Emergency Procedures

Question 1

Respiratory Acidosis indicates what two features in the patient?

Answer 1

Hypoventilation and hypoxemia

Question 2

What is the preferred sample type when evaluating respiratory status?

Answer 2

Arterial sample, however venous blood samples are helpful to evaluate the status of the patient at the cellular level.

Question 3

What are physiological consequences of respiratory acidosis?

Answer 3

Sympathetic activation, increased cardiac output, tachyarrhythmias. As PaCO2 increases, intracranial pressure and cerebral blood flow increases.

Question 4

What could you see clinically in patients with extremely high PaCO2 levels (60-70 mmHg)?

Answer 4

Disorientation, narcosis, and coma

Question 5

Causes of respiratory acidosis include what?

Answer 5

Depression of the respiratory center
Neuromuscular disease
Obstruction of large airways

Question 6

One of the causes of respiratory acidosis is depression of the respiratory center, what things are associated with this?

Answer 6

Medications (inhalant anesthesia, opioids, barbiturates)

Neurologic disease: cervical spinal cord lesion, brainstem lesion

Question 7

One of the causes of respiratory acidosis is neuromuscular disease, what things are associated with this?

Answer 7

MG, botulism, tetanus, tick paralysis, severe hypokalemia, organophosphates, aminoglycosides

Question 8

One of the causes of respiratory acidosis is obstruction of large airways, what things are associated with this?

Answer 8

Aspiration, kinked, or plugged ET tube, Tracheal collapse, brachycephalic syndrome, laryngeal paralysis, mass lesions, infiltrative lower airway disease (COPD, asthma)

Question 9

Primary treatment modality of respiratory acidosis is what?

Answer 9

Ventilation, oxygen, establishment of airway, reversals of drugs

Question 10

Key features of a respiratory acidosis?

Answer 10

pH low, PCO2 high, HCO3 High or Normal

Question 11

Key features of a respiratory alkalosis?

Answer 11

pH high, PCO2 low, HCO3 low or Normal

Question 12

Key features of a metabolic acidosis?

Answer 12

pH low, PCO2 low, HCO3 low

Question 13

Key features of a metabolic alkalosis?

Answer 13

pH high, PCO2 high, HCO3 high

Question 14

What does a respiratory alkalosis (hypocapnia) indicate?

Answer 14

hyperventilation

Question 15

During a respiratory alkalosis at what point does vasoconstriction occur?

Answer 15

PaCO2 decreases to less than 25 mmHg and when arterial pH increases to 7.6

This results in a reduction in myocardial and cerebral blood flow.

Question 16

Causes of respiratory alkalosis?

Answer 16

Fear, excitement, anxiety or pain
Hyperventilation (either by the patient or by mechanical ventilation)
Diseases such as pneumonia, pulmonary edema, pulmonary fibrosis, pulmonary thromboembolism
CHF
Severe anemia
Hypotension
Hepatic disease
Cushings
Heat stroke
sepsis

Question 17

What is treatment aimed at during respiratory alkalosis?

Answer 17

decreasing fear or anxiety
decreases mechanical ventilation
correcting hypoxemia

Question 18

Causes of metabolic acidosis?

Answer 18

EG, salicylate, lactic acidosis, DKA
Dilutional acidosis (increased free water associated with hyponatremia)
Hyperchloremic acidosis: renal failure, Addisons, diarrhea
Hyperphosphatemic acidosis: renal failure, urethral obstruction. uroabdomen

Question 19

Causes of metabolic Alkalosis?

Answer 19

hypochloremic alkalosis: vomiting of stomach contents, administration of loop diuretics, thiazides
Concentration of alkalosis from pure water loss, associated with hypernatremia- water deprivation, vomiting or diarrhea
Low albumin: PLE, PLN, hepatic failure

Question 20

What are the five causes of hypoxemia?

Answer 20

Hypoventilation
Decreased partial pressure of inspired oxygen
Ventilation (perfusion mismatch V/Q mismatch)
Diffusion impairment
Right to left shunt

Question 21

Examples of hypoventilation?

Answer 21

Cervical spinal cord lesion above the 5th cerical vertebrae or brainstem lesion
Tetnaus, botulism, tick paralysis, polyradiculoneuroritis, MG,
Inhalants
Fractured ribs, flail chest, pleural space disease
Aspiration, brachycephalic syndrome, tracheal collapse, largyneal paralysis, mass, plugged ET tube

Question 22

Causes of decreased partial pressure of inspired oxygen (FiO2)?

Answer 22

High altitude,

Inadequate minute ventilation, failure of CO2 filter

Question 23

Causes of ventilation issues - perfusion mismatch?

Answer 23

Asthma, bronchitis, COPD, PE

Question 24

Causees of diffusion impairments?

Answer 24

diffuse pulmonary interstitial disease, vasculitis, emphysema, pneumoina, severe pulmonary edema

Question 25

Causes of right to left shunts?

Answer 25

Atelectasis

Anatomic shunt with right to left blood flow (PDA, ventricular septal defect, atrial septal defect, tetrology of fallot