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BDS4 Sedation > Applied Physiology for Sedation > Flashcards

Applied Physiology for Sedation Flashcards

1
Q

What is used for quiet breathing?

A

the diaphragm

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1
Q

What is used for more forceful breathing?

A
  • intercostal muscles
  • accessory muscles
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2
Q

Describe the basics of breathing mechanics

A
  • inspiratory muscles contract
  • thoracic volume increases
  • thoracic pressure decreses
  • air pushed in along pressure gradient
  • expiration is passive
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3
Q

Describe the way in which airflow is driven by pressure gradients

A
  • alveolar pressure > atmospheric pressure
    • inspiration
  • alveolar pressure < atmospheric pressure
    • expiration
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4
Q

What is tidal volume?

A

the volume of air moving in and out of the lung during quiet breathing

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5
Q

What is inspiratory reserve volume?

A

the maximum intake volume of air and the extra reserve of air in

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6
Q

What is the expiratory reserve volume?

A

the maximum expired volume of air and the extra reserve of air out

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7
Q

What is the residual volume?

A

the volume of air left in the lung after maximum expiration

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8
Q

What is the vital capacity?

A

the sum of all of the moving volumes of air

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9
Q

What is total lung capacity?

A

vital capacity and residual capacity

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10
Q

How do restrictive conditions affect expiratory airflow?

A
  • reduced vital capacity
  • VC is close to FEV1
  • small volumes exchanged
  • similar rate to normal patient
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11
Q

What is FEV1?

A
  • forces expiratory volume in one second
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12
Q

How do obstructive conditions affect respiratory airflow?

A
  • reduced vital capacity
  • slow exchange of inspiration and expiration
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13
Q

What parts of the lungs make up the conducting zone and what does it mean?

A
  • trachea, bronchi, terminal bronchiole
  • no gas exchange
  • anatomical dead space
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14
Q

What parts of the lung make up the respiratory zone and what does it mean?

A
  • respiratory bronchiole, alveolar duct, alveolar sac
  • region of gas exchange
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15
Q

What is the average tidal volume?

A

450ml

  • 150ml dead space
  • 300ml fresh air
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16
Q

How does pulmonary gas exchange occur?

A
  • gas exchange occurs between the alveolar air and the pulmonary capillary blood
  • gases move across alveolar wall by diffusion
  • diffusion is determined by partial pressure gradients
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17
Q

What is ventilation?

A

the amount of gases passing in the lung

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18
Q

What is perfusion?

A

the amount of gases in pulmonary circulation

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19
Q

Where in the lung are ventilation and perfusion the greatest?

A

the base of the lung

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20
Q

What substance is most important for oxygen transport?

A

haemoglobin

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21
Q

Describe the structure of haemoglobin

A
  • globular protein
    • 200-300 per red blood cell
  • 2 alpha and 2 beta protein chains
    • metalloprotein
  • 4 haem groups
    • porphyrin ring
    • iron atom
  • iron reversibly binds to oxygen
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22
Q

How is oxygen transported?

A
  • mostly attached to haemoglobin
    • 97%
  • some dissolved in plasma
    • 3%
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23
Q

What does increasing the partial pressure of oxygen do to oxygen transport?

A
  • minimal change to oxygen bound to haemoglobin
  • amount dissolved increases proportional to partial pressure of oxygen
    • essentially excess oxygen dissolved
24
Q

When does haemoglobin have the greatest affinity for oxygen?

A
  • greatest affinity is at reduced oxygen saturations
25
Q

What factors increase the affinity of haemoglobin for oxygen?

A
  • decreased temperature
    • hypothermia
  • increased pH
    • alkalosis
  • easier to harvest oxygen in the lung but harder to give oxygen to tissues
26
Q

What factors decrease the affinity of haemoglobin for oxygen?

A
  • increased temperature
  • acidosis
  • increased 2,3 DPG
    • alternative by-product of glycolysis
    • involved in feedback loop
      • prevent hypoxia
27
Q

When dully saturated, how many ml of oxygen does a gram of haemoglobin carry?

A

1.34ml

28
Q

How is carbon dioxide transported?

A
  • bicarbonate ions
    • 70%
  • carbamino compounds
    • 20%
  • dissolved CO2
    • 10%
29
Q

How is breathing controlled?

A
  • voluntary skeletal breathing muscles
  • automatic process
  • rhythm generated by respiratory centres in the brain
  • basic rhythm modified by signals from sensory receptors
30
Q

What can act positively on respiratory centres?

A
  • peripheral (arterial chemoreceptors)
    • reduced oxygen pressure
    • increased carbon dioxide pressure
  • cerebral cortex
  • central chemoreceptors
    • decreased pH
    • increased carbon dioxide pressure (CSF)
  • joint and muscle receptors
    • movement
31
Q

What can act negatively on respiratory centres?

A
  • lung stretch receptors
    • inflation
32
Q

What is hypoxic hypoxia?

A

reduced oxygen delivery tissues due to:

  • reduced oxygen reaching alveoli
  • reduced oxygen diffusion into blood
33
Q

What is anaemic hypoxia?

A

reduced oxygen delivery tissues due to:

  • reduced oxygen transport in blood
    • low haemoglobin
      • e.g. CO poisoning
34
Q

What is stagnant/ischaemic hypoxia?

A

reduced oxygen delivery tissues due to:

  • reduced oxygen transport in blood
    • low blood flow
35
Q

What is cytotoxic hypoxia?

A

reduced oxygen delivery tissues due to:

  • reduced oxygen utilisation by cells
36
Q

What is cyanosis?

A
  • blue coloration of skin and mucous membranes
  • due to >5mg deoxygenated Hb in a litre of blood
    • 1/3 of normal (15gm Hb)
  • 2 forms
    • central
    • peripheral
37
Q

What is central cyanosis and how does it present?

A
  • affects the whole body
    • evident in oral tissues
  • generally due to decreased oxygen to blood (hypoxic hypoxia)
    • low atmospheric PO2
    • reduced airflow in airways (obstruction)
    • reduced oxygen diffusion into blood
    • reduced pulmonary blood flow
    • shunting (venous blood in arteries)
38
Q

What is peripheral cyanosis?

A
  • due to decreased oxygen delivery to a localised and peripheral part of the body
  • often due to decreased blood flow to tissues (stagnant hypoxia)
    • peripheral vascular disease
      • atherosclerosis
39
Q

At what oxygen saturation does cyanosis become evident in the oral cavity?

A

70%

40
Q

At what oxygen saturation is the pulse oximeter alarm set at?

A

90%

41
Q

What percentage of the blood is contained in the systemic circulation?

A

80%

42
Q

What are the 4 valves of the heart?

A
  • tricuspid
    • between R. atrium and R. ventricle
  • pulmonary
    • between R. ventricle and pulmonary
  • mitral (bicuspid)
    - between L. atrium and L. ventricle
  • aortic
    • between L. ventricle and systemic
43
Q

Describe the components of the conducting system of the heart

A
  • sino-atrial node
    • natural pacemaker
    • upper right side of atrium
  • atrio-ventricular node
    • delayed transmission
    • allows for ventricular filling
  • purkinje system
    • bundle of His
      • apex of heart
    • left and right bundle branches
44
Q

Describe the innervation of the heart

A
  • parasympathetic (vagus)
    • acts on SAN and AVN
      • slows transmission
      • increases delay
    • muscarinic cholinergic receptors
      • acetylcholine
    • negative chronotropic effect
    • negative dromotropic effect
    • reduces conductive velocity
  • sympathetic
    • acts on SAN, AVN and myocytes
      • beta-1 adrenoreceptors
      • noradrenaline
    • positive chronotropic effect
    • positive dromotrophic effect
    • positive inotropic effect
    • increases conduction and velocity
    • myocytes increase rate of relaxation
45
Q

Describe the phases and events of the cardiac cycle

A
  • ventricular systole
    • isovolumetric contraction
      • no change in blood volume
      • valves close
    • ejection phase
      • blood pushed out of ventricle
  • ventricular diastole
    • isovolumetric relaxation
      • no change in blood volume
    • passive filling
      • blood flows from atria to ventricle
    • active filling (atrial systole)
      • contraction of atria
46
Q

What are the different waves shown on an ECG and what do they show?

A
  • P-wave
    • atrial depolarisation
  • QRS-wave
    • ventricular depolarisation
  • T-wave
    • ventricular depolarisation
47
Q

When is coronary blood flow greatest?

A

during ventricular diastole

48
Q

What is cardiac output and how is it calculated?

A
  • how much blood the heart pumps into the circulatory system in a period of time

BP = CO x TPR

49
Q

What is stroke volume?

A
  • volume of blood ejected from the ventricle after every beat
50
Q

What is total peripheral resistance?

A
  • the combined resistance of all the systemic blood vessels
51
Q

What is hypovolaemia?

A
  • state of decreased intravascular volume
  • vasoconstriction to compensate blood loss
    • increased heart rate
    • increased total peripheral resistance
52
Q

What veins can be cannulated in the dorm of the hand?

A
  • basilic vein
  • cephalic vein
  • dorsal venous network
53
Q

What are the advantages and disadvantages of cannulation of the dorsal of the hand?

A
  • advantages
    • access
    • no nearby arteries
    • no nearby nerves
    • no joints
  • disadvantages
    • small veins
    • susceptible to cold and anxiety
    • mobile veins
    • more painful
54
Q

What vans can be cannulated in the cubital fossa in the forearm?

A
  • cephalic vein
  • median cephalic (cubital) vein
  • median basilic vein
  • basilic vein
55
Q

What artery is at risk when cannulating the cubital fossa?

A
  • brachial artery
56
Q

What are the advantages and disadvantages of cannulating the cubital fossa in the forearm?

A
  • advantages
    • larger veins
    • more predictable located
    • better tethered to underlying tissue
    • less painful
    • less venoconstriction
  • disadvantages
    • more challenging access
    • potential nerve damage
    • potential intra-arterial injection
    • joint immobilisation
57
Q

Where should cannulation of the cubital fossa occur?

A
  • lateral to the bicep tendon

BDS4 Sedation (9 decks)

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