Pulmonary Diagnostic Testing

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  1. Where do you get an ABG on an infant?
    • Heel stick
    • Capillary samples 
  2. How to get ABG on newborn baby
    Umbilical arterial line 
  3. What is pre & post ductal PO2
    • Allow continuous monitoring BP
    • Arterial smaples ABG
    • Blood replacement (transfusions)
  4. Radial artery first choice b/c
    Accessibility & collateral blood flow 
  5. If radial artery not available
    • Brachial artery alternative site
    • Femoral artery last choice 
  6. Why use a modified allens test
    Assess collateral circulation 
  7. Hazards/Problems with ABGs
    • Disruption blood flow-Hematoma
    • Clotting
    • Bleeding-Hold pressure site 5 min
    • Vessel spasm
    • Tissue Trauma
    • Anti-coagulation therapy  apply pressure longer. Hold till bleeding stops. 
  8. Air bubbles in sample cause:
    PaCO2
    PaO2
    pH
    • PaCO2     decrease toward 0 torr
    • PaO2       increase/decrease toward 150 torr
    • pH          increase 
  9. What is PCO2
    partial pressure CO2 (severinghcus electrode)
  10. What is PO2?
    Partial pressure O2 (clark electrode) 
  11. What is pH?
    Acid base status (sanz electrode) 
  12. Image Upload
  13. Alveolar Air Equation
    Partial pressure oxygen (PO2) in alveoli 

    • PAO2: (PB-PH2O)FiO2- PACO2
    •                                 R:0.8
  14. A-aDO2: A-a gradient-oxygen tranpsort
    Difference between alveolar and arterial PO2.

    A-aDO2: PAO2-PaO2

    • 25-65 on 100%: Normal 
    • 66-300: V/Q mistmatch
    • >300: Shunting 
  15. What is CaO2?
    Arterial oxygen content mixed venous blood 
  16. What is C(a-v)O2
    • Arterial -venous oxygen content difference
    • Oxygen consumption
    • It will increase when CVO2 decrease indicates cardiac output decrease 
    •  
  17. Cardiac Output Equation
    •        VO2      
    • C(a-v)O2 (10)
  18. What is the shunt equation
    Qs/QT
  19. VD/VT equation
    • PaCO2-PECO2 X100
    •      PaCO2
  20. PaO2 Values

    PaO2     SaO2
    40
    50
    60
    • SaO2
    • 70
    • 80
    • 90
  21. What does an increase in VD/VT mean?
    dedsapce producing pulmonary embolous 
  22. What to do when PCO2 above 45?
    • NO VENTILATION
    • Initiate vent
    • remove/decrease deadspace
    • increase current vent
  23. What to do when PCO2 below 35?
    • IS VENTILATING BUT TOO MUCH
    • No mech vent
    • Add deadspace
    • Decrease vent
  24. O2 HB dissociation curve shift to left 
    • Increased O2 affinity 
    • Higher O2 content for any given PO2
  25. O2 HB dissociation curve shift to right
    • Decreased O2 affinity
    • Lower O2 content at any given PO2
  26. Spirometers
    • Water seal (collins, Stead wells)-measure volume & time 
    • Measure volumes and flow rates
  27. Pneumotachometers (flow)
    • Trubine device (wright respirometer)
    • Measure flow, display volume 
  28. Peak Flow meters
    Patient exhales forcefully through device
  29. Kymography
    • Plots volume (Y-axis) against time (x-axis)
    • Needle moves up & down measure Vt
    • Horizontal=time 
  30. Galvanic Fuel Cell
    • Measure partial pressure, display FiO2 as %
    • Unable to calibrate, change fuel cell
    • Accuracy affected by water on sensor, high system pressure & changes in altitude. 
  31. Polarographic
    • Unable to calibrate change battery & check electrolyte level (refill if low)
    • Uses battery same as galvanic fuel cell 
  32. MIP (maximum inspiratory pressure)
    • Monitory & assess readiness to wean pts 
    • Assess respiratory muscle impariement guillain-barre and myasthenia gravic 
  33. MEP (maximum expiatory pressure)
    Evaluate pts ability to maintain airway & clear secretions 
  34. Vital Capacity
    Pt take maximal inspiration followed by maximal exhalation without force 
  35. Decreased VC
    Restrictive less 80%
  36. Decreased Volume
    Restrictive 
  37. FVC
    Volume expired forcefully and rapidly after maximum inspiration 
  38. FEV1 below 80%
    Obstructive 
  39. FEV1.0/FVC
    70% or less obstructive disease 
  40. Bronchoscopy
    • Visualize trachea & bronchi
    • Suspected foreign body (unilateral wheeze)
    • Recommend flexible bronchoscopy for intubation pts w/ suspected neck fracture 
  41. Decreased volumes
    • Restrictive
    • Inflammatory diseases
    • Cardiac diseases
    • Neurological/Neuromuscular 
    • Pleural disease
    • Thoracic deformities
    • Post-surgical pts
    • Fibrotic diseases 
  42. Obstructive Diseases
    • Cystic Fibrosis
    • Bronchitis
    • Asthma
    • Bronchiectasis
    • Emphysema 
  43. Restrictive decrease volumes
    VC or FVC
  44. Obstructive decrease flows
    FEV1, FEV1/FVC
  45. Restrictive loop
    skinny & tall 
  46. Obstructive loop
    short & wide loop
  47. Pre and post bronchodilator testing
    • Measure reversibility of obstructive pattern
    • Increasing 12% and 200ml FEV1 post study 
  48. Maximum voluntary ventilation (MVV)
    • Largest volume & rate breathed per min by voluntary effort
    • Breathe in and out as fast as possible until told to stop 
    • 12-15 secs
    • Measure mechanics breathing 
  49. Forced expiatory flow 25%-75% (FEF25-75)
    Decreased vales=small airway obstruction 
  50. Forced expiatory flow 200-1200 (FEF200-1200)
    Decreased values=large airway obstruction 
  51. PFT interpretation:
    80-100%
    60-79%
    40-59%
    <40%
    • 80-100%    Normal PFT
    • 60-79%      Mild Disorder
    • 40-59%      Moderate Disorder 
    • <40%        Severe Disorder 
  52. Image Upload
Author:
Anonymous
ID:
199467
Card Set:
Pulmonary Diagnostic Testing
Updated:
2013-02-10 21:42:54
Tags:
Respiratory Therapy
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Description:
Respiratory Therapy
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