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Copyright © 2008 by F. A. Davis.
00White (F)-FM 4/6/07 11:14 AM Page 3
Respiratory
Notes
Respiratory Therapist’s Pocket Guide
F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2008 by F. A. Davis Company
Copyright © 2008 by F. A. Davis Company. All rights reserved. This prod-
uct is protected by copyright. No part of it may be reproduced, stored in
a retrieval system, or transmitted in any form or by any means, elec-
tronic, mechanical, photocopying, recording, or otherwise, without writ-
ten permission from the publisher.
Printed in China by Imago
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Andy McPhee
Manager of Content Development: Deborah J. Thorp
Developmental Editor: Keith Donnellan
Art and Design Manager: Carolyn O’Brien
As new scientific information becomes available through basic and clin-
ical research, recommended treatments and drug therapies undergo
changes. The author(s) and publisher have done everything possible to
make this book accurate, up to date, and in accord with accepted stan-
dards at the time of publication. The author(s), editors, and publisher are
not responsible for errors or omissions or for consequences from appli-
cation of the book, and make no warranty, expressed or implied, in
regard to the contents of the book. Any practice described in this book
should be applied by the reader in accordance with professional stan-
dards of care used in regard to the unique circumstances that may apply
in each situation. The reader is advised always to check product infor-
mation (package inserts) for changes and new information regarding
dose and contraindications before administering any drug. Caution is
especially urged when using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the
internal or personal use of specific clients, is granted by F. A. Davis
Company for users registered with the Copyright Clearance Center
(CCC) Transactional Reporting Service, provided that the fee of $.10 per
copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923.
For those organizations that have been granted a photocopy license by
CCC, a separate system of payment has been arranged. The fee code for
users of the Transactional Reporting Service is: 8036-1467/08 0 ⫹ $.10.
00White (F)-FM 4/10/07 6:55 PM Page 5
✓ HIPAA Compliant
✓ OSHA Compliant
Isolation Categories
Isolation Respiratory Patient
Category Patient Placement Gloves and Gown Protection Transport
Droplet Private room. Always wear gloves and Surgical mask Patient should wear
11:22 AM
same organism.
Contact Private room. Wear gloves for any No mask is During transport
Cohorting is OK patient contact. Wear required. ensure that
if the second gown if you anticipate any contact
patient has the contact with patient, transmission by
same organism. soiled equipment, or the patient is
BASICS
soiled environmental minimized.
surfaces.
Copyright © 2008 by F. A. Davis.
Page 2
Age-Specific Considerations
Age Fears/ Verbal Motor Cognitive Special
Group Anxieties Strategies Senses Skills Ability Considerations
2
the airway.
Toddlers Separation Use concrete Senses are Begin to Can under- Requires close
from verbal com- acute. develop stand supervision.
parent(s). munication fine motor more than Don’t leave
strategies. skills. they can small objects
01White (F)-01
Child Separation, Use con- Senses Good Can under- Don’t leave
11:22 AM
important.
Adoles- Embarrass- Be more Senses Good May be Privacy is very
cent ment, loss of thorough are motor capable of important.
control, loss in expla- acute. skills. abstract Encourage
of conscious- nations. thought. verbalization
01White (F)-01
BASICS
(Text continued on following page)
Page 4
4
death. sions. ished. self-care
should be
encouraged.
Geriatric Loss of control, Be more Hearing, Joints are Possesses Patient’s skin is
changes in thorough taste, stiffer and abstract more fragile.
01White (F)-01
Cultural Diversity
Copyright © 2008 by F. A. Davis.
Touching Generally accept therapeutic Is generally acceptable within the same gender,
touch. Establish trust first. but is not acceptable between genders.
Gender role Responsibility for decision-making Most decisions are made by men. Care for daily
differences varies by educational level and needs is delegated to women.
socioeconomic status.
Religion and Belong to Baptist and other Muslim (generally Sunni branch), also Protestant,
spirituality Protestant sects; Muslim. Greek Orthodox, or other Christian faiths.
4/6/07
Blood/organ Will refuse blood if a Jehovah’s Mutilation of the body (autopsy) or organ
donation Witness. Are reluctant to donate donation may be refused. Some may donate
blood or organs. organs because it will benefit the community.
Diet and General, no prohibitions unless Most Muslims do not eat pork. Avoid icy drinks
nutrition prohibited by religious beliefs when sick or hot/cold drinks together.
01White (F)-01
BASICS
toward the caregiver. encouraged to take breaks from caregiving.
(Text continued on following page)
Page 6
Touching Shaking hands is OK. Strict Muslims do not Light touch handshake is OK.
allow male nurses to examine women. Maintain a respectful distance
while interacting with the patient.
Gender role Traditionally, a patriarchal family structure. Varies from nation to nation.
differences
Religion and Majority are Muslim or Christian, a few may May be traditional Native American
spirituality be Jewish. belief or Christian.
4/6/07
6
Blood/organ Organ donation and receiving blood products Blood and organ donation is
donation are acceptable. generally not desired, but may
be open to discussion.
Diet and Pork is prohibited by Muslims. Medications Restrictions will vary with
nutrition should not contain alcohol (also prohibited religious/spiritual beliefs.
01White (F)-01
by Muslims).
Death/dying Many visitors can be expected. No cremation Full family involvement occurs
& birth is allowed. May only want females present throughout all stages of life.
during delivery of a child. Circumcision may be refused.
Misc. Permanent life support is unacceptable. Most Older adults may prefer the use of
consider it shameful to accept Medicaid. “American Indian” over Native
BASICS
American.
(Text continued on following page)
Page 7
providers included).
Touching Except for handshaking, touching Touching is OK once familiarity or friend-
may be considered disrespectful. ship has been established.
Gender role Entire family shares equally in Typically, both men and women share in
differences decision-making. decision-making.
Religion and Primary religion is Roman Catholic. Primary religions are Jewish, Eastern
spirituality Orthodox, and Christian. Many may not
4/6/07
Death/dying Strong family support during labor. Father may not attend birth, but the
& birth Most are very expressive during closest female family member usually
bereavement. does.
Misc. Silence may sometimes indicate a Interpreters should be used whenever
disagreement with the plan of possible.
BASICS
care.
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8
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9
Weight, Temperature, and
Length Conversions (Continued)
Weight Temperature Length
Lb Kg F C Cm Inches Feet and Inches
5 2.3 85 29.4 206 81 6′9′′
2.2 1 75 23.9 208 82 6′10′′
2 0.9 74 23.3
1 0.45 73 22.8
72 22.2
71 21.7
70 21.1
69 20.6
68 19.9
32 0.0
9
F C 32
5 5
C (F 32)
9
inches cm 0.394 inches/cm cm inches 2.54 cm/inch
BASICS
01White (F)-01 4/6/07 11:22 AM Page 10
PB PH2o 310
BTPS ATPS
PB 47 273 T
STPD ATPS
PB PH2O
760
273
273 T
PB Barometric pressure
PH2O Partial pressure of H2O at spirometer temperature
47 Partial pressure of H2O at body temperature and
pressure saturated
310 Body temperature in Kelvin
T Spirometer temperature (C)
10
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11
Patient Interview
Purpose
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History Taking
■ Biographical
■ Age, gender, occupation, race/culture
■ Chief complaint
■ What resulted in the patient seeking medical attention?
■ What are the symptoms that caused the patient to seek
medical attention?
■ Are there any associated symptoms (sweats/chills, fever,
cough, etc.)?
■ Onset, duration, severity?
■ History of present illness
■ Detailed description of each symptom described in the chief
complaint
■ P, Q, R, S, T
◆ P (Provokes/Point): What causes it, what makes it better,
where is it?
◆ Q (Quality): Dull, achy, how much is involved, how does
it look, how does it feel?
◆ R (Region/Radiation): Where does it radiate or spread?
What makes it better? What makes it worse?
◆ S (Severity): Lichert scale 1 (no pain) to 10 (worst pain).
◆ T (Timing): When did it start? Is it constant? Is it sudden
or gradual?
■ Past medical history
■ Childhood illnesses
■ Hospitalizations (injuries, accidents, emergent conditions,
etc.)
■ Surgeries (elective, emergency, etc.)
■ Allergies, immunizations
■ Current medications (prescribed and over-the-counter)
■ Social history
◆ Smoking: How long? What (cigarettes, cigars, pipe, etc.)?
Have you quit? How long?
◆ Alcohol: How long? What (liquor, wine, beer)? How
often? How much? How long?
◆ Drug use: What? How often? How long?
12
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13
■ Family history
◆ Family history for chronic lung disease (asthma,
emphysema, bronchitis, cystic fibrosis)?
◆ Family history for heart disease?
◆ Family history for hypertension?
◆ Family history for renal disease?
◆ Family history for cancer?
■ Occupational/environmental history
◆ Work: Shipyard, mining, farming, foundry work, mill
work, insulation installation, welding, chemical exposure,
textile work, etc.
◆ Home: Air conditioning, evaporative cooling, humid-
ifier, molds, insulation, plants, smoking, wood stove
use
◆ Geographical: Histoplasmosis, coccidioidomycosis,
blastomycosis
Vital Signs
Vital Signs
Assess vital signs upon admission as ordered; on change in
status, with chest pain or any abnormal sensation; before and
after administration of blood products or medications that can
cause cardiovascular or respiratory changes; before and after
any intervention that can affect the cardiovascular or respira-
tory system.
Vital signs should include temperature (T), heart rate (HR),
respiratory rate (RR), blood pressure (BP), SpO2, and pain
assessment.
BED
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Page 14
Normal Ranges
Copyright © 2008 by F. A. Davis.
HR 140 80–180 80–140 80–140 80–140 75–120 50–90 50–90 50–90 60–100 60–100
RR 40–60 30–80 30–60 20–40 20–40 15–25 15–25 15–24 15–20 12–20 15–20
14
4/6/07
BP 73/55 73/55 73/55 90/55 90/55 95/57 95/57 120/80 120/80 120/80 120/80
SpO2 95% 95% 95% 95% 95% 95% 95 % 95% 95% 95% 95%
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BED
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15
Head and Neck Assessment
■ Head—Facial expressions, cyanosis, pursed lip breathing,
nasal flaring, eyes (pupil size and reaction)?
■ Neck—Jugular venous distension, use of accessory muscles,
tracheal position, lymph node palpation?
BED
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Ventilatory Patterns
Normal (Eupnea)
Cheyne-Stokes
Biot’s
Kussmaul’s
Palpation
16
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17
Assessment of Chest Symmetry
Anterior
Posterior
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Percussion
Auscultation
18
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19
Positions Used in Chest Auscultation
1 1
2
2
3
3
4 4
5 5
Anterior
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8
8
9 9
Posterior
BED
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Sputum/Cough
Ventilation Assessment
■ VE, VT, and Frequency
■ Minute Volume (VE)—The volume exhaled or inhaled in
1 minute
◆ Normal: 5–7 L/min (adult)
■ Tidal Volume (VT)—The resting volume inhaled or exhaled
during each breath
◆ Normal: 4–7 mL/kg
■ Frequency (rate)—The number of breaths per minute.
Normals:
◆ Term infant: 30–80
◆ 6-month-old: 30–60
◆ Pediatric: 20–40
◆ Adolescent: 15–25
◆ Adult: 12–20
■ Rapid Shallow Breathing Index (frequency/tidal volume [L])
■ Normal: 100
■ PaCO2
■ Normal: 35–45 mmHg
■ PEtCO2
■ Normal: 35–43 mmHg
■ Deadspace (VD ana, VD/VT)
■ Anatomic: Normal 1 mL/Lb body weight
VD 1 mL Body Weight (Lb)
■ VD/VT: Normal 0.25–0.35
PaCO2 PECO2
VD / VT
PaCO2
■ Alveolar Ventilation
VA (VD / VT VT)f
20
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21
Oxygenation Assessment
PaCO2
Alveolar air PAO2 FIO2(PB 47 mmHg)
0.8
Note: Only calculate at FIO2 of 0.21 or 1.0
Oxygen content CaO2 SaO2 (Hb 1.34) (PaO2 0.003)
Normal: 15–24 mL/dL
PaO2: 80–100 mmHg
SpO2: 90%
Oxygen delivery DO2 QT (CaO2 10)
Normal: 1000 mL/min
Venous oxygen SvO2 (Hb 1.34) (PvO2 0.003)
content Normal: 12–15 mL/dL
Arterial-venous CaO2 – CvO2
oxygen content Normal: 4–6 mL/dL
difference PaO2/FIO2 Normal: 200
PaO2/PAO2 Normal: 0.8–0.9
Oxygen VO2 QT (Ca-vO2 10)
consumption Normal: 250 mL/min
Oxygen extraction CaO2 CvO2
O2 ER
ratio CaO2
Normal: 0.25
End capillary CcO2 (Hb 1.34) (PAO2 0.003)
oxygen content
CcO2 CaO2
Pulmonary shunt Qs /QT CcO CvO
2 2
Normal: 0.20
BED
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Page 22
Oxygenation
Physical Findings Ventilation Indices
Inspection Palpation Percussion Auscultation VT f PaCO2 SpO2 CaO2 QS/QT
Bronchi- Use of ac- ↓ Normal or Normal or ↓Breath ↑ ↑ ↑ (chronic) ↓ ↓ ↑
5:05 PM
22
4/6/07
↑ A-P Dia
Emphy- Use of ac- ↓ Normal or Hyperreso- Crackles &
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muscles
↑ A-P Dia
Copyright © 2008 by F. A. Davis.
Page 23
crackles, &
4/6/07
rhonchi
Pulmonary Dyspnea ↑Fremitus Dullness ↓Breath ↓ ↑ ↓ ↓ ↓ ↑
Edema sounds,
crackles,
rhonchi &
02White (F)-02
wheezing
Pulmonary Dyspnea Normal Normal Wheezing, ↓ ↑ ↓ ↓ ↓ ↑
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Embolus crackles,
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pleural
friction rub
Atelectasis Dyspnea ↑Fremitus Dullness ↓Breath ↓ ↑ ↑ (severe) ↓ ↓ ↑
sounds,
crackles
02White (F)-02 4/6/07 5:05 PM Page 24
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Cardiac Assessment
Capillary Refill
■ Normal: 3 seconds
■ Increased: 3 seconds (low cardiac output or decreased
peripheral perfusion)
Heart Rate
■ Normals
■ Newborn 80–180/min
■ 1 year 80–140/min
■ 2 years 80–140/min
■ 6 years 75–120/min
■ 10 years 50–90/min
■ 16 years 50–90/min
■ Adult 60–100/min
■ Geriatric 60–100/min
■ Points of palpation: radial, brachial, femoral, carotid, popliteal,
posterior tibial, dorsal pedal
Blood Pressure
■ Normals
■ Newborn 73/55 mmHg
■ 1 year 90/55 mmHg
■ 2 years 90/55 mmHg
■ 6 years 95/57 mmHg
■ 10 years 95/57 mmHg
■ 16 years 120/80 mmHg
■ Adult 120/80 mmHg
■ Geriatric 120/80 mmHg
24
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25
Cardiac Palpation
Cardiac Auscultation
BED
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Aortic Pulmonary
Tricuspid Mitral
26
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27
■ Murmurs—Sustained heart sounds caused by turbulent
blood flow through the heart.
◆ Presystolic murmur: Heard at the start of S1 with its peak
occurring in the first third of systole. Caused by mitral
stenosis or increased flow through the pulmonic valve.
◆ Midsystolic murmur: Heard just after S1 peaking at mid-
systole. Caused by narrowed aortic or pulmonic valve.
◆ Late systolic murmur: Heard during late systole. Caused
by mitral valve prolapse or tricuspid valve defects.
■ Early diastolic murmur: Heard at the start of S2 peaking in
the first part of diastole. Caused by aortic regurgitation.
■ Mid-diastolic murmur: Heart after S2 peaking at mid
diastole. This is a low-frequency sound, caused by mitral
stenosis and best heard at the apex.
■ Late diastolic murmur: Heard late in diastole, often
extending into S1, can be caused by mitral and tricuspid
stenosis.
■ Bruits: Auscultatory heart sounds heard over the neck
(carotid arteries). The sound is caused by turbulence
(obstruction to blood flow) and is of mixed frequency.
Cardiac Enzymes
Enzyme Normal
Troponin (TnI) 0.0–0.1 ng/mL
Troponin (TnT) 0.18 ng/mL
Creatine phosphokinase (CPK) 150 U/L
CPK-MB 3 ng/mL
Neurological Assessment
■ Mental status: Alert, confused, lethargic, comatose
■ Motor ability:
■ Grip Strength: Ask patient to grip your hands. Is the grip
equal? Ask the patient to push/pull your hands. Is it equal?
■ Feet: Ask the patient to push/pull your hands. Is it equal?
BED
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Nutritional Assessment
Body Mass Index
weight in lbs.
BMI 703
(height in inches)2
Body Fat
Skinfold Thickness
Use calipers to measure skinfold thickness at the biceps, triceps,
subscapular, and suprailiac regions. Tables are used to translate
the data into relative percentage of body fat. Skinfold thickness
measurements are one way to estimate total body fat.
Maximum Percentage of Body Fat
20 years of age 17 %
20–22 years of age 18 %
23–25 years of age 19 %
25–29 years of age 20 %
30 years of age 22 %
28
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29
Lab Tests
Serum Albumin
Measure of the protein fraction in the blood that corresponds to
protein reserves in the muscles. The test can be used to screen
protein depletion. However, 1/2 life is long (20 days) so values
can be slow to change with changes in nutritional intake.
Thyroxin-binding Prealbumin
This value quickly reflects changes in nutrition (1/2 life 2 days).
Thyroxin-binding
Prealbumin (TBP) Level Assessment
10–20 mg/dL Normal
10 mg/dL Deficient
Retinol-binding Protein
A measure of a transport protein of retinol in the plasma (alpha
1-globulin). This has a short 1/2 life (12 hours), and quickly
reflects changes in nutritional status.
Retinol-binding Protein (RBP) Assessment
3–6 micro gm/dL Normal
3 micro gm/dL Deficient
Urea Nitrogen
Measurement of nitrogen content of the urine. An increase in
urea nitrogen reflects in increase in protein catabolism.
Urea Nitrogen Assessment
8–25 mg/dL Normal
25 mg/dL Increased catabolism of proteins
BED
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Copyright © 2008 by F. A. Davis.
Page 30
Basic Assessment
Name Weight Physician
30
4/6/07
Chief Complaint
Social History
Smoker: Yes ■ No ■
Cigarettes? Yes ■ packs/day ____ How many years? ____
HX of Present Illness Cigars? Yes ■ How many/day? _____ How many years? _____
02White (F)-02
Other? ________________
Alcohol use? Yes ■ No ■ What and how much/day? ____________
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BED
Basic Assessment
VITAL SIGNS HEAD/NECK MENTAL STATUS
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BED
Cyanosis? Yes ■ No ■
Basic Assessment
SPUTUM/COUGH VENTILATION OXYGENATION
Cough? Yes No VE CaO2
How long? VT SpO2
5:05 PM
32
4/6/07
Basic Assessment
ARTERIAL BLOOD GASES CHEST X-RAY PULMONARY FUNCTION
pH FVC
5:05 PM
PaCO2 FEV1
HCO3 FEV1/FVC
PaO2 PEF
33
4/6/07
BE DLCO
SaO2 FRC
Hb RV
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COHb TLC
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BED
MetHb RV/TLC
Current O2
Page 34
34
4/6/07
(MCH)
Mean cell hemoglobin 32–36% 32–36% Monocytes 2–10%
concentration
Platelets 150,000–400,000/ 150,000–
mm3 400,000/mm3
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ADV
03White (F)-03 4/6/07 11:18 AM Page 35
35
Chemistry
Sodium (Na ) 137–147 mEq/L
Potassium (K) 3.5–4.8 mEq/L
Chloride (Cl–) 98–105 mEq/L
Carbon dioxide (CO2) 25–33 mEq/L
Blood urea nitrogen (BUN) 7–20 mEq/L
Creatine 0.7–1.3 mg/dL
Total protein 6.3–7.9 gm/dL
Albumin 3.5–5.0 gm/dL
Cholesterol 150–220 mg/dL
Low-density lipoproteins (LDL) 130 mg/dL
High-density lipoproteins (HDL) 30–75 mg/dL
Glucose 70–105 mg/dL
ADV
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Microbiology
Microbiological assessment (bacteriology) is performed on body
fluid/substance samples to determine the cause of infection
(culture) and what antibiotics are effective (sensitivity). Besides
bacteria, samples can be tested for fungi, protozoa, and viruses.
Gram-Positive Common Viruses Common Fungi
Bacteria Influenza virus Aspergillus
Streptococcus Adenovirus Microsporum
Staphylococcus Respiratory syncytial Histoplasma
Mycobacterium virus Blastomyces
tuberculosis Parainfluenza virus Coccidioides
Cytomegalovirus
Gram-Negative
Bacteria
Klebsiella
Haemophilus Common Yeast
influenzae Candida
Legionella
pneumophila
Common
Protozoa
Pneumocystis
carinii
Histology/Cytology
Histology is the study of the microscopic structure of tissue,
whereas cytology is the study of cellular structure.
36
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37
Sample Preparation
Testing Preparation
Microbiology 0.9% saline
Ringer’s lactate
Cytology 95% alcohol
Saccomanno’s solution
Histology Formalin
Skin Testing
■ Skin testing is the diagnosis of disease by subcutaneous
injection of small amounts of protein essence of the organism.
Tuberculosis (TB), coccidioidomycosis, histoplasmosis,
sarcoidosis, and allergies may be diagnosed using this
technique.
■ TB Testing—Skin testing for TB is performed by injecting
0.1 mL of purified protein derivative (PPD) subcutaneously.
The test is read between 48 and 72 hours following injection.
The injection site is evaluated for a wheal and redness,
indicating a positive test.
ADV
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Value Range
pH 7.35–7.45
PaCO2 35–45 mmHg
HCO3 22–26 mEq/L
BE 2
PaO2 80–100 mmHg
To accurately interpret arterial blood gas results, one must first
memorize the normal values. Only after the normal values are
committed to memory can blood gases be interpreted.
Respiratory Disturbances
1. Evaluate the pH. Alkalosis? Acidosis?
2. Evaluate the PaCO2. Is the PaCO2 moving opposite the pH? If
yes, it’s a respiratory acid/base disturbance.
3. If it is a respiratory acidosis, determine if it’s acute or chronic:
■ Acute: If the PaCO2 increases by 10 mmHg the pH should
decrease by 0.08
■ Chronic: If the PaCO2 increases by 10 mmHg the pH should
decrease by 0.03
4. If it is a respiratory alkalosis, determine if it’s acute or chronic:
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39
■ Acute: For each 10 mmHg decrease in PaCO2 the pH should
increase by 0.08
■ Chronic: For each 10 mmHg decrease in PaCO2 the pH
should increase by 0.03
Metabolic Disturbances
1. Evaluate the pH. Alkalosis? Acidosis?
2. Evaluate the PaCO2. Is the PaCO2 moving the same direction
as the pH? If yes, it’s a metabolic acid/base disturbance.
Metabolic Acidosis
If it’s a metabolic acidosis:
1. Determine if it’s an anion gap (AG) acidosis:
■ AG Na (CI HCO3 )
■ Note: The HCO3 must be from an electrolyte panel not the
blood gas data.
■ Normal AG 8 – 12 (2)
■ If the AG is 12 then it’s an anion gap acidosis.
2. Determine the respiratory compensation using Winter’s
Formula.
■ PaCO2 1.5 (HCO3) 8 (2)
■ Note: The HCO3 must be from an electrolyte panel not the
blood gas data.
■ If the PaCO2 is less than expected (Winter’s Formula), there
is a primary respiratory alkalosis.
■ If the PaCO2 is greater than expected (Winter’s Formula),
there is a primary respiratory acidosis.
3. Determine the Delta gap:
■ Corrected HCO3 (HCO3 [AG 12])
■ If the Delta gap is 24 it’s a nonanion gap (AG) acidosis.
■ If the Delta gap is 24 there is a metabolic acidosis.
Metabolic Alkalosis
■ Compensation for metabolic alkalosis is not as linear as in
metabolic acidosis (Note: Don’t use Winter’s Formula!).
■ Compensation will tend to depress the respiratory drive,
increasing the PaCO2.
■ Calculate the expected PaCO2.
■ PaCO2 0.9 (HCO3) 9
■ Note: The HCO3 must be from an electrolyte panel not the
blood gas data.
ADV
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...e lhe deram os vestidos seculares,
que requereu ancioso de proseguir os
actos da sua liberdade por que
suspirava.
Frei Antonio da Piedade—«Espelho de
penitentes», tom. I.
Á
—Á vontade, respondeu Sepulveda, affastando-se um pouco, e
continuando a passeiar.
O ajudante leu com visivel interesse, e a sua physionomia,
durante a leitura, revelava surpreza.
Quando chegou ao fim da carta, mediu com um olhar
perscrutador a pessoa de José Maximo. Tudo o que se estava
passando lhe devia parecer muito extraordinario, porque Frederico
Pinto mostrava-se enleiado, sem atinar com o que havia de dizer.
Felizmente encontrou uma formula dilatoria, que lhe permittiu
tirar-se do embaraço.
—Folgo muito de conhecer o sr. José Maximo, e, como deseja meu
irmão, estou inteiramente ao seu dispôr. Louvo a sua patriotica
resolução, e oxalá que ella possa ser util á salvação do reino. Mas
vossa mercê comprehende que n’este momento não podêmos
alongar-nos n’uma conversação, que lhe aproveite. O meu coronel
está esperando por mim. Ámanhã fallaremos, se me der o prazer de
procurar-me em minha casa. Acolá...
E indicou-lhe o predio em que morava e que José Maximo já aliás
conhecia.
O estudante retirou-se um pouco contrariado. Imaginava elle que
o mesmo seria chegar ao Porto e iniciar-se no segredo das
combinações revolucionarias.
Frederico Pinto contou ao coronel Sepulveda o que acabava de
passar-se. Leu-lhe a carta de frei Simão, accentuando os periodos
que diziam:
«Este moço possue uma alma generosa e heroica. Adivinho n’elle
um homem de acção. Aproveital-o será bem servir a patria. Entrego-
t’o para que o protejas e dirijas.»
Sepulveda riu d’esta inesperada apparição de um rapaz exaltado
até á loucura do heroismo.
—Feliz idade! disse o coronel. Mas desgraçada familia, a quem elle
decerto prepara os grandes desgostos que resultam das
contingencias politicas.
—O que eu não sei é o que lhe hei de dizer! Que vá estudando, é
talvez o melhor conselho que posso dar-lhe. E se elle quizer ficar no
Porto, offerecer-lhe-hei o auxilio que precisar.
—Sim, respondeu Sepulveda muito reflexivo. Mas não me parece
conveniente que o hospéde em sua casa. O rapaz é exaltado, pode
comprometter o hospedeiro. De mais a mais, ninguem tem o dom de
adivinhar ao certo quanto tempo durará ainda a incubação de graves
acontecimentos. E lembre-se o ajudante de que, se o seu casamento
se antecipar, o que é possivel, a presença de um hospede
permanente ser-lhe-ha incommoda.
—Tudo isso me tinha lembrado, coronel, e foi essa a razão de lhe
não offerecer a minha casa.
—Mas, continuou Sepulveda sempre reflexivo, eu hei de fallar
n’este caso ao Fernandes Thomaz. Veremos o que elle diz.
Entretanto o ajudante vá-lhe dizendo que espere, sem lhe dar outras
explicações, que nos possam comprometter.
—De certo, meu coronel. Farei isso.
Aquillo, no Porto, estava ainda muito atrazado. Refiro-me aos
trabalhos preliminares da revolução. Fernandes Thomaz pensava
n’ella; Ferreira Borges tambem. Sepulveda estava disposto a auxiliar
o movimento. Mas não passava tudo ainda de vagos projectos,
descosidos e nublosos.
Comtudo, o coronel, logo que esteve com Fernandes Thomaz,
contou-lhe a historia de José Maximo. Riram ambos com o caso, mas
Fernandes Thomaz, com a sua intuição de revolucionario, acabou
por dizer:
—Quem sabe se o rapaz nos poderá prestar para alguma cousa,
visto que frei Simão o afiança! Veremos.
Trez dias depois, José Maximo escrevia para Cezár a frei Simão. A
sua carta, em cifra, denunciava certo desalento.
«Seu irmão, dizia-lhe elle, recebeu-me muito bem, mas, quanto ao
que nós sabemos, apenas me disse: Espere. E eu estou esperando
que o coração da patria accorde. Ardo na febre da impaciencia, e
receio que ella chegue ao periodo agudo do desespero».
Aproximando-se o natal de 1817, José Maximo consultou Frederico
Pinto sobre se deveria ir, como costumava, passar as ferias em
Cezár. Já o ralavam saudades de Anna de Vasconcellos. E, pelo que
tocava á revolução, não estava menos atormentado, se bem que
Frederico Pinto lhe tivesse dito uma ou outra vez com mais alguma
decisão: «Isto vai indo.»
Que fosse a ferias, aconselhou-lhe d’ahi a dias o alferes ajudante,
para que o tio de Cezár não desconfiasse da sua estada no Porto.
Mas concluiu por dizer-lhe em tom imperativo: «Vossa mercê deve
voltar depois do Natal, porque parece que os seus serviços vão ser
aproveitados.»
Oh! que doida alegria a que estas laconicas e mysteriosas palavras
deram a José Maximo! Ia vêr Anna de Vasconcellos e entrar,
finalmente, nos segredos da conspiração. Sentia-se duas vezes
ditoso. Sob esta agradavel impressão partiu para Cezár.
Uma vez em ferias, tudo se passou como de costume. José
Maximo, de arma ás costas, rodeiava, com disfarce, a casa do
Outeiro, para avistar Anna de Vasconcellos, que perpassava no pateo
de pedra voltado para os campos ou assomava de fugida a alguma
das janellas viradas ao nascente ou passeiava com as irmãs no souto
de Santa Luzia.
N’aquelle tempo Cezár era uma terra morta, muito solitaria. Não a
povoavam, como hoje, prédios garridos, de brazileiros dinheirosos.
As duas torres da egreja, uma sem sinos, pareciam envergonhadas,
em sua modestia, de defrontar-se com as estatuas pretenciosas do
jardim do abbade,—unica pompa evidente em Cezár. O basto
pinheiral da serra do Pinheiro, ao norte, occultava n’uma solidão
melancolica alguns vestigios de construcções celticas, ruinas do
passado. E ao sul, a capellinha alvejante da Senhora da Graça era a
unica nota risonha, que quebrava a monotonia triste do pinheiral,
prolongado e basto.
José Maximo não aguentaria o aborrecimento de Cezár, se a
imagem de Anna de Vasconcellos, vista de longe, não pairasse sobre
toda aquella adormecida solidão de pinheiros e campos de milho,
illuminando-a como uma aurora. Mas forçoso era contentar-se com
isso, vêl-a de longe, a discreta distancia, e com alguma secreta
entrevista que tinha com frei Simão na espessura da serra do
Pinheiro e em que juntos scismavam no que viriam a dar as
mysteriosas combinações revolucionarias do Porto.
Chegado o dia de Reis, José Maximo, ardente de impaciencia,
mandou um adeus escripto a D. Anna de Vasconcellos e partiu.
Ao cabo de algumas semanas de espera no Porto, passado o dia
21 de janeiro de 1818, Frederico Pinto disse-lhe com grande reserva:
—Amanhã, pelas oito horas da noite, vossa mercê irá á casa n.º
32 da rua das Taypas. Subirá cautelosamente até ao primeiro andar,
e ahi baterá quatro pancadas na porta, com os nós dos dedos. Se de
dentro lhe responderem com identico signal, vossa mercê poderá
entrar com plena confiança, porque estará entre amigos, e fará o
que lhe disserem.
José Maximo não dormiu essa noite, nem teve vontade de comer
no dia seguinte.
Dirigindo-se, á hora convencionada, para a rua das Taypas, entrou
na casa que Frederico Pinto lhe indicára, e bateu quatro pancadas
na porta do primeiro andar, com os nós dos dedos. Houve um
momento de silencio e de demora. Mas outras quatro pancadas
responderam de dentro, e a porta abriu-se.
José Maximo, entrando, viu trez homens sentados a uma mesa,
sobre a qual ardia um candieiro de latão com trez bicos. Todos os
trez homens tinham a cara coberta por uma mascara de panno
preto, similhante á dos Farricôcos das procissões de penitencia.
Este apparato de mysterio, em vez de maguar José Maximo,
agradou-lhe, porque lhe deu a impressão de estar n’um club
revolucionario, em exercicio de funcções.
Desde aquelle momento tambem elle era um conspirador.
Convidado a expôr as suas convicções politicas, José Maximo fel-o
com desembaraço, até com exaltação.
Applaudiram-lhe a fé patriotica, propria de corações generosos,
mas recommendaram-lhe discrição e prudencia.
—Tanto mais, disse um dos mascarados, que a missão de que
vossa mercê vae ser encarregado, requer um longo e sabio disfarce.
O nosso unico receio é a pouca idade de vossa mercê, que o pode
fazer cahir em surprezas e armadilhas.
José Maximo replicou com grande energia de caracter que,
qualquer que fosse a missão que lhe incumbissem, saberia
desempenhal-a com tino e perseverança.
Havia nas suas palavras uma rara dedicação partidaria em tão
verdes annos. Sentia-se n’aquelle moço, quasi imberbe, a alma de
um conspirador por vocação.
Um dos mascarados, ouvindo a profissão de fé de José Maximo,
passou a expôr a missão que lhe destinavam.
Precisavam conhecer a maneira de pensar das principaes
auctoridades civis e militares do Porto com relação ao projectado
movimento revolucionario: sondar até que ponto poderiam contar
com a sua tolerancia ou apoio; e sobretudo ser informados com
solicitude do que se fosse passando em casa d’essas auctoridades,
especialmente da qualidade e numero das pessoas que com ellas
tivessem mais demoradas conferencias.
—Para isto, disse um dos mascarados, precisa vossa mercê tomar
um disfarce qualquer, e esse disfarce não poderá deixar de ser o de
uma occupação humilde, que vossa mercê supportará com paciencia
e habilidade. O mais conveniente seria o de serviçal, por se adaptar
melhor ao nosso plano, visto ser pessoa de portas a dentro.
—Obedecerei incondicionalmente, respondeu José Maximo.
O inesperado d’este lance excedia todas as previsões, todos os
seus sonhos de conspirador. A surpresa como que o aturdira por
instantes. Mas um dos mascarados, julgando erradamente que José
Maximo esfriára perante o sacrificio que lhe era exigido, procurou
dissipar-lhe suppostos escrupulos, dizendo:
—Os nossos adversarios auctorisaram pelo exemplo os meios de
que lançamos mão. Pois não é verdade que, na mallograda tentativa
do anno passado, um desembargador, ajudante do intendente geral
de policia, não duvidou introduzir-se no carcere de um dos
conspiradores, o architecto Sousa, para lhe arrancar revelações?
Comtudo nós apenas procuramos o bem da patria; longe está do
nosso animo o perseguir individuos e fazer victimas.
—Todos os meios são bons, quando os fins os justificam,
respondeu resolutamente José Maximo.
—Muito bem! Vossa mercê terá que sahir de tempos a tempos da
casa que o receber como serviçal, para com o maior disfarce ir
relatar á pessoa, que móra no Campo de Santo Ovidio, tudo o que
tiver visto e ouvido. Convem que adopte um nome supposto, e uma
supposta naturalidade. Pode vossa mercê dizer-se nascido no
Alemtejo. Quanto ao nome, poderá ser Manuel... Manuel...
—Do Nascimento, atalhou um dos outros mascarados. Ficará
vossa mercê uzando o sobrenome e o appellido de uma famosa
victima da inquisição, o illustre Filinto Elysio.
—Mas convém que nós assentemos no seu nome de guerra para,
no caso de qualquer occorrencia desagradavel, sabermos que vossa
mercê e Manuel do Nascimento, por exemplo, são uma e a mesma
pessoa.
—Serei pois Manuel do Nascimento, respondeu José Maximo, e
natural do Alemtejo. O resto é comigo, e supponho que vossas
senhorias não terão motivo para arrepender-se.
—Assim o esperamos. Vossa mercê, segundo o nosso plano, terá
que estacionar em varias casas, taes como a do governador das
justiças, juiz de fôra do civel e presidente do senado, mas por agora
importa que vá offerecer-se á do governador das armas, o tenente-
general Filippe de Sousa Canavarro, que precisa de um serviçal,
segundo noticia que temos. Como decerto lhe serão exigidas
abonações, vossa mercê indicará João Pereira da Costa, seu antigo
patrão, residente em Beja, negociante e proprietario, como pessoa
competente para informar sobre seus costumes. O governador
mandará decerto escrever para Beja, e de Beja lhe responderão
satisfatoriamente. Isso é comnosco.
Pouco tempo durou a audiencia.
José Maximo, feliz por poder prestar um serviço á causa da
liberdade, sahiu da casa da rua das Taypas e foi passeiar para o
Campo da Cordoaria, muito ufano de si pela confiança que n’elle
depositava o club revolucionario do Porto.
Ora esse club não representava por então senão o pacto secreto
de trez patriotas, que tantos eram os mascarados, a saber:
Fernandes Thomaz, Ferreira Borges e Silva Carvalho.
Eis o nucleo do famoso Synhedrio, que planeou a revolução liberal
do Porto.
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