| A | B |
|---|
| Gallium lung scan | detects inflammatory conditions |
| ventilation perfusion lung scans look for | pulmonary embolism primarily |
| High VQ | pulmonary embolism |
| Low VQ | partially blocked bronchioles |
| Very low VQ | shunt with atelectasis, severe pneumonia, ARDS |
| pulomonary angiography | helps to find pulmonary embolism (blockages), but is invasive |
| bronchoscopy useful for | biopsy, sputum cultures |
| pre op to bronchoscopy | 6 hrs. beforehand use atropine (anticholinergic) |
| before an abg or A-line need to do | Allen's test |
| used to collect arterial blood | heparinized needle |
| if looking for a pulmonar emobolism, you need | VQ/ vent. pefusion scan (or if really necessary, pumonary angiography) |
| if evaluating for cancer need a | bronchoscopy or open lung (biopsy) |
| if evaluating for infection after a cxr need a | bronchoscopy for cultures and bronchial washings |
| if evaluating for possible asthma / copd need | pulmonary function tests |
| if looking for pneumonia need | chest xray ray |
| if a mass seen on chest xray, can evaluate more with | ct scan |
| nasal trumpet also known as | nasopharyngeal airway |
| advantage of nasal trumpet | can be used in pts. in which oropharyngeal airway is contraindicated |
| don't use nasal trumpet in these patients | pts. with basilar skull fractures (may have raccoon eyes) |
| use single canula in these pts. | patients with thick necks |
| with single canula you need to do this | continuous supplemental humidification |
| fenestrated tracheal tube has | openings (one large or a few smaller ones) |
| use this kind of tracheal tube when weaning or if pt. will have a trach tube for a long time | fenestrated |
| use in pts who have tracheomalacia | foam cuff trach |
| always some phonation and effective coughing | speaking valve /one way valve |
| deflate the tracheostomy tube before talking for this reason | to prevent suffocation |
| intermediate between trach tube & extubation | tracheostomy button |
| the tracheostomy button does this | permits inhalation but not exhalation |
| advantages of tracheostomy button | allows less airway resistance so braething is easier |
| metal trachs | for permanent use; needs adapter for anesthesia use |
| most permanent tracheostomies are this type | cuffless |
| problems with trachs | infection, pneumonia, airway obstruction, accidental decanulation, stenosis, tracheomalacia |
| airway obstruction in trachs caused by | cuff overinflation, dry secretions |
| in case of accidental decanulation you should do this! | Scream, then deflate cuff, remove inner canula, insert obturator into outer canula, elevate shoulder and hyperextend the neck |
| how to decrease risk of fistula formation /tracheal wall necrosis | use small NG tubes |
| ant. tracheal wall necrosis can lead to | inominate artery & exsanguination (then DEATH) |
| low wall pressure leads to | less tracheal wall necrosis |
| tracheal cuff pressure should be | <20 cm |
| foam cuff trachs prevent | tracheomalacia |
| need to have pt. comfortable with plugged trach for this time before you can extubate them | 24 hrs. |
| most common tumor of larynx | squamous cell carcinoma |
| signs of laryngeal cancer | hoarseness, extrinsic (burning pain with ingestion of citrus juices/hot fluids), pain radiating to the ear |
| on glottis or vocal cord | rarely metastasizes |
| either above or below the cord | easily metastasizes due to lymph flow |
| after laryngectomy | pt. loses loss of voice & loss of smell |
| laser used for this | small lesions of the vocal cords |
| partial procedure requires | temporary trach |
| complications of radical neck dissection | airway obstruction, hemorrheag, carotid artery rupture, fistula formation |
| assessing nutritional status post op radical neck | total protein & albumin levels, hgb/hct |
| post op radical neck position | semi fowlers (45 degrees) |
| edema | semi fowlers helps prevent |
