Monday, September 28, 2009


  • Formulating a clinical impression from physical assessment of the lungs and thorax is a complex task. It does not lend itself to “simplification”.
  • This chart is not intended to be a comprehensive table of pathophysiology of the lungs and thorax but as a tool to illustrate patterns of pulmonary abnormalities.
  • You may use the nonsense word/acronym I.P.A.P.i.c. to recall the categories of assessment.
  • Pulmonary abnormalities are often considered:
    Obstructive, Restrictive or Mixed Obstructive & Restrictive
    They can also be considered:
    Parenchymal, Extraparenchymal or Mixed
Click on the table below to enlarge.


Sunday, July 5, 2009


Signs for High Index of Suspicion of Chronic Obstructive Pulmonary Disease (COPD)
  1. 1) Shortness of breath on exertion.
  2. 2) More than a 10 pack/year history of cigarette smoking.
  3. 3) More than 40 years old.

Category: COPD - ACRONYM

Monday, June 22, 2009

Category: Pulmonary Function - FLOWCHART

FVC, a Tool You Can Use.

  • Formulating a clinical impression of a Forced Vital Capacity (FVC) maneuver is a high level task. It does not lend itself to “simplification”.
  • The intention of the algorithm below is to provide an organized method to review and use the FVC and to assist the practitioner in determining appropriate care. (Not formulate a comprehensive interpretation)

    Click on the algorithm image to enlarge.

Tuesday, June 2, 2009

Category: Physical Assessment - ACRONYM

The 5 W's, Causes of Post-Op Fever

  • Wind: the lungs (the most common in the 1st 48 hrs)
  • Wound: infection at the surgical site
  • Water: phlebitis at intravenous access
  • Walk: deep venous thrombosis
  • Whiz: urinary tract infection
The 5 most frequent to Worry about.

Category: Inhaled Medication - RHYMES & SONGS

Wednesday, May 13, 2009

Category: Smart phone and PDA - TECHNOLOGY

The two healthcare resources I find myself using most consistently on my ectopic brain (a.k.a. my PDA /Smart phone) are ePocrates and MedCalc. My earlier recommendations of these excellent portable memory expanders on the Palm and Windows Mobile operating systems still stands, with this addition.
If you are an iPhone or iTouch user the excellent characteristics of these programs shine on Apples portable systems.

Sunday, March 15, 2009

Category: Blood Gas - ACRONYM

The directions pH and HCO3 move with Alkalosis vs. Acidosis:

  • Respiratory move Opposite: pH is up, PCO2 is down (Alkalosis). pH is down, PCO2 is up (Acidosis).
  • Metabolic move Equal: pH is up, HCO3 is up (Alkalosis). pH is down, HCO3 is down(Acidosis).

Monday, March 2, 2009

Healthcare Education is stressful.
Memory tools don’t necessarily make learning fun but can add some lightheartedness to study time.

Category: Inhaled Medication - RHYMES & SONGS

End in ide or end in sone
Always an inhaled steroid.
  • budesonide
  • ciclesonide
  • flunisolide
  • beclomethasone
  • fluticasone
  • triamcinolone

Sunday, February 8, 2009

Category: Physical Assessment - BUNCHING

Recalling the “Mid-range Normal” of the primary Hematology TestsUsing multiples of 3
  • Red Blood Cell Count (RBC) “Mid-range Normalis approximately 5
  • Hemoglobin (Hgb) “Mid-range Normalis approximately 5 x 3 = 15
  • Hematocrit (Hct) “Mid-range Normalis approximately 15 x 3 = 45
Consult a lab resource for the actual normal range of pediatric, female and male values.

Sunday, January 18, 2009

Category: Smart phone and PDA - TECHNOLOGY

Medcalc is still my "go-to" freeware medical calculator, and for my needs is still is the best.
A complimentary alternative free calculator is Archimedes from Skyscape.
Skyscape is a leader in mobile medical information. Their huge catalogue of "for sale" and some free specialty content is impressive.

Category: Airway - ACRONYM

Describing Clinical Characteristics of a Tracheotomy Tube
Airway lumens
a) Single lumen
b) Dual lumen
c) Is connecting adaptor (15mmOD) removed with inner cannula out?

Brand & Composition
a) Company of manufacture
b) Metal – stainless steel, silver
c) Plastic – PVC, silicone

a) Cuffed or not cuffed
b) Inflated or deflated
c) Characteristics of the cuff (high vol low press, low vol high press, foam)

Diameter and Dimensions of tube
a) Inner diameter (I.D.)
b) Outer diameter (O.D.)
c) Length of tube (standard, short or long length)

a) Fenestration open
b) Fenestration closed
c) Position and construction of fenestration

Wednesday, January 7, 2009

Category: Quiting Smoking - BUNCHING

When You Quit Smoking — Health Benefits, pointing out the positive.
  • Around 20 minutes after quitting: Your heart rate and blood pressure begins to drop.
  • Around 20 hours after quitting: The carbon monoxide level in your blood drops to near normal.
  • Around 20 days after quitting: Your circulation improves. Coughing and shortness of breath decrease. Cilia (tiny hair-like structures that move mucus out of the lungs) begin to regain function, increasing their ability to clean the lungs.
  • Around 20 weeks after quitting: Your risk of heart disease begins to drop.
  • Around 200 weeks after quitting: Your stroke risk as well as cancer risk begins to drop.

Thursday, January 1, 2009

Category: Medication - BUNCHING

Helping Patients With the Change to H.F.A. Metered Dose Inhalers (MDI)
Teaching Points for administration of the new HFA MDI:
  1. HFA inhalers require multiple priming sprays, periodic cleaning of the actuator boot, and longer agitation prior to first use and when unused for a number of days. Refer to the package insert with each individual MDI for specific recommendations.

  2. HFA inhalers have substantially less taste. Patients associated the bitter taste of CFC powered MDIs with effectiveness and the relief of symptoms.

  3. HFA inhalers create a lower plume velocity, which results in less oral and pharyngeal deposition. Patients associated the more vigorous spray of CFC powered MDIs with relief of symptoms and effectiveness.
  1. Metered Dose Inhaler (MDI): A small pressurized metal canister in a plastic actuator that releases a mist of medicine to inhale when pressed.

  2. Chlorofluorocarbon (CFC): A fluorocarbon with chlorine; formerly used as a refrigerant and as a propellant.

  3. Hydroflouroalkane (HFA): The new alternative propellant created to replace CFCs, and the standard for MDIs starting in 2009.