphragm on affected side, mediastinal shift away from affected side.
  24. XRay:

    Pulmonary Institial Emphysema (PIE)
    Nodular irregular bubbles radiating outward from hilum, linear lucencies or streaks, "air-leak syndrome".
  25. XRay:

    Hyperlucency in a ring (dark area) around the heart or under the inferior heart border.
  26. Xray:

    Pleural Effusion
    1) diagnosed with lateral dicubitus xray

    2) Bibasilar infiltrates with meniscus, blunting or obliteratin of costophrenic angle.
  27. Xray:

    Pulmonary Edema
    Bilateral difuse fluffy infiltrates originating from the hilum in a butterfly or batwing pattern.
  28. Xray:

    Tetrology of Fallot (TOF)
    boot shaped heart
  29. Xray:

    Transposition of the great vessels (TGV)
    egg shaped heart
  30. Xray:

    Totally Anomalous Pulmonary Venous Return
    snowman shaped heart
  31. Radiograpic Procedures:

    Inspiratory/Expiratory films
    foreign body aspiration
  32. Radiographic Procedures:

    End Expiratory Film
    small pneumothorax
  33. Radiographic Procedures:

    Lateral Decubitus
    pleural effusion
  34. Radiograpic Procedures:

    Lateral Neck
    croup (subglotic) - "steeple sign"

    epiglottitis (above the golttis) - " thumb sign"
  35. Pathology:

    Choanal Atresia
    substernal and intrasternal retractions
  36. Pathology:

    Esophageal Atresia
    cannot swallow, increased oral secretions
  37. Preductal SaO2 of newborn at one minute
    60- 65%
  38. E
  39. EKG:

    normal sinus rhythm (NSR)

    treat other symptoms (TOS)
  40. EKG:

    sinus tachycardia
    HR greater than 200

    admninister O2, TOS
  41. EKG:

    sinus bradycardia
    HR less than 100

    administer epinephrine
  42. EKG:

    sinus arrhythmia
    treat other symptoms
  43. EKG:

    premature ventricular contraction (PVC)
    administer O2
  44. EKG:

    ventricular tachycardia (V-tach)
    defibrilate IF pulseless electrical activity (PEA)
  45. EKG:

    Ventricular fibrilation (V-fib)
    "defib for V-fib"

  46. PaO2/FIO2 ratio or P/F ratio
    1.) Determines the degree of lung injury; how much O2 does it take to get a good PaO2?

    2.)  normal: 380 mmHg or less

          less than 300 indicates ALI (acute lung injury)

    •       less than 200 signifies ARDS (acute respiratory
    •       distress syndrome)
  47. QS/QT
    • (A-aDO2) . 003
    • (a-aDO2) . 003 + C (a-v) O2

    • Shortcut:  Normal anatomical shunt is 5%.
    • If the A-a DO2 is 200 torr then an additional 10% shunt is estimated (100torr=5%, 200torr = 10%, etc) The total % shunt would be 15% (5% normal, plus 10%)
  48. Pulmonary Function Testing

    Spirometry ranges
    80-100 of predicted is normal

    60-79 of predicted is mild

    40-59 of predicted is moderate

    less than 40 of predicted is severe
  49. Pulmonary Function Testing

    best volume (fast or slow) for 3 seconds

    for restrictive lung disease

    best over all test
  50. Pulmonary Function Testing
    best flow rate

    for obstructive lung disease: CBABE (cystic fibrosis, chronic bronchitis, asthma, bronchieactasis, emphysema)


    FEV1/FVC% best test for obstructive lung disese

Card Set
Neonatal/Pediatric Specialist Respiratory Exam
lab values for the National Board of Respiratory Care Pediatric/Neonatal Specialist Exam
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