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Apex Review > Respiratory pathophysiology 6 > Flashcards

Respiratory pathophysiology 6 Flashcards

1
Q

A patient with pulmonary hypertension develops tricuspid regurgitation. Which treatments will MOST likely improve this patient’s condition? select 3
a. hypothermia
b. nitric oxide
c. nitroglycerine
d. nitrous oxide
e. PEEP
f. hyperventilation

A

b. nitric oxide
c. nitroglycerine
f. hyperventilation

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2
Q

Pulmonary artery hypertension is defined as a

A

mean PAP >25 mmHg

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3
Q

______________________ increases as a function of increased vascular smooth muscle tone, vascular cell proliferation, and/or pulmonary thrombi

A

Pulmonary vascular resistance

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4
Q

With pulmonary hypertension avoid conditions that

A

increase PVR

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5
Q

Conditions that increase PVR include

A

hypoxemia
hypercarbia
acidosis
hypothermia

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6
Q

Pulmonary hypertension increases ___________ workload, and this can progress to

A

right ventricular workload; RV failure (cor pulmonale)

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7
Q

With pulmonary hypertension should preoperative medications that reduce PVR be held?

A

no

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8
Q

Patients with pulmonary hypertension can be sensitive to ______________ as cardiac output is relatively fixed

A

inadequate preload

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9
Q

_________ should be treated aggressively in pulmonary hypertension

A

hypotension

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10
Q

___________ is better tolerated than ______________ anesthesia in pulmonary hypertension

A

Epidural anesthesia is better than spinal

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11
Q

Ventilation strategies for pulmonary hypertension include

A

inhaled nitric oxide
high-frequency jet ventilation

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12
Q

Another consequence of decreased RV stroke volume in pHTN is an increased RV volume at the end of diastole. This leads to

A

tricuspid regurgitation

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13
Q

Causes of pulmonary hypertension include

A

COPD
hypoxemia & hypercarbia
left heart dysfunction
mitral valve disease
congenital heart disease
connective tissue disorders
chronic thromboembolism
portal hypertension

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14
Q

Normal pulmonary vascular resistance is

A

150-250 dynes/sec/cm

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15
Q

Things that lead to increased PVR:

A

hypoxemia
hypercarbia
acidosis
SNS stimulation
Pain
Hypothermia

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16
Q

Drugs that lead to increased PVR:

A

nitrous oxide
ketamine
desflurane

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17
Q

Ventilatory effects that lead to increased PVR:

A

increased intrathoracic pressure
mechanical ventilation
PEEP
atelectasis

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18
Q

Things that lead to decreased PVR:

A

increased PaO2
hypocarbia
alkalosis

19
Q

Drugs that lead to decreased PVR:

A

inhaled nitric oxide
nitroglycerin
phosphodiesterase inhibitors (sildenafil)
prostaglandins PGE1 & PGI1
calcium channel blockers
ACE inhibitors

20
Q

Ventilation effects that lead to decreased PVR:

A

decreased intrathoracic pressure
spontaneous ventilation
preventing coughing/straining

21
Q

Elevated RA pressure can open the

A

foramen ovale, leading to a right to left intracardiac shunt

22
Q

If the pHTN patient experiences decreased SVR give

A

vasopressors

23
Q

If the pHTN patient experiences loss of atrial kick, give

A

NSR

24
Q

If the pHTN patient experiences increased PVR or RV failure, give

A

inhaled nitric oxide or iloprost

25
Q

What is the equation for PVR?

A

PVR= (mean PAP-PAOP) x 80/ CO

26
Q

Carbon monoxide:
a. shifts the oxyhemoglobin dissociation curve to the right
b. production is highest with isoflurane
c. binds to the oxygen binding site on hemoglobin with an affinity 200 times that of of oxygen
d. poisoning is reversed with methylene blue

A

c. binds to the oxygen binding site on hemoglobin with an affinity 200 x that of oxygen

27
Q

Carbon monoxide displaces __________________ which reduces

A

O2 from hemoglobin which reduces CaO2

28
Q

Carbon monoxide shifts the oxyhemoglobin dissociation curve

A

to the left, further starving tissues of oxygen

29
Q

Patients at risk for carboxyhemoglobinemia include

A

burn victims, smokers, and patients exposed to desiccated soda lime

30
Q

A ________ does not measure CoHgb and may give a falsely _________ result

A

pulse oximeter; elevated

31
Q

A __________________ is required to diagnose carboxyhemoglobinemia

A

co-oximeter

32
Q

The treatment for carboxyhemoglobinemia is

A

oxygen administration; hyperbaric oxygen therapy may be required

33
Q

When soda lime is desiccated, the risk of carbon monoxide formation is greatest with

A

desflurane (desflurane>isoflurane»» sevoflurane)

34
Q

Carbon monoxide poisoning leads to

A

metabolic acidosis

35
Q

Patients with carbon monoxide poisoning appearance:

A

cherry red appearance
(don’t become cyanotic)

36
Q

Hyperbaric oxygen is indicated if CoHgb exceeds what percent of total hemoglobin?

A

25%

37
Q

100% O2 should be administered until the CoHgb is less than:

A

5%

38
Q

Identify the strongest indications for intubation and mechanical ventilation. (select 2):
a. PaCO2 >60 mmHg
b. Vital capacity 25 mL/kg
c. inspiratory force <25 cm H2O
d. respiratory rate 35 breaths per minute

A

a. PaCO2 >60 mmHg
c. Inspiratory force <25 cmH2O

39
Q

Benefits of tracheal intubation include:

A

a patent airway
controlled ventilation
ventilation with high airway pressure
secured airway (protection from gastric aspiration)
removal of secretions
lung isolation
medication administration

40
Q

Strong indications for mechanical ventilation include:

A

vital capacity <15 mL/kg
inspiratory force <25 cm/H2O
PaOP <200 mmHg (on 100% FiO2)
A-a gradient >450 mmHg (on 100% FiO2
PaCO2 >60 mmHg
RR >40 or < 6 bpm

41
Q

What drugs can be administered down the ETT?

A

NAVEL
narcan, atropine, vasopressin, epinephrine, lidocaine

42
Q

Subjective signs of respiratory distress include

A

dyspnea
accessory muscle use
anxiety and restlessness
SNS stimulation (pupil dilation, diaphoresis)
mouth breathing during inspiratory efforts
lip cyanosis
pursed lip breathing or self-PEEP

43
Q

Identify the absolute indications for one-lung ventilation. (select 2)
a. esophageal resection
b. bronchopleural fistula
c. pulmonary infection
d. thoracic aortic aneurysm repair

A

b. bronchopleural fistula
c. pulmonary infection

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