Midterm Review

WEEK 1:
• father of medicine
-Hippocrates
• Respiratory Focus
-prevention, protocol administration, developmental of care plans, rehabilitation & management of diseases, family & patient education, and tobacco cessation counseling
• RT Scope of practice
-patient assessment, disease management, diagnostic evolution, management, education, rehabilitation & care of patient with cardiopulmonary, system
deficiencies or abnormalities
-application of technology and use of protocols
• RT licensure testing
- CRT & RRT
- TMC: test taken for licensure
• Committees and what they do
- AARC (American Association for Respiratory Care)
nonprofit national and international organization for RT
- Respiratory Care Board of California
governing agency for Respiratory Care in California
- CoARC (Commission on Accreditation for Respiratory Care
credits colleges and universities
- JCAHO ( Joint Commission)
predominant standard setting and accrediting body in healthcare
- NBRC (National Board of Respiratory Care)
creates the test requirements, exam schedules, study guide, and requirements for marinating credentials
• Body mechanics for lifting
- lift with knees and not with back; don’t twist and lift at the same time
• Electrical for Respiratory equipment
- always plug Respiratory equipment into the red outlet b/c it is connected to the back up generator
• RACE Acronym
Rescue: anyone in immediate danger
Alarm: pull fire alarm
Contain: close all doors in fire area
Extinguish: only small fires
• Therapist responsibilities in a fire
- respond to the area of the fire with an extinguisher and turn off the zone valves
• Conditions for a fire to occur
- flammable material, oxygen must be present, and material must be heated to or above ignition temperature
• Breach of legal obligation
-legal and ethical obligation to the patient. Breach can lead to licensure suspension, termination, and possible jail time
• Lack of Communication
- language barrier, mental impairment, stroke, trauma, age, and cultural differences
• Patients right to refuse
- Autonomy: right of patient to decide their treatment
• Assault and Battery
- Assault: intentional act that places someone else in fear of immediate bodily harm
- battery: nonconsensual physical contacts
• Advanced Directives:
- Living Will: patient states their wishes for care in writing
- Durable Power of Attorney: patient gives power to someone else for healthcare decisions
• PHI
- protective Health Information
- past, present, or future mental/physical health
- who and what health care was given previously
- past, present, or future payment or nonpayment
• HIPAA
- Health Insurance Portability and Accountability Act
- standard that protects a patient past, present, and future medical information
- protects from being discussed, looked at, tampered with, and breached

WEEK 2
• Gas properties
- solid state
- fixed volume and shape
- high degree of internal order and strong mutual attractive force between atoms
- motion referred to as “jiggle”. (Short distance to travel before collision)
- liquid state
-fixed volume but shape adapts to container
- less degree of mutual attraction
- melting (solid to liquid), freezing (liquid to solid), and sublimation (solid to vapor w/out becoming liquid)
- Gaseous state
- no fixed shaped or volume
- rapid and random motion with prequent collision
- easily compressed and expand to fill the container
• increased internal energy (kinetic and potential energy)
- heating a substance and performing on the system
• 0 Kelvin
- the lowest possible temperature
- no kinetic energy so molecules cease to vibrate
• Celsius and Fahrenheit conversions
- ° C = (°F-32)/1.8
- ° F= (1.8x°C)+ 32
• Absolute Humidity
- AKA water vapor content
- amount of water vapor in gas but varies with temperature and pressure
- 43.8 mg/L at 37°
• Relative Humidity
- gas not fully saturated
• 100% RH reached in the trachea
• Gas and the effect of temperature
- high temperature increases vaporization and velocity
• Patterns of flow
- Laminar Flow: moving in a discrete cylindrical layers/ streamline
- Turbulent flow: fluid molecules form irregular chaotic patterns
- Transitional flow: mixture of laminar and turbulent flow
Week 3
• Lab vs Therapeutic vs Anesthetic gasses
- Lab gases (carbon dioxide): equipment calibration and diagnostic testing
- Therapeutic gas (oxygen, Helium, Heliox, NO): relieve symptoms and improve oxygenation
- Anesthetic gas (Nitrous Oxide): Combines with oxygen to privies anesthesia during surgery
• Properties of Oxygen
-colorless, odorless, transparent, and tasteless
- not flammable but COMBUSTABLE
- large quantities: Fractional distillation
- Small quantities: physical separation of oxygen from air
• Properties of Air
- colorless, and odorless
- 21% oxygen, 78% Nitrogen, and 1% trace gases
• Properties of Carbon Dioxide
- colorless and odorless
- does not support combustion
-used for calibration of blood gas analyzers and diagnostics
• Heliox Indications
- mixture of oxygen and helium
- used for sever cases of airway obstruction
• Nirtic Oxide Indication
- colorless and nonflammable
- can cause methemoglobinemia if exposed to high concentration
- infants with hypoxic respiratory failure
- pulmonary hypertension
• cylinder colors
- oxygen green
- air yellow
- carbon dioxide grey
- Helium brown
- Nitrous oxide blue
- Heliox Brown/Green
• Safety testing timeframe
- 5 to 10 years
• Relief Valves
- gas released if too much heat
- prevent pressure from getting too high
- frangible metal disk rupture, fusible plug melts, and valve opens due to spring loaded
• Compressed gas vs Liquifies gas
- Compressed gas:
- filled to service pressure at 70 F
- can be filled to 10% (+) over
- measured by pressure
- Liquified Gas:
- filled to specified filling density
- measured by weight
• E tank and H tank Calcualtions
- E= 0.28 and H=3.14
• ASSS, DISS, PISS
- ASSS (American Standard Safety System)
- large cylinders and their attachment
- prevents accidental misconceptions
- DISS ( Diameter Index Safety System)
- low pressure gas connectors
- pressure reducing valve, central piping systems, and inlets of blenders, flow meter, vents
- PISS (Pin-Index Safety System)
- small cylinders
- pinholes vary
- 2-5 oxygen
- 1-5 oxygen

WEEK 4
• clinical objectives fro oxygen therapy
- correct acute hpoxemia
- chronic hypoxemia
- decrease workload imposed by hypoxemia to the cardiopulmonary system
• Indication for oxygen therapy
- hypoxemia
- acute care- hypoxemia suspended
- severe trauma
- acute myocardial infraction
- short term therapy/ surgical intervention
• oxygen toxicity and ROP
-PaO2 < 60mmHg
- SaO2 < 90%
• oxygen toxicity with FiO2 100% more than 24 hours
- alveolar capillary membrane thickens
- 25 to 30 hours : lung compliance decreases
- 30 to 72 hours: decreases diffusing capacity
• know which oxygen devices go into the categories of low-flow, reservoir, and high-flow
- low-flow: nasal cannula
- reservoir: simple mask, partial rebreathing mask, and nonrebreathing mask
- high-flow: Air entertainment Venturi Mask
• Nasal Cannula
- advantages: well tolerated and can add a humidifier
- delivers FiO2 of 0.24-0.44 and 1 to 6 L/min
- room air 21%
- 1 L/min 24%
- 2 L/min 28%
- 3 L/min 32%
- 4 L/min 36%
- 5 L/min 40%
- 6 L/min 44%
- FiO2 depends on how much room air patient inhales
- Bubble humidifier: nasal cannula over 4 L/min
• Reservoir Cannula
- conserve oxygen
- 50% to 75%
• Simple Mask
- 6 to 10 L/min; minimum flow is 5 L/min
- FiO2 0.35 to 0.50
- varies with input, mask volume, extent of air leakage, and breathing patterns
• Rebreather Mask
- FiO2 0.40 to 0.70
- minimum of 10 L/min to prevent the bag from collapsing
• Common problems with O2 devices
- device replacement
- system leaks and obstruction
- improper flow adjustment
- skin irritation
• high flow system total flow
- at least 60 L/min total flow
• Magic Box calculation
- 20 * 20 and 100 does not change
100
• Obstructed entertainment ports
-increased FiO2 and total output flow decreases
• Function of high-flow nasal cannula
- delivers high FiO2
- meets or exceeds the patients inspirations flow
- CO2 washout from dead spaces
• What is a blending system
- proves high O2 concentration/ flow
- separate pressurized air & O2 sourced input
- gases mixed manually or with precision valve
- this system allows control over both FiO2 and total flow output
• # P’s of O2 delivery system
- Purpose: increase FiO2 sufficiency to correct arterial hypoxemia
- Patient consideration:
-Severity and cause of hypoxemia
- Patient age group
- Degree of consciousness and alertness
- Presence or absence of tracheal airway
- Stability of minute ventilation
- Mouth-breathing versus nose-breathing
- Performance :O2 systems vary according to actual FiO2 delivered and stability of FiO2 under changing patient demands
• Hyperbaric Oxygen Therapy
- physiological effect
- Bubble reduction - Embolisms
- Hyperoxygenation of blood and tissue Vasoconstriction
- Enhanced host immune function
- Neovascularization (Natural formation of new blood vessels)
- Indications
- Acute Conditions
 - decompression sickness
- air and gas embolism
- carbon monoxide and cyanide poising
-Acute traumatic ischemia (compartment syndrome, crush injury)
- Acute peripheral arterial insufficiency
- Intracranial abscesses
- Crush injuries and suturing of severed limbs
-Clostridial gangrene
- Necrotizing soft tissue infection
- Ischemic skin graft or flap
- Chronic Conditions
- Diabetic wounds of the lower extremities and other nonhealing wounds
- Refractory osteomyelitis
- Actinomycosis (chronic systemic abscesses)
- Radiation necrosis (HBO as an adjunct to conventional treatment)
- Hazards
- Barotrauma
- Ear or sinus trauma
-Tympanic membrane rupture
- Alveolar overdistention and pneumothorax
- Gas embolism
- Oxygen toxicity
-CNS toxic reaction
- Pulmonary toxic reaction
- Other
- Fire
- Sudden decompression
- Reversible visual changes
- Claustrophobia
- Decreased cardiac output
• Nitric Oxide (Physical Effects)
- improves blood flow to lung
- reduces shunting
- improves oxygenation
- decreases pulmonary vascular resistance
- lower cost alternative drug therapies (inhaled epoprostenol sodium) gaining popularities
• Helium Oxygen therapy
-indication
- low density
- decreases WOB for airways obstruction
- 80/20 minimum helium-O2 mixture 1.8
- 70/30 helium-O2 mixture 1.6
- Delivered to patient via tight-fitting nonrebreathing mask with high flow
• Mixture of Carbogen
- 5% :95% OR 7% : 93%
- commonly used for hiccoughs, carbon monoxide poising, preventing complete washout of CO2 during cardiopulmonary bypass