spc
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| The pattern of how gas is distributed through the lung areas is known as? | show 🗑
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| show | gas exchange is not possible, deadspace ventilation
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| Anatomic Dead space? | show 🗑
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| Alveolar dead space? | show 🗑
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| Physiologic dead space? | show 🗑
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| When there is not enough blood supply to the alveoli for gas to diffuse this called? | show 🗑
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| What are the two methods of determining dead space? | show 🗑
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| show | Can be a single or multiple breath test, uses 100% oxygen
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| show | includes alveolar dead space, given as a ratio of dead space to tidal volume
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| The fowler method measures the amount of air in the patients? | show 🗑
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| How to perform a nitrogen washout test? | show 🗑
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| Phase 1 of the N2 washout? | show 🗑
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| show | middle airways expired, 02 decreases and N2 increases abruptly
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| show | alveolar gas is exhaled, 02 and N2 change slowly and evenly
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| show | abrupt increase in N2 that continues until RV is reached. This phase indicates the patients closing volume
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| show | point at which the airways in the lungs bases are closed
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| The portion of the graph that includes the closing volume and residual volume is called the? | show 🗑
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| show | CV/VC= 7.7% (male) 8.7% (female)
CC/TLC= 24.8% (male) 25.1% (female)
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| Closing volumes will be increased in patients with COPD because? | show 🗑
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| Patients with diseases that cause swelling of the smaller airways will also have increased closing volumes? | show 🗑
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| show | identify the presence of small airway disorders before spirometry can detect them
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| show | 20%-40%
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| The bohr method uses what equation? | show 🗑
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| show | VAeff= frequency (RR) x (vt-vd)
Multiply the VT and VD first, then subtract the number from the VT
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| show | 3-8 lpm
>8 lpm= hyperoxia and hypocarbia
<3 lpm= hypoxemia and hypercapnea
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| show | FVC
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| The amount of air that remains in the lungs after a forced exhalation? | show 🗑
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| Volume exhaled during the first second of an FVC, shows average air flow from the larger airways? | show 🗑
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| show | uses the same diffusion pathway as 02, great affinity for hemoglobin, no CO remains dissolved in plasma during the diffusion process
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| Disadvantages of using carbon monoxide? | show 🗑
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| show | evaluate pulm disease (asbestosis, sarcoidosis, cystic fibrosis, emphysema), differentiate emphysema, CB, and asthma, determine if systemic disease is affecting lungs, evaluate amniodorone reactions, effects of pulm hypertension, pulm edema, evaluate inte
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| DLCO measurements are based on? | show 🗑
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| show | Single breath ( DLCO SB)
Steady state (DLCO SS)
Re breathing method
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| What is the gas mixture used for DLCO? | show 🗑
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| What does an increased closing volume indicate? | show 🗑
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| What are some disadvantages of the single breath DLCO test? | show 🗑
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| show | VC must be> or = to 90% of the pt’s previously measured VC, Inspiration must be performed within 4 secs of the pts max exhalation, Pt must maintain a stable inspiratory breath hold for 9 to 11 secs w/ no evidence of leaks, allow 4 mins between tests
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| What are 3 steps that must be taken before a DLCO study to ensure valid results? | show 🗑
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| show | any disease that decreases AC membrane surface area will decrease DLCO, anything that increases blood flow to the AC membrane will increase DLCO (exercise or disease) asthma will be normal or increased DLCO
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| show | Inspired CO(FICO) and He (FIHe)
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| show | Mouth piece in mouth, nose clips, blow out as much air as possible (get down to the pt’s RV), take max inspiration (special gas mixture), hold breath for 10 secs, exhale back to RV level
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| show | measurements can be made with pt breathing normally, gas mix contains 0.1% CO with the remaining balance air. Inhaled with each breath for 5-6 minutes, during the last two minutes pt exhales in douglas bag. An ABG is also drawn
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| show | Pt re breaths from a reservoir containing the gas mixture for 30 to 60 seconds at RR of 30 bpm. The final CO He and 02 % are measured after this interval. An equation is then used to calculate DLCO
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| show | The results are less affected by V/Q abnormalities or by changes in the pt’s lung volumes during the test
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| show | Single breath is the easiest, Steady state is moderate, Re breathing is the most complex. Single breath is the most common
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| show | The severity and extent or pulmonary disorders, especially bronchiectasis and bullous lung disease
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| What are perfusion scans used for? | show 🗑
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| V/Q scans are used for? | show 🗑
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| show | Decreases DLCO due to decreased alveolar-capillary (AC) surface area
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| How would fibrosis cause a decreased DLCO? | show 🗑
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| show | To determine the severity of asthma and the success of asthma treatment – it measures the amount of inflammation in the airways – the higher the NO, the greater amount of inflammation
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| After starting a subject on an inhaled corticosteroid, a repeat FeNO measurement is obtained. The exhaled NO level has decreased significantly. What does this indicate? | show 🗑
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| CV+RV= | show 🗑
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| show | The DLCO increases. For each gram of change in the pt's Hb level the DLCO will change 7%. The older the subject the lower their predicted DLCO
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| show | 25mlCO/min/mmhg
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| Predicted DLCO values? | show 🗑
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| show | emphysema, cystic fibrosis, pulm resection, pulm/fat emboli, anemia, interstitial lung disease(asbestosis, sarcoidosis, fibrosis, pneumonitis) pulm hypertension/edema
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| show | supine position, increased pulm blood flow, exercise, pulm hemorrhage, polycythemia with increased Hb, left heart failure, left to right cardiac shunt, high altitudes that increase Hb
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| Which parameters does a blood gas analyzer measure & which does it calculate? | show 🗑
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| What does a co-oximeter measure? | show 🗑
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| show | radial, brachial, femoral, dorsalis pedis
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| show | air bubbles, analyzer protein build up, bacteria growth, electrode cracks, loss of electrolyte solution, aging of electrolytes, electrode membrane problems
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| show | P02 in room VS P02 in atmosphere
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| Advantages of POC devices? | show 🗑
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| There are two types of analyzer electrodes that measure? | show 🗑
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| show | Will lower C02, if blood P02 is low it will falsely raise it, if blood P02 is high it will falsely lower it.
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| How is a Modified Allen's Test performed? | show 🗑
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| show | Dyspnea, cyanosis, heavy use of accessory muscles, CPR, changes in vent settings, metabolic conditions
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| show | Negative result on a Modified Allen's Test, do not test through a lesion, scar, sore, distal to a dialysis or surgical shunt, coagulopathy or anticoagulation therapy
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| show | Infection, arteriospasm, air or blood clot emboli, hematoma, hemorrhage, vessel trauma, vasovagal response, pain
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| What is the most important aspect of a Quality Assurance program? | show 🗑
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| Errors when handling blood gas samples? | show 🗑
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| show | determine FRC
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| What is performance evaluation? | show 🗑
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| What are components of a quality assurance program? | show 🗑
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| show | parts of the machine are replaced such as filters, membranes, etc.. The manufacturers provide schedules for maintenance
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| show | Manufacturer provides a schedule of routine function checks and parts replacement that must be strictly adhered.
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| Automated calibrations? | show 🗑
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| show | every 2 hours
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| show | a set of 5 fake blood gas samples with unknown values that are developed by the manufacturer, they are run and then compared to acceptable ranges
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| CVM must be performed when? | show 🗑
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| Correlation studies? | show 🗑
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| What is remedial action? | show 🗑
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| Examples of errors that would need remedial action? | show 🗑
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| show | procedural changes, staff training, closer supervision, frequent preventative maintenance. The action should always be appropriate for the problem
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| Thorough record keeping is required by both? | show 🗑
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| show | College of American Pathologists, Joint Commission for Healthcare Accreditation, agency for healthcare administration, american thoracic society (ATS)
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| What are Levey-Jennings plots used for? | show 🗑
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| show | Uses control (fake) samples every 8 hours with known values
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| show | If the sample has an error that is part of a trend, is in normal range, has a random error ( sporadic, out of range) or a systemic error (bias, abrupt shift outside of limits)
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| show | Mandated by Federal Gov't. 4-5x's/yr 5 external samples are sent to lab, they are run w/in a 10 day period and the results are returned. All results must be correct.
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