Kettering CSE Flashcards Guaranteed A+
Level 1 Assessment ✔️✔️Visual Assessment-
*General Appearance
*Appearance of the chest
*Respiratory Pattern/ Rate
*Sensorium
*Posture
*Pt color
#AND PALPATE A PULSE!!
#Chest excursion (appearance)
Level 2 Assessement ✔️✔️Bedside Assessment-
#Interview/Hx:
*Symptoms, *Hx of present illness, *Medical Hx, *Family Hx, and *Advance directives (DNR status)
#Palpation/Percussion:
*Pulse, *Tracheal position, *Diagnostic chest percussion, and *Temperature.
#Auscultation:
*Breath sounds, *Blood pressure, *Bowel sounds, and *Heart sounds.
#Non-invasive Monitoring:
*Capnography, *Oximetry, *ECG monitor, and
*Transcutaneous monitoring.
#Other assessments:
*Reflexes ( Pupil, Gag, transtracheal, babinski, etc.), *Range of Motion, *Capillary refill, and
*Hemodynamic monitoring.
#Sputum production
,#Dynamic Compliance
#COHB
#RAW
#Static Compliance (min 25; normal ~60)
Level 3 Assessment ✔️✔️Basic Lab Tests-
*ABG
*CBC
*12 Lead Electrocardiogram (EKG; ECG)
*Electrolytes
*Chest x-ray
#NOTE: IF YOU HAVE TIME FOR ONE, U HAVE TIME FOR ALL!!!!!
#ANY problem between lab tests do a FOLLOW-UP test!!
Level 4 Assessment ✔️✔️Special Tests-
#Laboratory: (For infections)*Sputum culture & Sensitivity, *Urinalysis and *Blood culture
#Pulmonary Function: (Pre-op) *Volumes, *Flowrates and *Pre-post bronchodilator (Asthma)
#Imaging Studies: *CT scan (PE), *MRI (Looking for something in Soft tissues), *Lateral Neck (epiglottis),
*Angiograms (PE Dx), *PET scan and *Lateral decubitus (pt layin on a side to see fluid; pleural effusion).
#Cardiopulmonary Testing: *Bronchoscopy (aspriation, lavage etc), *Stress test, and *Echocardiogram
#Hemodynamic Monitoring: (On vent- critically ill)*Arterial lines, *Pulmonary Artery line (Swan-Ganz),
and *Intracranial Pressure (ICP)
#Other Diagnostic tests: *Sweat Chloride( Cystic Fibrosis), *V/Q scan (PE), *ELISA test (Used to Dx virus
infections- HIV), *Edrophonium test (Dx MG), *APGAR score, *Cardiac enzymes, *Polysomnography, and
*Glasgow Coma scale (Used to assess pt in coma. Pts score 3-8 usually said to be in a coma).
Initial settings for Adult mechanical ventilation ✔️✔️VT: 5-10mL/kg of IBW;
*For Severe Asthma- Initial VT of 4mL/kg
, *For ARDS- Vt 4-8ml/kg, maintain Pplat <30cmH20, consider permissive hypercapnia and subsequent
resp. acidosis.
* Neuro pts- can do Larger Vt
*Lung issue pts- use smaller Vt
VC: (2xVT); => 10mL/kg
Pressure:
*Pplat from VC, or to achieve target VT,
*or =<35cmH20
RR (F): 10-20BPM
FIO2:
*Pt on room air or NO prior info- 40-60%;
*Pt currently on O2- Set at same level prior to ventilation
PEEP:
*No prior info- 2-6cmH20;
*Pt currently on CPAP- Set at same level prior to ventilation
Initial settings for Infant mechanical ventilation ✔️✔️*NOTE: Pressure/RR - 20/20 minimum!!!!
PIP or VT:
*PIP 20-30cmH20;
*VT 4-6mL/kg
RR (F): 20-30BPM
