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Apex Review > Respiratory pathophysiology 4 > Flashcards

Respiratory pathophysiology 4 Flashcards

1
Q

The Haldane effect describes how the

A

oxygen tension in the blood determines the blood’s ability to buffer CO2

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2
Q

Inhibition of hypoxic pulmonary vasoconstriction increases

A

both shunt and dead space; increased dead space diminishes CO2 excretion and manifests as hypercapnia

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3
Q

Identify the MOST appropriate strategy for mechanical ventilation in the patient with COPD.
a. I:E ratio 1:1
b. FiO2 <50%
c. Respiratory rate 7 breaths per minute
d. tidal volume 10-12 mL/kg

A

c. respiratory rate 7 breaths per minute
(a way to increase the expiratory time? per Apex)

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4
Q

For patients with COPD, always consider _____ for procedures involving the extremities and the lower abdomen.

A

regional anesthesia

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5
Q

For COPD patients, do not consider neuraxial anesthesia if the patient requires sensory blockade >

A

T6

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6
Q

This block should be avoided in patients with COPD.

A

interscalene blockade b/c it causes paralysis of the ipsilateral hemidiaphragm

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7
Q

For patients with COPD receiving regional anesthesia, be careful of

A

excessive sedation and ventilatory depression

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8
Q

What gas should be avoided for patients with COPD?

A

nitrous oxide is associated with rupture of pulmonary blebs–> pneumothorax

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9
Q

Volatile agents impair

A

hypoxic pulmonary vasoconstriction (>1.5 MAC) and increase shunt
unless shunt is severe, it can be overcome by increasing FiO2

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10
Q

For patients with COPD, select a volatile agent with

A

a low blood:gas solubility

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11
Q

All halogenated anesthetics are

A

bronchodilators (sevo and iso are better than des)

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12
Q

Key considerations for mechanical ventilation of the COPD patient:

A

use a tidal volume of 6-8 mL/kg IBW
use a longer expiratory time
add PEEP (stay alert for dynamic hyperinflation)
slow inspiratory flow

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13
Q

Atelectasis is exacerbated by

A

muscle relaxants and longer surgeries

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14
Q

A patient with COPD is double stacking. Which interventions will improve this patient’s condition? (select 2)
a. increase inspiratory time
b. decrease respiratory rate
c. disconnect the circuit
d. increase inspiratory flow

A

b. decrease respiratory rate
c. disconnect the circuit

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15
Q

Dynamic hyperinflation occurs when a

A

new breath is given before the patient was able to exhale the previous breath fully
this is also known as breath stacking

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16
Q

Risk factors for dynamic hyperinflation include

A

high minute ventilation
increased airway resistance
reduced expiratory flow (such as COPD)

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17
Q

Consequences of dynamic hyperinflation include

A

barotrauma
pneumothorax
hypotension

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18
Q

Treatment of dynamic hyperinflation (auto-PEEP) includes

A

removing the patient from the breathing circuit to allow for the pressure in the lungs to equalize with the atmospheric pressure
prolong expiratory time (increasing I:E ration, reduce RR, reduce flow resistance by using a larger diameter ETT & frequent suctioning if needed)

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19
Q

What can lead to increased airway resistance?

A

secretions
obstructed ETT
fighting the ventilator

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20
Q

Factors that reduce expiratory flow include

A

bronchoconstriction
airway collapse
inflammation

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21
Q

How can the cardiac system be impacted from auto peep?

A

impaired venous return
hypotension
overestimation of CVP & PAOP

22
Q

All of the following are examples of restrictive lung disease EXCEPT:
a. sarcoidosis
b. cystic fibrosis
c. negative pressure pulmonary edema
d. flail chest

A

b. cystic fibrosis

23
Q

Restrictive lung disease is an umbrella term for

A

a collection of disorders that impair normal lung expansion during inspiration

24
Q

Areas of restriction include the

A

pulmonary interstitium
pleura
rib cage
and/or abdomen

25
Q

Categories of restrictive ventilatory defects include:

A

acute intrinsic
chronic intrinsic
disease of the chest wall, mediastinum, & pleura
other

26
Q

What are examples of acute intrinsic disorders that cause restrictive disease?

A

aspiration
upper airway obstruction

27
Q

What are examples chronic intrinsic disorders that cause restrictive disease?

A

sarcoidosis
amiodarone-induced pulmonary fibrosis

28
Q

Restrictive ventilatory diseases of the chest wall, mediastinum, and pleura include

A

flail chest
pleural effusion
ankylosing spondylitis

29
Q

Other examples of restrictive ventilatory defects include

A

pregnancy
obesity
ascites

30
Q

_________________ is diagnostic for restrictive lung disease

A

A FEV1 and FVC <70%
- the FEV1/FVC ratio is unchanged

31
Q

One of the most significant risks of RLD is

A

barotrauma

32
Q

The best ventilatory strategies for RLD include

A

tidal volume= 6 mL/kg IBW
RR= 14-18 breaths/min
PIP <30 cmH2O
I:E ratio= 1:1

33
Q

Characteristics of restrictive lung disease include

A

decreased lung volumes and capacities
decreased compliance
intact pulmonary flow rates

34
Q

Patients with RLD have reduced ______________ making them more prone to _________________

A

FRC; rapid arterial desaturation

35
Q

All of the following reduce the incidence of ventilator-associated pneumonia EXCEPT:
a. oropharyngeal decontamination
b. minimizing the duration of mechanical ventilation
c. limiting sedation
d. proton pump inhibitors

A

d. proton pump inhibitors

36
Q

Aspiration most commonly occurs during

A

anesthetic induction and intubation or within 5 minutes of extubation

37
Q

Aspiration can lead to

A

airway obstruction, bronchospasm, impaired gas exchange, and bacterial respiratory infection

38
Q

Risk factors for aspiration pneumonitis include

A

pregnancy
trauma
emergency surgery
GI obstruction
GERD
PUD
hiatal hernia
ascites
difficult airway management
cricoid pressure
impaired airway reflexes
seizures
residual neuromuscular blockade

39
Q

Mendelson’s syndrome is a

A

chemical aspiration pneumonitis that was first described in OB patients receiving inhalation anesthesia

40
Q

Risk factors for Mendelson’s syndrome include

A

Gastric pH <2.5
Gastric volume >25 mL (0.4 mL/kg)

41
Q

Pharmacologic prophylaxis to prevent aspiration includes

A

antacids
H2 antagonists
GI stimulants
Proton pump inhibitors
antiemetics

42
Q

Signs and symptoms of aspiration icnlude

A

hypoxemia (hallmark sign)
dyspnea
tachypnea
cyanosis

43
Q

Primary treatment of aspiration includes

A

tilting the head downward (or to the side)
suctioning the upper airway
securing the airway (if indicated)
applying PEEP

44
Q

Patients who aspirate must be observed

A

in the PACU

45
Q

A patient can be safely discharged to home if they do NOT experience any of the following within ________ of the aspiration event:

A

two hours
new cough or wheeze, radiographic evidence of pulmonary injury
A-a gradient >300 mmHg
SpO2 decrease >10% of preoperative values on room air

46
Q

The best method to prevent ventilator associated pneumonia is to

A

avoid intubation all together
minimize the duration of mechanical ventilation

47
Q

Aspiration causes three potential problems:

A

gastric contents enter the airway
gastric contents cause a chemical burn to the airway & lung parenchyma
infectious material enters the airway

48
Q

What is the result of gastric contents entering the airway?

A

risk of airway obstruction

49
Q

What is the result of gastric contents causing a chemical burn to the airway and lung parenchyma?

A

risk of bronchospasm and impaired gas exchange

50
Q

What is the result of infectious material entering the airway?

A

bacterial infection (not all aspiration leads to infection)

51
Q

Routine use of pharmacologic prophylaxis for patients NOT at risk for aspiration is

A

NOT recommended

52
Q

_____________ to reduce the risk of aspiration is NOT recommended

A

anticholinergics

Apex Review (224 decks)

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