Term
| What to do for Vfib or Vtach |
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Definition
| begin V fibrillation/pulseless ventricular tachycardia algorithm |
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Term
| recommended dose by intratracheal route |
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Definition
| "NAVEL drugs, 2 to 2.5 times the usual dose diluted in 10 mL of normal saline or distilled water" |
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Term
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Definition
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Term
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Definition
| Circulation - check and start chest compressions if no pulse is found |
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Term
| action associated with the letter B |
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Definition
| check for breathing and provide breathing if necessary |
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Term
| an infant or child who has already had a 2nd shock and needs a third |
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Definition
| "2 J /kg, 2 to 4 J/kg, then 4 j/kg" |
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Term
| an adult in need of a 2nd shock |
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Definition
| "200 J, then 200 to 300 J, then 360 J" |
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Term
| action taken after a third shock is delivered by AED |
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Definition
| "CPR should be performed for 60 seconds then check for signs of circulation (defined as the patient is breathing, coughing, or moving). During this time, preparations should be under way for intubation and an IV access should be started if one is not present and functioning well" |
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Term
| treat sinus bradycardia that does not respond to atropine |
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Definition
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Term
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Definition
| The average cardiac output for men and women of all ages is approximately 5 L/min at rest (normal range is 4 to 8 L/min) |
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Term
| storage areas of total blood volume |
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Definition
| Approximately 64% of the total blood volume is normally in the venous system |
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Term
| variables of cardiac output |
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Definition
| "It is the product of heart rate (HR) and stroke volume (SV), the volume of blood ejected by the ventricle by a single heart beat. Varies with age, sex, body size, blood viscosity, and tissue demand for oxygen" |
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Term
| cardiac output standardization |
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Definition
| The advantage of using an indexed measurement such as cardiac index is that the normals are standardized and comparisons can be made among patients of different sizes |
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Term
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Definition
| "Ejection fraction (EF) represents the percentage of the end-diastolic volume that is ejected with each beat. Normal ejection fraction is 65% to 70%. Ejection fraction is either measured directly or calculated from the following formula: EF=SV/EDV. The ejection fraction declines as cardiac function deteriorates. When the ejection fraction falls to the 30% range, a patient's exercise tolerance is severely limited because of the heart's inability to maintain an adequate cardiac output." |
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Term
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Definition
| "Bradycardia is a HR less than 60 beats/min in an adult. Low HR does not drop cardiac output if the heart can compensate with increased SV; the best example is the well-trained athlete with a resting pulse rate below 50 but a normal blood pressure. However, if a patient has a damaged heart that cannot alter SV to compensate for bradycardia, cardiac output will fall" |
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Term
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Definition
| "Preload is the stretch on the ventricular muscle fibers before contraction. Preload is created by the end-diastolic volume. In 1914, Starling found that up to a critical limit, the force of a muscle contraction was directly related to the initial length of the muscle prior to contraction. His theory has come to be known as Starling's law of the heart. Simply stated, the greater the stretch on the resting ventricle, the greater the strength of contraction within physiologic limits. When the physiologic limits are exceeded, greater stretching of the muscles does not result in an increased force of contraction." |
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Term
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Definition
| "Preload is the stretch on the ventricular muscle fibers before contraction. Preload is created by the end-diastolic volume. In 1914, Starling found that up to a critical limit, the force of a muscle contraction was directly related to the initial length of the muscle prior to contraction. His theory has come to be known as Starling's law of the heart. Simply stated,The greater the stretch on the resting ventricle, the greater the strength of contraction within physiologic limits. When the physiologic limits are exceeded, greater stretching of the muscles does not result in an increased force of contraction." |
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Term
| "ventricular function curves, relationship between CO and PCWP " |
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Definition
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Term
| "When performing ventricular function curves on a patient with a suspected failing right ventricle, how does cardiac output typically change as central venous pressure increases" |
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Definition
| Cardiac output increases at first and then decreases. |
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Term
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Definition
[image]
It is important to understand that pressure is the result of the volume, space, and compliacne of the chamber the volume is entering. Forcing 100 mL of water into a small, rigid chamber takes more pressure than filling a compliant balloon with 100 mL of water. The figure shows how ventricular pressure is affected by changes in volume and ventricular compliance (elasticity, stretchability, distensibility). When compliance is reduced, a much higher pressure is generated for a given volume. Pressure also increases more rapidly as the ventricle fills; thus the ends of teh curves rise more abruptly as the ventricle becomes full and tension is developed in the ventricular walls. Factors that decrease ventricular compliance and therefore cause the pressure to increase out of proprortion to the volume include the following:myocardial ischemia, and infarction, hemorrhagic and septic shock, pericardial effusions, right ventricular dilation and overload (causing the septum to shift to the left and impinge on the left ventricle) |
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Term
| proper location for a thoracentesis puncture to remove a pleural effusion |
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Definition
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Term
| causes for placing chest tube at different locations |
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Definition
| "when treating a pneumothorax, a chest tube will usually be inserted in the 2nd or 3rd intercostal space on the anterior chest on the mid-clavicular line and directed toward the apex. For a pleural effusion, the chest tube will be inserted in the intercostal space around the 6th to the 9th rib, mid-axillary, and directed to posterior base of the lung" |
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Term
| medications used for conscious sedation |
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Definition
| OPIOIDS (Analgesics) Morphine Meperidine (Demerol) Fentanyl (Sublimaze); SEDATIVES Diazepam (Valium) Midazolam (Versed) Lorazapam (Ativan) Propofol (Diprivan) REVERSAL AGENTS Naloxone (Narcan) Flumazenil (Romazicon) |
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Term
| diseases diagnosed by BAL procedure |
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Definition
[image]
BAL is useful in the diagnosis of some interstitial lung diseases (Table 16-1).12 This technique requires close cooperation between the bronchoscopist and the assistant in order to distend terminal bronchioles and alveolar spaces rapidly with pyrogen-free normal saline and then collect this cell-rich fluid without contamination or loss |
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Term
| Arterial cannulation indications |
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Definition
| "the PA catheter must be inserted only in those patients in whom the anticipated benefit outweighs the potential risks. the decision to place a PA catheter is individualized on a case-by-case basis. Common factors to consider include:Experience of the attending physician, Availability of proper equipment and personnel to insert and maintain the catheter,Diagnosis of the patient,Cardiac history of the patient, Pulmonary history of the patient. The common situations in which PA catheter monitoring is considered include: Diagnosis and treatment of patients with severe cardiogenic pulmonary edema, especially if the patient has unstable angina, has ventricular pathology, or does not respond to initial therapy Diagnosis and treatment of patients with severe acute respiratory distress syndrome (ARDS) who are hemodynamically unstable Monitoring of a patient who has had major thoracic surgery (e.g., coronary bypass surgery) with a recent history of myocardial infarction or poor ventricular function Diagnosis and treatment of patients in cardiogenic or septic shock" |
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Term
| Insertion technique for arterial pressure monitoring catheter |
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Definition
| "The catheter is usually placed in the radial, ulnar, brachial, axillary, or femoral artery. The radial artery is preferred because this site is readily accessible and usually has adequate collateral circulation. The radial artery site is easy to monitor and provides a stable site for blood withdrawal. The femoral artery provides pressure measurements that are less affected by peripheral vasoconstriction, but significant leakage of blood into the surrounding tissue can occur without detection." |
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Term
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Definition
[image]
An arterial waveform should ahve a clear upstroke on the left, with a dicrotic notch representing aortic valve closure on the downstroke to the right. If the dicrotic notch is not visible, the pressure tracing is dampened and probably is inaccurate, and teh numbers are lower than the patient's actual pressure. The dicrotic notch disappears in some patients when the systolic pressure drops below 50 or 60 mmHg |
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Term
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Definition
| "It is important to remember that although vasodilator therapy decreases afterload and therefore decreases the energy demands on the heart, it also increases the size of the �vascular container.� If the container is made larger but the volume in the container stays the same, the amount of blood returning to the heart (venous return) decreases, and preload decreases. Conversely, when the volume in the ventricle is more than the ventricle can pump effectively, decreasing the preload can unload the ventricle and improve cardiac output. However, if the venous return decreases too much, the stretch on the ventricle (preload) will be inadequate and cardiac output will fall. In addition, if vasodilation causes the arterial diastolic pressure to fall below 50 mm Hg or mean arterial pressure (MAP) to fall below 60 mm Hg, perfusion to the coronary arteries may decrease, and cardiac output will be compromised even further." |
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Term
| Central venous pressure represents |
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Definition
| "Central venous pressure (CVP) is the pressure of the blood in the right atrium or vena cava, where the blood is returned to the heart from the venous system. Because the tricuspid valve is opened between the right atrium and ventricle during diastole (ventricular filling), right atrial pressure or CVP also represents the end-diastolic pressure in the right ventricle (RVEDP) and reflects preload for the right ventricle. To obtain a CVP measurement, a venous catheter is placed in a major vein " |
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Term
| Central venous pressure should be monitored |
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Definition
| "CVP monitoring is indicated to assess the circulating blood volume (adequacy of cardiac filling) or the degree of venous return or to evaluate right ventricular function. Patients who have had major surgery or blood loss due to trauma and those suspected of severe dehydration may benefit from placement of a CVP catheter to guide fluid replacement therapy. Patients with either cardiogenic or noncardiogenic pulmonary edema also need CVP monitoring to guide fluid therapy. In addition, the venous catheter is useful to evaluate the patient suspected of having damage to the right ventricle from myocardial infarction. Once the catheter is in place, the line can be used for rapid infusion of fluids or medications and to obtain blood samples for measurement of routine laboratory studies (e.g., complete blood counts and electrolytes)." |
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Term
| Central venous pressure catheter insertion site |
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Definition
| "Femoral central venous catheters are the easiest to place and have the least risk for complications, but they provide less reliable hemodynamic information because the catheter tip is far from the right atrium and pressure waveforms are often dampened. Most ICU patients must remain supine in bed so that the femoral catheter does not get kinked by the patient sitting up. Diarrhea makes the catheter somewhat harder to keep clean. A chest x-ray should be performed after subclavian or internal jugular central venous line insertion to ensure placement before use and to rule out pneumothorax" |
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Term
| Central venous and atrial pressure waveforms |
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Definition
| "CVP waveforms reflect pressure changes in the right atrium. This is equivalent to the PAWP waveform, which approximates left atrial pressures. Both CVP and PAWP waveforms have three waves for each cardiac cycle: a, c, v" |
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Term
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Definition
| "The v wave results from atrial filling while the AV valve is closed during ventricular systole. The downslope of the v wave (y descent) occurs when the tricuspid and mitral valves open and the ventricle begins to fill with blood. When an AV valve does not close all the way (incompetent or leaky valve), some of the blood is ejected backward into the atrium during systole (tricuspid regurgitation), creating exaggerated v waves and an elevated CVP measurement." |
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Term
| Increased central venous pressure during inspiration |
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Definition
| "CVP decreases with spontaneous inspiration and increases with mechanical ventilation. When a patient is receiving intermittent mandatory ventilation, the pressure decreases with the spontaneous breaths. When the patient triggers a mechanical breath, the pressure decreases and then immediately rises above baseline levels when the ventilator breath is initiated." |
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Term
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Definition
| "Usually, the patient with hemoptysis coughs up small amounts of blood and then stops. Occasionally, massive hemoptysis (> 200 mL/24 hr) occurs, and it signals the need for bronchoscopy in most cases. Whenever massive bleeding occurs, the patient should be examined with a large-bore rigid bronchoscope. This type of scope allows better removal of the blood while maintaining ventilation." |
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Term
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Definition
| "Bronchitis is the most common cause of episodic hemoptysis in smokers. Most patients with hemoptysis caused by lung cancer have an abnormal chest roentgenogram. In this setting, flexible bronchoscopy is definitely indicated." |
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Term
| Transbronchial biopsy technique |
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Definition
| "The flexible fiberoptic bronchoscope can be used to reach to the periphery of the lung and remove a small piece of lung for submission to the pathologist. A considerable amount of crush artifact is usually associated with these transbronchial biopsy (TBB) samples. In most cases, however, there is sufficient lung parenchyma to stain, examine, and provide a diagnosis. TBB samples are usually collected under fluoroscopic guidance in order to ensure accurate sampling because bleeding and pneumothorax are serious concerns." |
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Term
| Bronchoscopy complications |
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Definition
| "Premedication: Respiratory failure, Hypotension, Hyperexcitement. Local anesthesia: Laryngospasm, Bronchospasm, Seizures, Cardiopulmonary arrest, Methemoglobinemia. Bronchoscopy, Bronchospasm or laryngospasm. Hypoxemia: Cardiac arrhythmias, Aspiration. During biopsy: Pneumothorax, Bleeding, Loss of biopsy tip. Postprocedure: Persistent bleeding, Fever, Pneumonia" |
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Term
| Deep stages of sleep and age |
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Definition
| "Sleep stage 2 is a deeper sleep state than sleep stage 1 and is the predominant stage of NREM sleep in adults. Approximately 10 to 20 minutes after entering sleep stage 2, the sleeper moves into sleep stages 3 and 4, which reflect increased depth of sleep. During sleep stages 3 and 4, commonly called slow-wave sleep, the sleeper may be difficult to rouse. Slow-wave sleep (also called delta sleep) is characterized by the presence of extremely high-amplitude waves (> 75 ?V) " |
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Term
| Obstructive sleep apnea anatomic site |
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Definition
| "OSA and hypopneas are the most common forms of SDB in adults. OSA is thought to occur because of an upper airway occlusion during sleep, and hypopnea is thought to be due to partial airway closure. OSA/hypopnea may be caused by several anatomic abnormalities, including micrognathia (small lower jaw), large tongue, large tonsils, retrognathia (underdevelopment of the mandible), or a deviated septum. Although the exact pathophysiological mechanism of OSA/hypopnea remains unclear, it is clear that the most common site of the obstruction is in the pharynx." |
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Term
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Definition
| "snoring, excessive daytime sleepiness, morning headaches, sleep fragmentation, memory loss, confusional wakening, personality changes, impotence, night sweats, cardiac dysrrhythmias, pulmonary and systemic hypertension, congestive heart failure, enuresis, non-restorative sleep, choking or gasping sensation at night, insomnia, restless sleep, sore/dry throat upon wakening, cognitive deficits, decreased vigilence, morning confusion, gastroesophageal reflux" |
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Term
| Positive Correlations in obese children with sleep-disordered breathing |
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Definition
| "In a study of 62 obese children, researchers demonstrated a positive correlation between the degree of hyperinsulinemia and SDB severity. The RDI, glucose level, and measures of the degree of hypoxemia during sleep were associated with fasting insulin level.28 Similar to the findings observed in obese children, studies of adult obese subjects with SDB found a higher degree of insulin resistance compared with weight-matched control subjects without SDB" |
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Term
| Cardiac dysrhythmias and sleep apnea |
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Definition
| Changes in the heart rate and cardiac dysrhythmias are more common in OSA patients. Bradycardia often occurs during the apneic period and is followed by tachycardia immediately after the apnea.34 Premature ventricular contractions occur in approximately 20% of patients with OSA and are the most common dysrhythmia |
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Term
| Characteristics of children with sleep-disordered breathing |
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Definition
| "Snoring is a hallmark symptom of OSA in the child, as in the adult. Pediatric SDB patients can be of any age or gender and may be overweight or have failure to thrive. In the infant, specific and numerous anomalies are linked with sleep apnea, more so than in the typical adult patient, making evaluation of pediatric sleep apnea more complex. PSG features are also quite different in infants and children. Unfortunately, questionnaires cannot reliably predict OSA in the child. The SDB child may be either sleepy or hyperactive and have a variety of other problems, including developmental delay, poor school performance, aggressive behavior, and social withdrawal. Although rare, brain damage, seizures, and coma can result from asphyxial brain damage.45 Untreated OSA can have a negative influence on school performance and behavior. Gozal46 found that first-graders who had an unusually high prevalence of snoring and nocturnal gas exchange abnormalities were poor achievers until their SDB was treated. After treatment, their academic scores significantly improved." |
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Term
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Definition
| "Most people associate breathing problems in infants with sudden infant death syndrome (SIDS); however, SIDS is only one of the many potential sleep-related breathing disorders in children. SIDS, by definition, has no known cause. It is the leading cause of death in children under the age of 1 year. SIDS has a peak incidence between 2 and 4 months of age, and the majority of cases occur in the first 6 months of life.OSA may be a risk factor for ALTEs and SIDS. The exact relationship between ALTEs and SIDS is not known. Data from a large-scale prospective study in Belgium, however, revealed that patients who had undergone PSG, and who later died of SIDS, had episodes of OSA, less movement time, and more regurgitation after feeding. CSA was not a significant predictor of SIDS in this study. Other data suggest that supine sleep is safer than prone sleep in otherwise healthy infants. Deaths have been reduced because of the promotion of infants sleeping on their backs. There has been a 15% to 20% decrease since the guidelines were written by the American Academy of Pediatrics. The frequency of prone sleeping has thus decreased and the SIDS rate has decreased by more than 40%. Despite these encouraging statistics, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (e.g., maternal smoking), the importance of other hazards, such as soft bedding and covered airways, have been demonstrated only recently." |
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Term
| Referral of hospitalized patient to sleep center |
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Definition
| "Observation of the hospitalized patient during sleep may provide the opportunity to evaluate the patient's gross sleeping characteristics. The evaluator should identify whether the patient snores and should pay strict attention to whether the patient has pauses in respiration. If pauses are present, they should be timed. As part of this observation, the sleeping position, presence or absence of cyanosis, and breathing effort should be noted. If the patient is hospitalized for several days or nights, a series of observations may coalesce into a broad evaluation of the patient's sleeping pattern. A referral to a sleep center for the appropriate diagnosis is in order if the patient is noted to have pauses in breathing with sleep" |
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Term
| Daytime sleep latency test |
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Definition
| "In the patient whose reported sleepiness seems out of proportion to his/her level of SDB, a multiple sleep latency test (MSLT) is recommended after an overnight PSG. Sleep latency is defined as the amount of time required for sleep onset after going to bed. Individuals with excessive daytime sleepiness will fall asleep quickly even during daytime naps repeated throughout the day. The MSLT is the most reliable and valid test used to assess daytime sleepiness objectively. After sleeping the same amount of time at night in the SDC as they do at home, patients take a series of four or five naps, every 2 hours during hours they are normally awake. Before the MSLT, patients must be drug free for a period of about 2 weeks, especially from drugs that may affect sleep (particularly REM sleep). The sleep-wake schedule must be routine for at least 7 days before testing, and a nocturnal PSG must be performed the night before the MSLT to rule out other sleep disorders that may affect the test results.An MSLT is interpreted by measuring the average sleep latency for four or five daytime naps taken by the patient. It is normal to stay awake for more than 15 minutes during the daytime on the MSLT. At the other extreme, if someone falls asleep in less than 5 to 8 minutes on average, this is considered to be severe sleepiness.66 This level of sleepiness is not specific to one sleep disorder but is often associated with OSA, UARS, narcolepsy, and sleep deprivation, among other sleep disorders." |
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Term
| Use of shielded brushes during bronchoscopy |
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Definition
| "Because the mouth harbors bacteria, shielded brushes must be used to get uncontaminated material from the area of the lung where pneumonias are located to accurately determine which organism is causing the pneumonia. When the offending organism is determined, the appropriate antibiotic can be selected." |
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