I accidently found out a very good website on listening to breath sound. You can quiz yourself too.
Here it is.
http://www.easyauscultation.com/lung-sounds.aspx
Hope it helps.
All about Respiratory Therapy
Saturday, February 23, 2013
Tuesday, May 22, 2012
Isolation Wear: Dress & Undress in Order
Isolation Wear: Dress & Undress in Order
v Dress in this order:
· Hair covering
· Foot covering
· Gown
· Mask
· Goggles
· Gloves
v Undress in this order:
· Hair covering
· Food covering
· Mask
· Goggles
· Gloves
· Gown
**This stuffs from first year lap.
Pneumothorax
Pneumothorax
· ↓ BS, tachycardia & hypotension
· ↓ chest expand on affected side
· Air in pleural space
· Depressed diaphragm (CXR)
· Tracheal shift away from affected side
· Greater space between ribs (CXR)
· Hyperresonance on percussion
· Subcutaneous emphysema
· Area is black on chest X-ray
· Absence of lung markings (CXR)
· Air surround collapsed lung
· ↓ static compliance, resistance stay the same
ü If <20% observation
ü 100% O2
ü If >20% simple aspiration large-bore needle at 2nd intercostals space or
ü Chest tube at 5-6th intercostals space along anterior axillary line
ü Not below 9th intercostals space (liver, kidneys, etc…)
Newborn & Pediatric ETT Size
Newborn & Pediatric ET tube size
Newborn
|
ID (mm)
|
<1000 g
|
2.5
|
1000 – 2000g
|
3.0
|
2000 – 3000g
|
3.5
|
3000g to 6 months old
|
3.5 – 4.0
|
Pediatric
|
ID (mm)
|
18 months
|
4.0 (children between one & 2 yrs old use #4)
|
3 years
|
4.5
|
5 years
|
5.0
|
6 years
|
5.5
|
8 years
|
6.0
|
*There is a formula to calculate the ETT too, from the pink book.
v Use for children >2 years old
v [Age (years)/4] + 4 = Uncuffed tube (mm ID)
v [Age (years)/4] + 3.5 = Cuffed tube (mm ID)
Assessing Lung Sounds
Hi guys,
I found this lecture on you tube, I think it is very helpful for anyone still have a hard time distinguish all breath sounds, and where those sounds coming from.
http://www.youtube.com/watch?v=GP8Gqb9-saY&feature=related (part 1)
http://www.youtube.com/watch?v=4a8mahH-VEo&feature=relmfu (part 2)
I found this lecture on you tube, I think it is very helpful for anyone still have a hard time distinguish all breath sounds, and where those sounds coming from.
http://www.youtube.com/watch?v=GP8Gqb9-saY&feature=related (part 1)
http://www.youtube.com/watch?v=4a8mahH-VEo&feature=relmfu (part 2)
Friday, May 18, 2012
ABG Values & ABG Errors
ABG Interpretation, Normal Values & ABG Errors
Name
|
Normal Range
|
Name
|
Normal Range
|
pH is not normal
Both PaCO2 & HCO3 are not normal
|
Partially Compensated
|
pH
|
7.35 – 7.45 (<7.25 help)
(acidosis – alkalosis)
|
pH is normal
Both PaCO2 & HCO are not normal
|
Compensated
|
PaCO2
|
35 – 45 (>55 need help)
(alkalosis – acidosis)
|
pH is not normal
Either PaCO2 or PaCO2 must be normal
|
Uncompensated
|
HCO3
|
22 – 26
(acidosis – alkalosis)
|
PaO2
|
80-100 mmHg normal
| ||
PaO2
|
79 – 60 Mild hypoxemia
| ||
PaO2
|
59 – 40 Moderate Hypoxemia
| ||
PaO2
|
< 40 severe hypoxemia
| ||
PaO2
|
>100 Hyperoxia
|
What if?
|
What will effect?
|
How to avoid it?
|
Air in the sample of ABG
|
Raises pH
Lowers PaCO2
Raises low PaO2
Lowers high PaO2
|
Remove all bubbles
Throw away foamy samples
Cap syringe quickly
Mix after air is removed
|
Excess Anticoagulant (dilution
|
Raises pH
Lowers PaCO2
Raises low PaO2
Lowers high PaO2
|
Remove any visible heparin
Use dry heparin
|
Venous admixture
|
Lowers pH
Raises PaCO2
Can greatly lower PO2
|
Avoid brachial/femoral sites
Do not aspirate sample
Use short bevel needle
Avoid artery overshoot
Cross check with SpO2
|
Metabolic effects
|
Lowers pH
Raises PaCO2
Lowers PO2
|
Analyze within 15mins
Place sample in ice
|
These stuffs are found in RTP laps in first years.
Oxygen Therapy Devices
Oxygen Therapy Equipment/Devices
A. Variable Performance Devices à low flow devices (not flow per meter, be careful), do not supply all the insp. Flow demands of the patient.
· Nasal cannula (prongs)
· Nasal catheter
· Masks (simple, partial rebreathing mask, non-rebreathing mask)
· Trach collar
· Oxygen tent (canopy)
Percent oxygen varies depend on pt’s resp pattern like volume and rate, fit, flow rate, peak insp flow rate (normal is 25-35lpm, when distress may go to 60lpm)
B. Fixed Performance Devices à High air flow oxygen enrichment (HAFOE) devices
· Venturi mask (Air entrainment mask)
· T-tube flowby (Briggs adaptor)
· CPAP system
· Oxyhood (for baby)
· Ventilator
C. O2 devices:
Name
|
LPM
|
Oxygen Percentage
(appox.)
|
Nasal Cannula/catheter
|
1 – 6 lpm
|
24 – 44%, add 4% per liter as ↑
|
Simple Mask
|
5 – 10 lpm (min to put on 5lpm to prevent CO2 to build up)
|
35 – 50%
|
*Partial Rebreathing Mask
|
8 lpm or greater
|
Up to 60%
|
*Non Rebreathing Mask
|
8 lpm or greater
|
Up to 70%
|
*Note: Set the rate that allow the bag to collapse no greater than ½ during inspiration
| ||
Oxy-hood w/ heated humidifier or nebulizer
|
7 lpm or greater ( to prevent CO2 accumulation)
|
21 – 100%
|
Trach Collar
|
8 - 12 lpm
| |
Face Shield (tent)
|
8 - 12 lpm
| |
Aerosol mask
|
8 - 12 lpm
| |
T-tube assembly or Briggs
|
8 – 12 lpm
| |
Venturi Mask (Entrainment msk)
|
Lpm varies
|
O2 percentage is constant
24%, 28%, 35%, 50% have to use exact amount
|
Oxygen Tent (croup)
|
12 – 15 lpm
|
21 to 40% & 50%
|
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