Cardiopulmonary Outcomes
I.
II.
III.
IV.
V.
BIPAP
a. A noninvasive way to assist spontaneous ventilation. It utilizes 2 pressures- a
high pressure for inspiration and a low pressure for end exhalation. It uses a full
facial mask or a just a nasal mask.
b. Indications include but are not limited to acute CHF, acute COPD exacerbation,
OSA, impending respiratory failure.
CPAP
a. A noninvasive way to assist spontaneous ventilation. Only utilizes one,
continuous pressure, above atmospheric pressure to improve ventilation. Utilizes
a full facial mask or nasal mask.
b. Indications include but are not limited to OSA, respiratory failure or
insufficiency, COPD exacerbation
Mechanical Ventilation
a. Invasive means of controlling a patients’ ventilation. Either via endotracheal tube
or tracheostomy. Respiratory therapy sets the tidal volume, respiratory rate,
FiO2, PEEP, among other settings. The patient can either be controlled or assisted
with ventilation.
b. Indications include but are not limited to respiratory failure, post-op, chronic
neuromuscular conditions, acute CVA
Arterial Blood Gas Interpretation
a. Normal blood gas values
i. pH (7.35-7.45)
ii. pco2 (35-45)
iii. HCO3 (22-26)
b. pH below 7.35=acidosis pH above 7.45 = alkalosis
c. Can be caused by either respiratory or metabolic
d. May be either compensated or uncompensated
Oxygen Delivery Systems
a. Nasal Cannula
i. 1-6 LPM. May be used with humidification
b. High Flow Nasal Cannula
i. 6-15 LPM. Must be used with humidification
c. Heated High Flow Cannula
i. 20-50 LPM. Must be used with heated humidification
d. Venti Mask
i. 25-50%
e. Aerosol mask
VI.
VII.
VIII.
IX.
X.
i. 24-100%
f. Non-rebreather
i. 15 LPM. Delivers close to 100% Fio2
Incentive Spirometer
a. Sit upright
b. Maintain tight lip seal on mouthpiece.
c. Take a slow deep inspiration
d. Hold breath at end of inspiration
e. Take note of volume inspired
Normal Breath Sounds
a. Bronchial
i. Loud, tubular, blowing sounds
b. Brocnho-vesicular
i. Blowing through a straw
c. Vesicular
i. Low and soft pitched
Adventitious Breath Sounds
a. Rhonchi
i. Snorous wheezing
b. Rales
i. Sounds like clicking, rattling, or bubbling
c. Wheezing
i. High pitched whistling sound
d. Stridor
i. Harsh vibratory sound
Echocardiogram
a. Ultrasound of the heart. Can measure cardiac functions such as wall motion,
ejection fraction, valve function, blood flow through various chambers and
vessels of the heart, different pressures and gradients within the heart, assess
various pathologies associated with the heart.
Role of RT during emergency responses
a. Rapid Response
i. Can be called by anyone including the family of the patient
ii. Goal is to deploy a rapid assessment team to patients room. Patient can be
exhibiting signs of decreased oxygenation, acute change in blood pressure
or decrease in mental capacity.
b. Code
i. Called for a patient in cardiopulmonary arrest. RT obtains and secures
airway. Performs CPR in rotation with other ACLS staff on scene.
Depending on the outcome, patient may be placed on mechanical
ventilation
c. Dr. Rush
i. Called overhead for a person in need on hospital grounds. Can be
anything from a patient passing out while having blood drawn in the lab to
a person collapsing in the parking garage. Patient is then assessed for
need of immediate medical care.