ACCS Review Part 1 Respiratory solved

ACCS Review Part 1 Respiratory solvedGlasgow Coma Scale is used to assess level of consciousness after head injury. Eye=4: verbal stimuli 3, to pain 2 Mouth=5: confused 4, inappropriate 3, incoherent 2. arm=6, localize pain 5, withdraw from pain 4, flex to pain 3, extension to pain 2. 8 or less intubate Changes in CVP can indicates changes in Fluid balance, decreased CVp2 can indicate hypovolemia, increased CVP6 can indicate hypervolemia 00:36 01:38 Orthopnea difficulty breathing except in the upright position, CHF patients General malaise Electrolyte imbalance - nausea, weakness, headache Hemiparesis abnormal posturing, could indicate brain injury. Miosis pinpoint pupils ptosis drooping of the upper lids diplopia blurred or double vision nystagmus cyclic movement of the eyeballs Erythema redness of the skin Ecchymosis subcutaneous hematoma or bruises Tracheal Deviation: Pulled to Abnormal side Pulmonary atelectasis, Pulmonary fibrosis, diaphragmatic paralysis 00:02 01:38 Tracheal Deviation: Pushed to normal side Massive PE, Tension Pneumothorax, Neck or Thyroid tumors outside of lung Flat or Dull sounds flat- heard over the sternum, muscle or areas of atelactsis, dull- heard over fluid-filled organs, heart or liver (PE, or pneumonia) If PaO2 increases with Oxygen therapy then the patient has a V/Q Mismatch 66- 300 torr If PaO2 does not increase with Oxygen therapy then the patient has a shunt 300 torr Arterial Oxygen Content (CaO2) Best measurement of oxygen delivered to the tissues, Normal = 17-20 vol% ml/dL Mixed Venous Oxygen Content (CvO2) Total amount of oxygen carried in the Mixed venous blood, Normal = 12 - 16 vol%, CvO2 values will decreases when Cardiac output decreases C(a-v)O2 difference will increases when the CvO2 is decreases and would indicate decreasing in Cardiac output Arterial-Venous Oxygen Content Differences C(a-v)O2 normal :4 - 5 % Shunt Equation (Qs/Qt) For every 100 A-aDO2 = 5% shunt, 300= 20% shunt; (5x3) + Normal 5 = 20% calculating PAO2 (FiO2 x 7) + 10 A-aDO2 = PAO2 - PaO2, Alveolar-Arterial Oxygen Gradient P/F Ratio Normal 380 or greater, Mild ARDS = Less than 300, Moderate ARDS = Less than 200, Severe ARDS = Less than 100, Arterial catheter with Pressure transducer should be at - should be at the level of heart, - if transducer is placed above the heart, reading are lower than actual, -if transducer is placed below the heart, reading are higher than actual, PAP inserted through the jugular or subclavian vein are position in the the pulmonary artery approximately 50cm of catheter is inserted, if 50cm of catherete is inserted - catheter is curling in the right atrium or right ventricle, Ballon should be deflated and the catheter withdrawn PAP normal 25/8, Mean 14 PCWP, pulmonary Wedge Pressure 4-12 mmHg Left Heart MAP (systemic Arterial System) Mean Arterial PRessure 120/80 CVP Systemic Venous System (Central Venous Pressure) 2-6 mmHg or 4-12 CmH2O Normal Cardiac Output (Qt) 4-8 L/min Normal Cardiac Index (CI) 2-4 L/min