Quiz 9 Flashcards
Lower lung?
Dependent
Upper lung?
Non-dependent
Axillary roll placed on _________, NOT in the _______.
upper chest wall
axilla
In the ___________ position the dependent lung is better ______ & ________ During ________?
awake & lateral
perfused (gravity) & ventilated
V/Q mismatch
________________ favors the upper lung because it is more compliant in
Positive pressure ventilation
In an ______________ upper lung is not ventilated but is still perfusing (although less than dependent lung), this causes a large _______ intrapulmonary shunt (20-30%)
Open Pneumothorax
right to left
Factors that inhibit hypoxic pulmonary vasoconstriction?
- Hypocapnia
- Vasodilators: nitroglycerin (NTG), nitroprusside (SNP), b-adrenegic agonists (dobutamine), calcium channel blockers
- Inhalation agents
During apnea: PCO2 increases ______ for the first minute and then ______ for each additional minute of apnea
5mmHg
3mmHg
Measures for one lung ventilation if getting hypoxic
- FIO2 of 0.8 to 1.0
- Fiberoptic scope to ensure proper ETT placement
- 10cc/Kg, suction ETT
- Adjust RR to keep PaCO2 at 40mmHg
- Add 5cm H2O CPAP to nondependent lung – warn surgeon
- Add 5cm H2O PEEP to dependent lung – tx’s atelectasis but may increase vascular resistance
- Increase both CPAP and PEEP slowly
- Ask surgeon to clamp or ligate nondependent PA
- Return to two lung ventilation always an option
which double lumen tube is easier to place?
Left
What will labs be during MH?
- myoglobinuria
- initial metabolic acidosis then a combined metabolic & respiratory acidosis
- creatinine kinase (CK) > 1000 IU
- hyperkalemia
- hypercalcemia
- hyperphosphatemia
- hypoxemia
S/S MH?
- Tachycardia
- Increased ETCO2 (2-3x)
- decrease in SaO2 & SpO2
- rigidity despite muscle relaxant onboard
- dysrhythmias
- tachypnea
- cyanosis
- sweating
- unstable BP
- mottling of skin
- trismus (masseter spasm) after succinylcholine
- darkening of blood in surgical field
- decreased mixed venous saturation
- cola-colored urine
- heating and exhaustion of CO2 absorber
- hyperthermia (up to 2 degrees C per hour)
Treat hyperkalemia from MH with?
-Bicarb
or
-Dextrose (25-50g) and insulin (10-20 units)
Continue dantrolene how long and dose?
1 mg/Kg IV Q6hrs for 72 hrs to prevent a recurrence
What should not be given while on dantrolene due to life-threatening hyperkalemia and myocardial depression that may occur
Ca-channel blockers
