Neonatal/Pediatric Specialist Respiratory Exam

PAO2 = (PB-PH2O) x FIO2 - (PaCo2 x 1.25)


short cut: the PAO2 for a child on 50% oxygen with a PaCO2 of 40 torr when the barometric pressure is 747 is

300

Measures the amount of ventilatory support required to provide the level of oxygenaton obtained.


An OI of greater than 40 is associaciated with mortality rates of 80 % and is common criteria for ECMO.


Normal value is 380 mmHg or greater.  (As the number goes down, the patient is getting worse.)

Ph 7.25 - 7.35

26-40

50-70 mm Hg

17-23 mEq/L

-10  to +2

7.34 - 7.46

85 - 100 mm Hg

30-45 mmHg

20-28 mEq/L

-4 to +2

7.34 - 7.45

80-100

35-45

22-26 mEq/L

-2 to +2

Reticulonodular, reticulogranular densities, ground glass appearance, honeycomb pattern, air bronchograms

Diffuse hazziness, opacification, presence of bullae, spongelike appearance.

Patchy infiltrates, scattered densities, plate-like densities, elevated hemidiaphragm.

Hypoplastic lung on affected side, mediastinal shift away from affected side, NG tube enters abdomen and passes back above diaphragm.

Air bronchograms, consilidation, discoid shaped infiltrate.

Hyperlucency, absent vascular markings, flattened diaphragm on affected side, mediastinal shift away from affected side.

Nodular irregular bubbles radiating outward from hilum, linear lucencies or streaks, "air-leak syndrome".

Hyperlucency in a ring (dark area) around the heart or under the inferior heart border.

1) diagnosed with lateral dicubitus xray

2) Bibasilar infiltrates with meniscus, blunting or obliteratin of costophrenic angle.

Bilateral difuse fluffy infiltrates originating from the hilum in a butterfly or batwing pattern.

boot shaped heart

egg shaped heart

snowman shaped heart

foreign body aspiration

small pneumothorax

pleural effusion

croup (subglotic) - "steeple sign"

epiglottitis (above the golttis) - " thumb sign"

substernal and intrasternal retractions

cannot swallow, increased oral secretions

60- 65%

normal sinus rhythm (NSR)

treat other symptoms (TOS)

HR greater than 200

admninister O2, TOS

HR less than 100

administer epinephrine

treat other symptoms

administer O2

defibrilate IF pulseless electrical activity (PEA)

"defib for V-fib"

defibrilate

1.) Determines the degree of lung injury; how much O2 does it take to get a good PaO2?

2.)  normal: 380 mmHg or less

      less than 300 indicates ALI (acute lung injury)

•       less than 200 signifies ARDS (acute respiratory
•       distress syndrome)

• (A-aDO2) . 003
• (a-aDO2) . 003 + C (a-v) O2

• Shortcut:  Normal anatomical shunt is 5%.
• If the A-a DO2 is 200 torr then an additional 10% shunt is estimated (100torr=5%, 200torr = 10%, etc) The total % shunt would be 15% (5% normal, plus 10%)

80-100 of predicted is normal

60-79 of predicted is mild

40-59 of predicted is moderate

less than 40 of predicted is severe

best volume (fast or slow) for 3 seconds

for restrictive lung disease

best over all test

best flow rate

for obstructive lung disease: CBABE (cystic fibrosis, chronic bronchitis, asthma, bronchieactasis, emphysema)

FEV1

FEV1/FVC% best test for obstructive lung disese