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Normal Oral Temp
98.6 degrees
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Normal Rectal Temp
97.5-100.4 degrees
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Causes of increased respiratory rate.
hyperthermia, acidosis, hypoxemia, anxiety, pain
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Causes of reduced respiratory rate.
hypothermia, alkalosis, hyperoxia, sedation, coma
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Components of blood pressure.
- LV contractility
- Arterial resistance
- Blood volume
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ECG changes with hyperkalemia.
- high, peaked T waves
- depressed ST segments
- widening QRS complex
- bradycardia
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ECG changes with hypokalemia.
- flat/inverted T waves
- depressed ST segments
- PVC's
- ventricular fibrillation
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Causes of hypokalemia.
diuretic medications
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ECG changes with hyperchloremia.
- prolonged ST segment
- prolonged QT interval
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ECG changes with hypochloremia.
- shortened QT interval
- wide and rounded T waves
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Causes of hypernatremia.
- dehydration
- vomiting
- NG Tube drainage
- diarrhea
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Causes of hyponatremia.
fluid overload
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ECG changes with hypercalcemia.
- shortened QT interval
- wide, rounded T waves
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ECG changes with hypocalcemia.
- lengthened ST segment
- lengthened QT interval
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Normal Chloride level.
95-106 mEq/L
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Normal Potassium level.
3.5 - 5.5 mEq/L
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Normal Sodium Level.
135 - 145 mEq/L
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Normal Calcium level.
4.5 - 5.5 mEq/L
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Normal Bicarb level.
22 - 25 mEq/L
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Normal Glucose level.
70-110 mg/100 mL
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Significance of increased creatine kinase.
elevates 4-6 hours after MI.
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Significance of increased troponin I and troponin T.
elevates 2-4 hours after MI
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Significance of increased natriuretic peptide.
seen in CHF.
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Normal adult Hemoglobin level.
13.5 - 18.0 g/100 mL
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Normal adult Hematocrit level.
40% to 54%
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Normal adult RBC.
4.6 - 6.2 million.mL
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Definition of polycythemia.
increased number of circulating erythrocytes
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Significance of leukocytosis.
active bacterial infection is present
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Significance of neutrophilia.
acute, severe bacterial infection is present
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Normal adult WBC,
4500 - 11,000 mm3
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Significance of leukopenia.
acute viral infection
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Normal PT value.
11 - 12.5 seconds
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Normal PTT value.
60 - 70 seconds
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Signs of dehydration.
tachycardia, hypotension, high urine specific gravity, oliguria, low CVP, low PCWP, tenting of skin, slow capillary refill, mental confusion
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Signs of fluid overload.
tachycardia, hypertension, low urine specific gravity, increased urine output, increased CVP, increased PCWP, peripheral edema, pulmonary edema (crackles/rales)
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Inidcations CXR.
post ETT/Trach intubation, post jugular/subclavian line insertion, post chest tube insertion, hemoptysis, sudden deleterious change in CP condition, suspected pulmonary infarct, suspected pneumothorax, post invasive thoracic procedure
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Signs of Pneumothorax.
sudden chest pain, increase in dyspnea/SOB, absent breath sounds over a lung field, tracheal deviation, shifted heart sounds,asymmetrical chest movement, hyperresonant percussion, sudden increase in peak or plateau pressure (or both), sub-Q emphysema
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Indications Upper-airway radiograph.
aspirated foreign body, laryngeal edema, laryngeal tumor, croup
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Indications for Thoracic CT Scan.
tumor, hematoma, abscess, cyst, pleural effusion, aortic/bascular abnormality, trauma
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Indications for MRI Scan.
imaging of head, spinal cord & surrounding structures, imagin of heart & great vessels, imaging of kidneys, liver & other organs
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Indications for PET Scan.
determining the regional metabolism of heart or brain, measuring the size of an MI, measuring the effects of treatment on a cancerous tumor, determining pulmonary perfusion or ventilation
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Indications for perfusion scan.
pulmonary embolism, tumor or vascular problem, pulmonary hypertension
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Indications for ventilation scan.
airway obstruction, atelectasis
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Indications for Lateral CXR.
visualization behind heart & hemidiaphragms, localize lesions, measure A-P diameter
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Indications for Oblique CXR.
visualization of heart borders, mediastinal structures, hilar structures and lung mases
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Indications for Lateral Decubitus CXR.
visualize fluid within pleural space
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Indications for lordotic (apical lordotic) CXR.
visualzation of upper lung fields, apices, middle lobe & lingula
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On CXR, Radiopaque items appear:
white
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On CXR, Radiolucent items appear:
dark
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Identification of Pneumothorax on CXR,
Black area (oneumothorx) surrounding collapsed lung, no lung markings visible in air-filled space, edge of lung can be visualized, lung/structures shifted to opposite side
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Mediastinal shifts:
AWAY from pneumothorax or pleural fluid; TOWARD atelectasis or pulmonary fibrosis
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Unilateral elevation of hemidiaphragms:
seen in atelectasis & pulmonary fibrosis
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Unilateral depression of hemidiaphragms:
pleural fluid, tension pneumothorax, FB obstruction, airway tumor
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Bilateral elevation of hemidiaphragms:
free abdominal fluid
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Bilateral depression of hemidiaphragms:
asthma, COPD
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Normal adult Cardiothoracic Ratio:
< 50%
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CXR sign of pleural effusion:
obscured costophrenic angle & hemidiaphragm
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CXR sign of Pulmonary Edema:
fluffy white infiltrates in either or both lungs, usually more extensive in LL
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Asymmetric chest wall movement may indicate:
pneumothorax or atelectasis
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Hypopnea
shallow breathing
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Obstructed Inspiration
Inspiratory time is equal to or greater than expiratory time. Seen in FB Aspiration, postextubation laryngeal edema, croup, epiglotitis
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Obstructed Expiration
Expiratory time is longer than normal. Seen in asthma, COPD, CF, status asthmaticus
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Kussmaul's Respiration
rapid, parge breaths; usually secondary to acidosis from diabetes ketoacidosis
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Cheyne-Stokes Respirations
waning and waxing tidal volumes; associated with head injury, stroke, increased ICP, CHF
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Biot's Respiration
unpredictably variable with periods of apnea; associated with meningitis, head injury, brain tumor, increased ICP
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Sputum changes in color from white/yellow to green:
indicates pneumonia
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Green, foul-smelling sputum is indicative of:
pulmonary abcess
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Pink-tinged, frothy, bubbly secretions may indicate:
pulmonary edema
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A thready pulse is indicative of:
heart disease
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A bounding pulse is indicative of:
hypertension
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Atelectasis causes the trachea to shift:
toward the affected side
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Pulmonary fibrosis causes the trachea to shift:
toward the affected side
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Pneumothorax causes the trachea to shift:
away from the affected side
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Hemothorax, pleural effusion & empyema cause the trachea to shift:
away from the affected side
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Decreased vesicular breath sounds may be caused by:
pleural effusion, hemothorax, empyema, pulmonary fibrosis, emphysema, pleural thickening
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Greatly decreased breath sounds may be caused by:
pneumothorax, severe atelectasis, bronchial intubation, large pleural effusion, obese patient
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Unequal vesicular breath sounds may be caused by:
pneumonia, consolidation, atelectasis, FB, tumor, spinal or thoracic deformity
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Characteristics of Wheezing (Rhonchi):
continuous sounds, more commonly heard on expiration, low pitched commonly associated with secretions in airways, high pitched momphonic expiratory sounds commonly associated with closure of one large airway (?tumor), high pitched polyphonic expiratory sounds associated with closure of many small airways
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Characteristics of Crackles (Rales):
more commonly heard on inspiration; discontinuous poping sounds; early inspiratory crackles are common in asthma, COPD; late inspiratory crackles are common in atelectasis, pneumonia, pulmonary edema or fibrosis
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Early inspiratory crackles:
asthma, COPD
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Late inspiratory crackles:
atelectasis, pneumonia, pulmonary edema, fibrosis
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Characteristics of Stridor:
harsh, monophonic, high-pitched, inspiratory sound, heard over larynx; if inspiratory & expiratory, may be caused by FB
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Characteristics of Friction Rub:
loud, grating, clicking, creaking sound most commonly heard over lower lung areas; not affected by coughing or suctioning; associated with pulmonary infarct, pneumonia, abscess or empyema
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S1
lub sound when mitral & tricuspid valves close
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S2
dub sound when pulmonary and aortic valves close
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Gallop Rhythm
addition of S3 and/or S4 sounds; suggests CHF
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A hyperresonant percussion note is indicative of:
pneumothorax
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Dubowitz Score 35-45
between 38 & 42 weeks gestation: normal term infant
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Dubowitz Score < 35
preterm infant
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Dubowitz Score > 45
postterm infant
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Componants of APGAR Score
heartrate, respiratory effort, muscle tone, reflex response, color
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Siiverman Scoring System
assesses newborn's level of respiratory distress: 0 = no respiratory distress and 10 = great respiratory distress
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Transillumination of Neonatal Chest
halo sign indicative of pneumothorax
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Epiglottitis:
pediatric emergency: dx on hx & pe: rx = intubation; 2-4 years old, sudden onset, fever, drooling, hazy subglottic neck radiograph, low-pitched stridor, difficulty swallowing, elevated WBC
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Croup: Rx
cool, bland aerosol
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Signs: Foreign Body Aspiration
sudden breathing difficulty, cough, inspiratory stridor
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Positive Mantoux Test
wheal > 10 mm
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