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% Document Info
\author{Maria K (mkravatz)}
\pdfinfo{
  /Title (respiratory.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Respiratory Cheat Sheet)
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\noindent
\begin{multicols}{3}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Respiratory Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18118/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 4th December, 2018.\\
   Updated 4th December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Notes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{All body systems depend on adequate O`2`} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Purpose of breathing}}: {\emph{+ O`2` \& - CO`2`}}} \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{3.08574 cm} x{1.89126 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Oxygenation}}  \tn
% Row 0
\SetRowColor{LightBackground}
Includes... \{\{nl\}\} - {\bf{Ventilation}} \{\{nl\}\} - {\bf{Hgb \& RBC transport}} & \{\{nl\}\} - {\bf{Gas exchange}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{ATP production}} is vital for cell activity \& life} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\emph{Cellular hypoxemia}} impairs the cell's energy production, disrupts cell function} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Acute lung tissue is at the alveolar-capillary membrane level} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Mechanics of Breathing}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Concepts of airway resistance, lung compliance, opposing lung forces} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Inspiration}}: {\emph{chest wall muscles contract, inc. intrapleural pressure = lung expands}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Expiration}}: {\emph{lung deflates passively}}} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Blood flow through the lungs}}: \{\{nl\}\} - Bronchial \{\{nl\}\} - Pulmonary: highly vascular capill. network} \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pulse ox}}: {\emph{measures O`2` bound to Hgb}} (3\% plasma, 97\% Hgb)} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Smoking}} = carboxyHgb binds faster to Hgb} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ventilation-Perfusion Ratios}} \{\{nl\}\} {\emph{V/Q Scans}}: r/o pulmonary embolus} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Dead space}}: {\emph{lung area has V/Q mismatch}} \{\{nl\}\} - Do not participate in gas exchange \{\{nl\}\} - Enough O`2` but not enough blood flow} \tn 
% Row Count 16 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Shunt}}: {\emph{blood bypasses alveoli w/o getting O`2`}}} \tn 
% Row Count 18 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Silent unit}}: {\emph{pt can have dead space \& shunt}}} \tn 
% Row Count 19 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hypoxemia}}: {\emph{not enough O`2` in the blood}}} \tn 
% Row Count 20 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hypoxia}}: {\emph{not enough O`2` in the tissues}}} \tn 
% Row Count 21 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Oxygen-Hemoglobin Dissociation Curve}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/mkravatz_1543795674_Oxy-Hgb Dissociation Curve.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hgb saturation = oximetry}}  \newline {\bf{O`2` partial pressure (mm Hg) = paO`2`}}  \newline {\emph{Don't just get SpO`2` when acute, get ABG's!}}  \newline - pH is important  \newline - Aerobic \{\{fa-arrow-right\}\} anaerobic metabolism \{\{fa-arrow-right\}\} lactic acid buildup  \newline {\emph{Oximetry has a +/- 2 margin of error}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Personal History Assessment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Smoking (\#1)}} - {\emph{how long, how much \{\{fa-arrow-right\}\} might not be ready to hear it but responsible to inform about risks \& complications}}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Allergies}} - {\emph{year round, don't have to be allergic for things to affect breathing}} \{\{nl\}\} - Breathing in cold air is a very powerful irritant! (at least a cough)} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Drug use}} - {\emph{ACEI (cough), amiodarone (cough), beta-blockers (compete for B`2` sites)}}} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Travel}} - {\emph{TB, outside country, soil}}} \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{SES}} - {\emph{what's in home environment, pet hair, heating system in fall/winter}}} \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Family Hx}} - {\emph{genetics (recurr./chronic, acute)}}} \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Occupation}} - {\emph{if mask required, ventilation}}} \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Changes w/ Aging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Chest wall}}: {\emph{stiffer, m/s issues \{\{fa-arrow-right\}\} dec. compliance}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pharynx \& larynx}}: {\emph{muscles atrophy, airways lose cartilage, vocal cords start to slack}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Lungs}}: {\emph{lose elasticity \{\{fa-arrow-right\}\} dec. compliance}}} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Alveoli}}: {\emph{lose starting at 35yo but breathing not impacted unless chronic disease present}}} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pulmonary vasculature}}: {\emph{alveolar-capillary membrane thickens \{\{fa-arrow-right\}\} impairs gas exchange}}} \tn 
% Row Count 11 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ciliary action}}: {\emph{move mucus \& filter grunge (mucociliary exhalade)}} \{\{nl\}\} - Cilia paralyzed for 4 hr after every cigarette} \tn 
% Row Count 14 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Subjective \& Objective Data Assessment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} SUBJECTIVE DATA} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cough}} - {\emph{cardinal symptom of respiratory disease (6-8 wk = chronic)}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Sputum}} - {\emph{color? odor? changes? (normal = clear)}}} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CP}} - {\emph{assoc. w/ other things (GI, MI, etc.)}}} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Dyspnea}}: {\emph{length? onset? what helps? rate?}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} OBJECTIVE DATA} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{General appearance}}: {\emph{visibly dyspneic? using accessory muscles (sternocleidomastoid, trapezius, intercostals)? position to breathe?}}} \tn 
% Row Count 11 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vital signs}}: {\emph{(later) all affected w/ work of breathing}}} \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Physical assessment}}: {\emph{inspection, palpitation, percussion, auscultation}} \{\{nl\}\} - Always want extent to which you hear adventitous breath sounds} \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.58804 cm} x{2.38896 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Evaluation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Laboratory Assessment \{\{nl\}\} - {\emph{RBC}} (r/t Hgb transport) \{\{nl\}\} - {\emph{Hgb}} \{\{nl\}\} - {\emph{Sputum}} (sample for antibiotics, C\&S) \{\{nl\}\} - {\emph{ABG's}} (pH, CO`2` \{\{fa-arrow-right\}\} hypo-/hyperventilating; acidic/acidotic; bicarb.)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
Radiography & CT scan \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Pulse ox & Capnography \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
PFT's & Bronchoscopy \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Thoracentesis & Lung biopsy \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
V/Q scan & Etc. \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Radiography}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{X-rays}}: {\emph{air}} = black / {\emph{everything else}} = white} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CXR}} - infiltrates, infusions, masses \{\{nl\}\} - Daily in ICU for changes} \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CT Scan}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Thin slices, more specific than radiography} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Often w/ contrast (more detailed) \{\{nl\}\} - {\emph{Assess allergies (shellfish, iodine), kidney function}}} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pulse Oximetry}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Measure of O`2` attached to Hgb; SpO`2` or SaO`2`} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Normal value: 95-100\%}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Value affected by... \{\{nl\}\} - Poor peripheral perfusion/cold \{\{nl\}\} - Nail polish \{\{nl\}\} - Same arm as BP cuff \{\{nl\}\} - Applied correctly?} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Don't diagnose with value!}}} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Capnography}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Measure of CO`2` in exhaled air, which correlates w/ arterial CO`2`}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Normal value = 20-40}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Now checking capnography w/ PCA pumps} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests (PFTs)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/mkravatz_1543798307_PFT Diagram.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{R/t volume and flow  \newline Good way to track and trend where pts are}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Bronchoscopy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Insert scope to examine upper \& lower airway} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Invasive, need consent \{\{fa-arrow-right\}\} time-out!} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Therapeutic vs. diagnostic} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Labs}}: {\emph{platelets}} (CBC), {\emph{PT/INR}} (clotting)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{NPO}} 4-8 hr before} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Premedicate}}: {\emph{sedation, topical to paralyze cords}}} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{VS \& Assessment}}: {\emph{pre- \& post-scope, infection, bleeding}} \{\{nl\}\} - May cause perforation or pneumothorax \{\{nl\}\} - Accessory muscles \{\{nl\}\} - Asymmetical expansion \& breath sounds \{\{nl\}\} - Acutely dyspneic \{\{nl\}\} - Tachypneic \{\{nl\}\} - Hypertensive} \tn 
% Row Count 13 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Thoracentesis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Therapeutic (remove fluid) vs. diagnostic} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Need consent, comfort pt} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Sterile procedure!}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pre \& Post}}: {\emph{CXR, check puncture site, s/s of infection, VS, incentive spir. \& deep breathe}}} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}}: {\emph{pneumothorax, pain on affected side, mediastinal shift}} \{\{fa-arrow-right\}\} insert chest tube?} \tn 
% Row Count 8 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Upright, leaning \{\{fa-arrow-right\}\} permits better access} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{3.08574 cm} x{1.89126 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lung Biopsy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Purpose}}: {\emph{to obtain tissue sample for eval.}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Various approaches: \{\{nl\}\} - {\emph{Transbronchial Bx (TBB)}} \{\{nl\}\} - {\emph{Endobronchial Bx (EBB)}} \{\{nl\}\} - {\emph{Mediastinoscopy}} \{\{nl\}\} - {\emph{Open lung Bx}} (general anesthesia)} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
Conscious sedation & Fluoroscopy \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Pre}}: {\emph{CT for depth and density of mass}}} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Post}}: {\emph{gag reflex, VS (infection), pneumothorax, bleed, hemoptysis}}} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ventilation-Perfusion (V/Q) Scan}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Does ventilation match perfusion? \{\{nl\}\} - {\emph{Mismatch = ventilated not always perfused}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Low/moderate/high probability for risk of pulmonary embolus}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Procedure}}: {\emph{pt gets inhaled nucleotide}}} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Mixed Venous O2 Saturation (SVO2)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Get from pulmonary arterial line} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Purpose}}: {\emph{to eval. O`2` supply-demand balance}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Normal value = 60-80\%}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Venous gas (60-80\%) \textless{} arterial (80-100\%) \{\{nl\}\} - Easier sample, less painful \{\{nl\}\} - What's going on at peripheral level} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Embolism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{A collection of matter that enters venous circulation and into the lungs}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{DVT's is a big risk!}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}:} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{1) Alveolar dead space inc. as blood shunted away} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{2) Vasoactive \& bronchoconstrictive substances released \{\{fa-arrow-right\}\} vasoconstriction \{\{fa-arrow-right\}\} dec. bood flow to lungs \{\{fa-arrow-right\}\} worsens PE} \tn 
% Row Count 9 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{3) Pulmonary vascular resistance inc.} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{4) Pressure in pulmonary artery inc.} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{5) R ventricle workload inc.} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{6) CO dec. \{\{fa-arrow-right\}\} systemic blood pressure dec.} \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{7) Deoxygenated blood moves into arterial circulation \{\{fa-arrow-right\}\} hypoxia \& hypoxemia} \tn 
% Row Count 16 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Depends on SIZE of blood clot!}}} \tn 
% Row Count 17 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PE Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Anything causing {\bf{venous stasis}} - {\emph{vericose veins, inactivity (spinal cord/hip surgery), restrictive clothing, prolonged travel, obesity}}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hypercoagulable}} - {\emph{obesity, trauma, cancer, factor deficiencies, birth control (estrogen)}}} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Venous endothelial disease}} - {\emph{vericose veins, trauma, surgery, vascular vein disease}}} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Smoking}} - {\emph{inc. fibrinogen = inc. viscosity}}} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Change in {\bf{aging}}} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{VIRCHOW'S TRIAD}}: \{\{nl\}\} (1) {\emph{venous stasis}} \{\{nl\}\} (2) {\emph{hypercoagulability}} \{\{nl\}\} (3) {\emph{venous endothelial damage/injury}}} \tn 
% Row Count 12 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} 80-90\% come from venous} \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{PE Clinical Manifestations \& Physical Assessment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{RESPIRATORY} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{SOB/dyspnea (worsening)}} - {\emph{tachypneic, cyanotic, use of accessory muscles, cough, restless, panicky, confused}}} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{\{\{bt\}\} CARDIAC} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Tachycardia}} & {\bf{Early/late HTN}} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
{\bf{Pleuritic CP}} & {\bf{EKG changes}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{S`3` or S`4`}} (pooling, R-sided workload inc.)} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{paCO`2` inc. }} = acidotic} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PE Management Goals}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1. Improve gas exchange} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. Improve lung perfusion} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{3. Dec. risk for further clot formation} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{4. Prevent complications} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Anti-Coagulation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Administered ASAP for therapeutic effect} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Length of time-variable} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heparin}} - usually autely (unless massive) \{\{nl\}\} - {\bf{-Kinases}} (antithrombolytic) \{\{nl\}\} - Bridge w/ {\bf{Warfarin (Coumadin)}} - treat 3-6 months but depends on size \& risk factors} \tn 
% Row Count 6 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Other agents: \{\{nl\}\} - {\bf{Enoxaparin (Lovenox)}} \{\{nl\}\} - {\bf{Fondaparinux (Arixtra)}}} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Newer agents:  \newline - {\bf{Rivaroxaban (Xarelto)}} \newline - {\bf{Dabigatran (Pradaxa)}} \newline - {\bf{Apixaban (Eliquis)}} \newline - {\bf{Endoxaban (Savaysa)}} \newline {\bf{{\emph{Pro}}: infrequent labs}} / {\bf{{\emph{Con}}: no quick reversal}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PE Diagnostic Evaluation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Suggestive, not definitive} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diagnosed w/ {\bf{diagnostic tests, Sx, \& labs}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Labs}} - CK, CRP, ESR, D-Dimer} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Radiology/CT}}, {\bf{TEE}} (cardiac assess)} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{V/Q scan}} - now more pulm. angiography} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{D-Dimer}}: {\emph{protein fragment active w/ clots}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PE Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{O`2` therapy}} - {\emph{fix hypoxemia (vent/mask/NC)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anti-coagulation}}, {\bf{Thrombolytic agents}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Surgery}} {\emph{(embolectomy)}} \& {\bf{Filters}} {\emph{(break up traveling clots; temporary or permanent)}}} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ekos}}: {\emph{endo catheter through blood vessels to deliver clot-busting med \&/or break up clot}}} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Strategies to Prevent PE's}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Early mobilization}}, {\bf{Freq. position changes}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Active/passive ROM}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{TEDs \& SCDs}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Avoid tight clothes}} - {\emph{esp. popliteal area}}} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Lifestyle changes}} - {\emph{obesity/wt loss, smoking, birth control, activity, diet (salads), hydration, medic alert bracelets}}} \tn 
% Row Count 7 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anti-coagulation therapy}} - {\emph{PT/INR, UFH}}} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Avoid valsalva maneuver}} \{\{fa-arrow-right\}\} {\emph{laxatives}}} \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment/eval of peripheral circulation}} - {\emph{color, temp., \& sensation in extremities}}} \tn 
% Row Count 12 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Bleeding precautions}} - {\emph{electric razors, hold pressure, scissors \& knives}}} \tn 
% Row Count 14 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heparin-Induced Thrombocytopenia (HIT)}}: {\emph{heparin antibodies develop \{\{fa-arrow-right\}\} bind to pH \& activate thrombin (\{\{fa-arrow-right\}\} develop clots)}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}