By Gary C. White MEd RRT RPFT
A Davis's Notes booklet. This leading edge consultant retains self belief luck within sight of a scrub pocket! respiration Notes presents quick-reference details in a procedure-based layout that incorporates helping illustrations, fill-in-the-blank varieties, and algorithms to lead perform.
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Extra resources for Respiratory Notes: Respiratory Therapist's Pocket Guide (Davis's Notes)
S3—Produced by rapid ventricular filling following systole. Auscultated at the apex of the heart (5th intercostal space midclavicular line). ■ S4—Presystolic gallop. Auscultated late in diastole at the apex (5th intercostal space midclavicular line). Lowfrequency sound and often transient, caused by decreased ventricular compliance or in increased diastolic volume. BED ASSESS 02White (F)-02 BED ASSESS 4/6/07 5:05 PM Page 26 Copyright © 2008 by F. A. Davis. Positions used in heart auscultation Pulmonary Aortic Tricuspid Mitral ■ Abnormal auscultatory heart sounds: ■ Split S1—Delayed closure between the tricuspid and mitral valves (abnormally long S1 interval) can be caused by right bundle branch block, preventricular contractions (PVCs), or ventricular tachycardia.
A. Davis. 47 Artifacts ■ Patient motion: irregular appearance of the ECG. Try to minimize motion if possible. ■ Wandering baseline: poor contact with electrodes. Change electrodes, prep skin with isopropyl alcohol. ■ 60 Hz artifact (common mode interference): poor ground, current leakage or faulty electrical outlet. Change outlets, ground ECG instrument, change leads. ECG Assessment ■ Rate: ■ 60–100/min—Normal ■ Ͻ60—Bradycardia ■ Ͼ100—Tachycardia ■ Rhythm: Regular? Irregular? Regularly irregular?
Loss of lung markings in region of free air. Consolidation: Increased radiodensity (lighter than normal), often more lobar (compare PA with lateral). Pleural effusion: Blunting of costophrenic angles (PA) and posterior (lateral). A lateral decubitus projection can help to quantify. Congestive heart failure (CHF): Enlarged left ventricle (early). Increased hilar congestion. Increased fluid density with Kerley B lines along the right base. Increased size of heart silhouette. Pulmonary edema: Diffuse patchy infiltrate pattern.