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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 Assessm...

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  • October 29, 2024
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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

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