Respiratory Therapy Overview

Incentive Spirometry

• Recommended post op therapy

Cystic Fibrosis

• Home therapies: Vest, O2 therapy, PEP, mucolytic
• Sweat test determines chloride levels in sweat

Oxygen Therapy

• Indications: Hypoxemia, Hypoxia, Cyanosis, Short term therapy (post op), Asthma, OSA, Use of accessory muscles
• Hazards: O2 toxicity, Slows breathing/heart rate, Oxidative stress, Absorption atelectasis, Fire hazards, Increased hypoxic drive for COPD patients
• Complications: Nausea, Dizziness, Muscle twitching, Vision loss, Loss of consciousness

PEEP - Peak End Expiratory Pressure

• Adverse Effects: Hypotension, Decreased venous return, Decreased cardiac output, Alveolar overinflation, Pulmonary Barotrauma

Murphy's Eye

• Allows lung ventilation when endotracheal tube bevel is occluded
• Prevents obstruction and continues ventilation

Signs of Oxygen Need

• Hypoxemia/Hypoxia
• Cyanosis
• Diaphoresis
• SOB

Large Volume Nebulizer

• Used for: Bland aerosol therapy, Post extubation stridor, Croup, Delivery of airway-moisturizing mist

Obstructive vs. Restrictive Lung Problems

• Obstructive: Flow problem, Restricted airflow, Breathing difficulties
• Restrictive: Volume problem, Decreased lung capacity, Reduced elasticity

Inhaled Nitric Oxide (NO)

• Indications: Pulmonary hypertension, Hypoxic respiratory failure

Ventilator Alarms

• Low Pressure Alarm: Patient disconnecting, Leaks in ventilator circuit, Airway leaks, Chest tube leaks, Disconnecting tubing
• High Pressure Alarm: Secretions/mucus buildup, Patient biting tube, Tube migration into right mainstem bronchus, Bronchospasm, Mucosal edema/secretions, Pneumothorax, Patient-ventilator asynchrony, Condensation in circuit, Kinks in inspiratory circuit, Valve issues

Massive Oxygen Leak

• Action: Put the flow meter back in

High Pressure Limit Causes

• Mucus plugging
• Kink in the tube
• Obstruction

Low Pressure Alarm Causes

• Leaks in ventilator circuit
• Chest tube leaks
• Disconnecting tube from ventilator circuit
• Rupture of endotracheal tube cuff

Ventilator Complications

• Pulmonary Barotrauma
• Lung injury
• Pneumonia
• Respiratory muscle weakness
• Secretion retention
• Hyperinflation
• Occlusion in tube due to secretions

Non-Invasive Ventilation

• Used for: COPD, Obesity, OSA, Acute/Chronic respiratory failure

PFT - Pulmonary Function Tests

• Decreased lung volume: Restrictive lung disease
• Decreased flow: Obstructive lung disease

ABG - Arterial Blood Gas

• Indications: Assess blood gas levels, Sign of respiratory distress, Assess mechanical vent settings, Assess non-invasive monitoring accuracy

L/S Ratio

• Used to determine surfactant levels

Racisater Safety Feature

• Pop off valve

ABG Air Bubble

• Decreases CO2 levels

2 Rescuer CPR for Infants

• Compression Ratio: 15:2
• Preferred Technique: Circle (2 hands)

Surfactant Cells

• Type 2 alveolar cells

Goblet Cells Function

• Secrete mucin to create protective mucus layer

Normal Breath Sounds

• Vesicular

Finger Clapping Sign

• Chronic hypoxia, COPD

Idiopathic

• Unknown cause

Epi Alternatives

• Amiodarone
• Racemic Epi

Clot Risk Rhythm

• Atrial Fibrillation (A-fib)

ABG - Radial vs. Brachial Artery

• Radial artery is more superficial, making pulse easier to detect

RSBI - Rapid Shallow Breathing Index

• Calculation: RR/VT
• Normal value: Less than 105

ET Tube Suctioning - Carina

• Can cause bradycardia due to vagus nerve stimulation

Wheezing Post-Bronchodilator

• Indicates air movement

Heliox 80:20

• Factor: 1:8

Heliox 70:30

• Factor: 1:6

Heliox Therapy Indications

• Decrease inflammation
• Post-extubation stridor

Xopenex Doses

• 0.31 mg
• 0.63 mg
• 1.25 mg

Heated Humidifier Temperature

• 37-39 degrees Celcius

Laryngeal Edema vs. Laryngeal Stenosis

• Laryngeal Edema: Fluid buildup and swelling in larynx tissues
• Laryngeal Stenosis: Scarring in larynx that limits normal opening

Brovana

• Name: Arformoterol tartrate
• Dose: 15 mcg (once daily)
• Category: Long-acting beta agonists (LABAs)

Tracheostomy Patient Speech

• Methods: Fenestrated trach, Speaking valve, Deflated cuff

Mucomyst Dose

• 10% and 20%
• Know individual doses for each percentage

NIF, MIP, RSBI

• NIF: Negative inspiratory pressure. Normal: -20 to -40
• MIP: Maximum inspiratory pressure
• RSBI: Rapid shallow breathing index. Normal: < 105

SBT Parameters

• NIF
• Vital capacity
• Heart Rate (HR)
• Respiratory Rate (RR)

ABG Interpretation 7.59 19 25

• Uncompensated respiratory alkalosis

Peak Flow Meter

• Used with: Asthma patients

Laryngeal Blades

• Miller (straight)
• MacIntosh (curved)

O2 Pulse Device with High CO2

• Reading: 100% O2
• Appearance: Pink

BiPAP Adjustment for Low O2 and CO2

• Adjust EPAP and FiO2

SpO2 vs PaO2

• SpO2: Peripheral oxygen saturation
• PaO2: Partial pressure of oxygen in arterial blood

CPAP Indications

• OSA
• Pulmonary edema
• CHF
• COPD
• Obesity

Bubbler/Nasal Cannula Wheezing

• Cause: Kink in the tube

Ventilator Waveform - Fast I Time

• Square waveform

PEEP - Peak End Expiratory Pressure

• Meaning: Positive pressure applied at the end of expiration
• Purpose: Improve oxygenation

SBT Failure Signs with T Piece

• Increased heart rate
• Increased work of breathing
• Low RR

Allen Test

• Purpose: Assess collateral blood flow to the hand
• Procedure: Apply pressure to radial and ulnar arteries, release ulnar pressure, observe blood return in 8-10 seconds

ET Tube End Piece (2 Holes)

• Murphy's eye

BiPAP Adjustment for High CO2

• Increase IPAP (to increase gradient between IPAP and EPAP)
• Backup RR

ETT Placement Confirmation

• Auscultation
• Chest rise
• Chest X-ray

Capnography Colors

• Yellow: ET tube in correct place
• Purple: Problem with ET tube placement
• Brown: Unknown ET tube placement

Rising PIP (Peak Inspiratory Pressure)

• Actions: Suctioning, Bronchodilator, Switch to pressure control

Incorrect Pulse Reading

• Actions: Change location, ABG, Manual check

FiO2 1L

• 24% (know the rule of four)

PCO2 Normal Range

• 35-45 mm Hg or Torr

Pulmicort Dosages

• Corticosteroid medication
• 0.5 mg
• 1 mg

Pulmicort Complications