CRT Review
Terms
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-
Tracheal Deviation:
Pulled toward abnormal side. -
1) atelectasis
2) pul. fibrosis
3) pneumonectomy
4) diaphragmatic paralysis -
Tracheal Deviation:
Pulled toward normal side. -
1) pleural effusion(MOST COMMON)
2) tension pneumothorax
3) neck or thryroid tumors
4) large mediastinal mass -
Percussion:
Resonance - normal
-
Percussion:
Flatness -
atelectasis
over sternum
full sound -
Percussion:
Dullness -
pleural effusion
over fluid-filled organs
thudding sound -
Percussion:
Tympany -
COPD
over air-filled organs
drum-like sound -
Percussion:
Hyperresonance -
pneumothorax / emphysema
over areas of above pathologies
booming sound -
Auscultation:
Bilateral vesicular
Bronchial Breath sounds -
normal over the trachea/bronchi
abnormal over lung periphery - indicates consolidation=pneumonia
Tx: antibiotics -
Auscultation: Rales
1)Coarse
2)Medium
3)Fine -
1)large airways - Sx
2)medium airways - CPT
3)alveoli/fluid/CHF/Pul.Edema - bronchoscopy,IPPB,IS,Diuretics,
Digitalis -
Auscultation: Wheeze
1)Lateral
2)Unilateral -
1) bronchospasm - bronchodilator
2) foreign body obs. - bronchoscopy/Sx -
Auscultation: Stridor
1)supraglottic
2)subglottic
3)Foreign Body Obs. -
1)epiglotitis/sever swelling - Intubate
2)croup/post extubation - racemic epi/humidity
3) solids/fluid -bronchoscopy/sx - Auscultation: Pleural Rub
-
-inflammed visceral/parietal pleura
-pleurisy,TB,pneumonia,pul.infarction,cancer
-Tx: steroids/antibiotics -
Heart sounds:
S1 -
First sound (normal)
closure of mitral/tricuspid -
Heart sounds:
S2 -
Second sound (normal)
closure of pulmonic/aortic valve -
Heart sounds
S3
S4 -
abnormal
1) CHF
2) mycocardial infarction /cardiomegaly - 4 Critical Life Functions
-
1) Ventilation - open airway
2) Oxygenation - increase FiO2
3) Circulation - Chest comp
4) Perfusion - increase BP - Normal Urine Output
- 40 cc/hr
- Orthopnea
-
CHF, heart problem
Tx: diuretics
Difficulty breathing except in an upright position. - General Malaise
-
Electrolyte Imbalance
Run down feeling, nausea, weakness, fatigue, headache - When are costophrenic angles obliterated?
- pleural effusions
- When is the diaphragm flattened?
- COPD
- Lateral decubitus
-
Pt lying on the affected side.
Valuable for detecting PLEURAL EFFUSION - Radiolucent
-
Air
Dark pattern
normal lungs - Radiodense
-
Solid / Fluids
White pattern
normal bones/organs - Infiltrate
-
Ill defined radiodensity
Atelectasis
Tx: IPPB/IS - Consolidation
-
Solid white area
Pneumonia / Pleural Effusion
TX: Lasix - Hyperlucency
-
Extra air
COPD, Asthma attack,
pneumothorax
Tx: Lasix - Vascular markings
-
lymphatics, vessels, lung tissue
increase presence = CHF
absence = pneumothorax - Diffuse
-
spread thru-out
Atelectasis/pneumonia - Opaque
- fluid/solid
- Fluffy infiltrates
-
Diffuse whiteness
Pulmonary Edema - Butterfly pattern
-
Infiltrate in shape of butterfly/batwing
Pulmonary Edema - Patchy Infiltrates
-
Scattered densities
Atelectasis - Platelike Infiltrates
-
Thin-layered densities
Atelectasis - Ground Glass Appearance
-
reticulogranular
ARDS / IRDS
Tx: surfactant, PLS ventilation - Honeycomb Pattern
-
reticulonodular
ARDS / IRDS - Airbronchogram
- Pneumonia
- Peripheral Wedge-shaped Infiltrate
- Pulmonary Embolus
- Concave Superior Interface/border
- Pleural Effusion
- Basilar Infiltrates with Meniscus
- Pleural Effusion
- Main indication for Bronchography
- Bronchiectasis
- V/Q Scan: Results indicate normal ventilation scan but abnormal perfusion scan
- Pulmonary Emboli
- Indication for Electroencephalography
- evaluation of sleep disorders
-
ICP: normal value
When to initiate tx? -
5-10 mmHg
>20 mmHg
Tx: increase RR, blow off CO2 to cause vasoconstriction. Mannitol=diuretic gets fluid out of brain. - Indication for Ultrasonography of the Heart (Echocardiogram)
- Noninvasive method for monitoring cardiac performance (on newborns)
-
RBC:
1)Normal value?
2)What does it carry?
3)Significance of Low?
4)Significance of High? -
1)4-6 mill/cu mm
2)O2/hgb
3)anemia
4)polycythemia, presence of Chronic hypoxemia/COPD -
Hb:
1)Normal value?
2)What does it carry?
3)Significance of Low?
4)Significance of High? -
1)12-16 gm/100 ml
2)O2
3)anemia
4)polycythemia -
Hct:
1)Normal value?
2)Significance of Low?
3)Significance of High? -
1)40-50%
2)anemia
3)polycythemia -
WBC:
1)Normal value?
2)Significance of Low?
3)Significance of High? -
1)5,000 - 10,000 per cu mm
2)Viral infection (leukopenia)
3)Bacterial infection (leukocytosis) -
K+
1)Normal Values?
2)Significance of Low?
3)Significance of High? -
1)(4.0) 3.5-5.0
2)hypokalemia: metabolic alkalosis, excessive excretion,renal loss, vomiting. [FLATTENED T-WAVE]
3)hyperkalemia: metabolic acidosis, kidney failure. [SPIKED T-WAVE] -
K+
-
K+
1)Normal Values?
2)Significance of Low?
3)Significance of High?
1)(4.0) 3.5-5.0
2)hypokalemia: metabolic alkalosis, excessive excretion,renal loss, vomiting. [FLATTENED T-WAVE]
3)hyperkalemia: metabolic acidosis, kidney failure. [SPIKED T-WAVE] -
Honeycomb Pattern
(chest x-ray) - ARDS/IRDS
- Paradoxical Chest Movement
- Flail chest
- Radiolucent
-
Normal lung