Saturday, February 23, 2013

Distinguish Breath Sound quiz

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.

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)

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%