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Very precise FiO2. 24-60%
Venturi mask
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12-15 lpm to keep inflated. Close to 100% O2
Non-rebreather and partial non-rebreather masks
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For high-humidity. Oral surgery or non-compliance of other masks. Not for increase FiO2
Face tents
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Fraction of inspired O2. Percent of gas patient is breathing that's made of O2.
FiO2
-
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% 1 liter of oxygen increases FiO2
3
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% FiO2 of O2 with 1 liter per nasal cannula
24%
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% FiO2 of O2 with 2 liters per nasal cannula?
27%
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Can be standard or High-flow. usually 1-4 or 1-6 lpm. Needs humidity if >4L. May need humidity with less
Nasal Cannula
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Is oxygen a medication?
yes
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FiO2 is > or = 50% for 24-48 hours
Oxygen Toxicity
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Symptoms of oxygen toxicity.
Sub-sternal chest pain. Dyspnea, Hypoxemia
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What is the target Sp O2 for patients with chronic hypercapnia?
90-92%
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Which breathing technique strengthens the diaphragm?
Diaphragmatic
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Breathing technique that prolongs expiration, increases airway pressure during expiration and reduces air trapping.
Pursed lip breathing
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Is trach care a sterile or clean technique?
In the hospital we use a sterile technique. The pt may use a clean technique at home.
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Precautions used for particles >; 5 microns. Influenza/Pneumonic Plague/Some Pneumonias (mycoplasma, meningococcal)
Droplet
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Precautions for particles <; 5 microns including Shingles/TB/SARS
Airborne
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Shingles Precautions
Regular mask until lesions are dry.
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Precautions for TB
N95 respiratory mask and negative pressure room
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Precautions for SARS
N95 respiratory mask and contact precautions
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Precautions for MRSA & VRE
Contact precautions only
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The two types of Positive Pressure Ventilation
NIPPV (non-invasive positive pressure ventilation) and mechanical ventilation
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The two types of Non-invasive PPV
CPAP and BiPAP
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What are the differences in the CPAP and BiPAP?
CPAP is a continuous positive airway pressure to keep small airways open. BiPAP has a Bi-level positive airway pressure, different pressures for inhalation and exhalation
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Do endotracheal tubes need to be humidified?
Yes
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What is the normal cuff pressure on an endotracheal tube for an adult?
15-25 mm/Hg
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What is a common problem with Trach cuffs?
Pressure ulcers
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If a patient is ambulatory and has a chest tube, what needs to be done before they can get up?
Disconnect the suction and leave it open to air
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What three things do you need to do after removal of the chest tube?
Put an occlusive dressing such as Duoderm over the opening. Get a Chest X-ray. Monitor the patient.
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The 3 jobs of any chest tube.
Prevent air from entering the pleural space. Drain air and/or fluid from the chest. Control suction (possibly).
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Will a trach always have a cuff?
No
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Best benefit of a trach?
Decreased risk for aspiration
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Usual cause of URI's
virus possibly strep
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What do you do for a nosebleed?
Head forward, pinch bridge of nose for 15 minutes.
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How is Sleep Apnea diagnosed?
O2 sats But 85% of the cases go undiagnosed.
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How effective are the BiPAP and CPAP for Sleep Apnea?
95% effective
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What is Provigil?
Drug used for Sleep Apnea. Has no cardiac side effects and has a low risk for abuse
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How effective is a tracheostomy for Sleep Apnea?
100% But it is very invasive
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When can you clamp a chest tube?
If the MD orders it or to change the system or check for leaks but be quick!!!
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What do you do if the chest tube is accidentally disconnected?
Put the end in sterile saline or water. (This seals the system until it can be reconnected.)
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What should you do if the chest tube is accidentally dislodged for the patient?
Use gauze and tape 3 sides. This will allow the air to be exhaled but not inhaled through the hole. If the air goes in the hole it will accumulate in the chest area and cause pressure on the lung.
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How will vitamin C help with URI's?
May help with prevention.
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How will Echinacea help with URI's?
May help treat symptoms-some may help decrease the duration.
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Do Probiotics help with URI's?
They may help some.
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Will Ginsing help with treatment of URI's?
Only if it is taken daily for 4 months before the symptoms first appear. It may cause HTN and agitation.
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What is Epitaxis? What is it a risk for? How can it be cured?
It's a nosebleed. There is an increased risk for sinusitis if packing is used to stop it. Epi can be used on the packing to help decrrease the blood flow.
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Biggest thing to watch for with a nose fracture.
May have a C-spine fracture. Monitor for clear fluid drainage (may be CSF). There may be rings on the dressing from the CSF mixing with the blood. Dipstick the clear fluid. If it is positive then it is CSF.
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Three things to do for a nose fracture.
Elevate head/Use ice. Protect from re-injury for 6 weeks. May need ENT to realign bones.
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What causes Sinusitis?
A blockage of drainage. 60% are bacterial (if a fever is present then it's probably bacterial). It can be nosacomial.
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What are the 3 types of Sleep Apnea?
Central, Obstructive, and Mixed.
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How can Sinusitis be prevented?
Increase drainage
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What is the greatest complication of Sinusitis?
It could extend to the brain.
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What are the treatments for Sinusitis?
Antibiotics and decongestants.
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Why should decongestants be used for no more than 3 days?
It can cause rebound congestion.
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Risk factors for OSA?
Male gender, Obesity(BMI>30), Large neck circumference(male >17, female>15), Cranial/facial abnormalities. Middle-aged and older.
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Symptoms of OSA?
Loud snoring with periods of apnea. Non-restful sleep. Daytime sleepiness. Headache and dry/sore throat in the morning.
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What are the effects of OSA on the body?
HTN. Increased Cortisol, Increased Epinephrine, CAD, Insulin resistance.
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What might you see in children with OSA?
ADHD or poor school work.
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How is OSA diagnosed?
Sleep Study
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How do CNS depressants affect OSA?
Causes a deeper sleep. Monitor the patient closely.
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