Question

1)

A. What is the dicrotic notch from the pulmonary artery catheter wave line?

B. What does nitric oxide do for a mechanically ventilated patient?

C.

When a COPD patient leans forward braced in  ______________________________, this lends particular advantage to the pectoralis accessory muscles of inspiration?

a- an anterior-posterior position
b- a tripod position
c- a prone position
d- a supine position

Answer 1

A. Dicrotic notch represents the closure of aortic valve.It is a downward deflection in the pressure contour .This causes immediate closure of the semilunar valves.This is sometimes used in the ejection period.Sometimes in pulmonary trunk and in aorta the blood flows back towards the heart,and when the blood pressure is traced a small dicriotic notch can be seen.With the increasing age the aorta stiffens and the elasticity will decrease.Therefore the notch may be less and arise perfusing coronary arteries.

B . Nitric acid provide selective pulmonary vasodialation in ventillated lungs and reduce the  pulmonary hypertension and elevated pulmonary vascular resistance.

c When a COPD patient leans forward braced in a tripod position ,this lends particular advantage to the pectoralis accessory muscles of inspiration.

In tripod position,the patient is sitting and leaning forward.The hands should be outstretched on their knees.The forward leaning helps helps by compressing abdominal contents and flattened diaphragm upwards helps in restoring the dome shaped appearance of diaphragm..It improves the trachoabdominal movement.This position is the optimum position for the cOPD patients to generate maximum inspiratory pressure and thus by obtaining relief from dyspnoea.