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 2^nd intercostals space or

ü  Chest tube at  5-6^th intercostals space along anterior axillary line

ü  Not below 9^th 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)

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%

Postural Drainage Positions

Postural Drainage Positions

a)  Right Upper Lobe & Left Upper Lobe

1. Apical

·         High fowler, leaning back against a pillow

2. Posterior

·         Leaning forward grasping a pillow or sitting on side of bed & resting on bedside table

3. Anterior

·         Supine w/ bed flat & pillow under knees

b) Right Middle Lobe includes medial & lateral segment

·         Pt lying on L side, rotated ¼ turn away from the RT w/ pillow behind , bed place 15° angle trendelenburg

c) Left lingula - includes superior & inferior segment

·         Pt lying on R. side, rotate ¼ away , bed place in 15° angle trendelenburg

d) Right Lower Lobe

1. Anterior – supine, bed in 30° trendelenburg

2. Posterior – prone, bed in 30-40° trendelenburg

3. Superior – prone, bed flat, pillow under stomach

4. Lateral – lay on left side, with 30° angle trendelenburg

5. Medial – lay on R. side, with 30° angle trendelenburg

e) Left Lower Lobe

1. Anterior – supine, bed 30° angle trendelenburg

2. Posterior – prone, bed 30-40° angle trendelenburg

3. Superior – prone, bed flat, pillow under stomach

4. Lateral – lay on R. side, 30° angle trendelenburg

5. Medial – Lay on L. side, 30° angle trendelenburg

Notes:

Ø  Volume of sputum produced per day indicating the need to cpt  is 25-30 cc/day

Ø  Postural drainage should be held about 3-15 mins

Ø  Vibration should be done in expiration breathing cycle

Ø  Percussion in one area last 3-5 mins

Ø  Hypertension is the most adverse response to trendelenburg position