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BDS4 Sedation > Applied Physiology for Sedation > Flashcards

Applied Physiology for Sedation Flashcards

(58 cards)

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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?

Study These Flashcards
A
  • minimal change to oxygen bound to haemoglobin
  • amount dissolved increases proportional to partial pressure of oxygen
    • essentially excess oxygen dissolved
24
When does haemoglobin have the greatest affinity for oxygen?
- greatest affinity is at reduced oxygen saturations
25
What factors increase the affinity of haemoglobin for oxygen?
- decreased temperature - hypothermia - increased pH - alkalosis - easier to harvest oxygen in the lung but harder to give oxygen to tissues
26
What factors decrease the affinity of haemoglobin for oxygen?
- increased temperature - acidosis - increased 2,3 DPG - alternative by-product of glycolysis - involved in feedback loop - prevent hypoxia
27
When dully saturated, how many ml of oxygen does a gram of haemoglobin carry?
1.34ml
28
How is carbon dioxide transported?
- bicarbonate ions - 70% - carbamino compounds - 20% - dissolved CO2 - 10%
29
How is breathing controlled?
- voluntary skeletal breathing muscles - automatic process - rhythm generated by respiratory centres in the brain - basic rhythm modified by signals from sensory receptors
30
What can act positively on respiratory centres?
- 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
What can act negatively on respiratory centres?
- lung stretch receptors - inflation
32
What is hypoxic hypoxia?
reduced oxygen delivery tissues due to: - reduced oxygen reaching alveoli - reduced oxygen diffusion into blood
33
What is anaemic hypoxia?
reduced oxygen delivery tissues due to: - reduced oxygen transport in blood - low haemoglobin - e.g. CO poisoning
34
What is stagnant/ischaemic hypoxia?
reduced oxygen delivery tissues due to: - reduced oxygen transport in blood - low blood flow
35
What is cytotoxic hypoxia?
reduced oxygen delivery tissues due to: - reduced oxygen utilisation by cells
36
What is cyanosis?
- 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
What is central cyanosis and how does it present?
- 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
What is peripheral cyanosis?
- 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
At what oxygen saturation does cyanosis become evident in the oral cavity?
70%
40
At what oxygen saturation is the pulse oximeter alarm set at?
90%
41
What percentage of the blood is contained in the systemic circulation?
80%
42
What are the 4 valves of the heart?
- 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
Describe the components of the conducting system of the heart
- 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
Describe the innervation of the heart
- 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
Describe the phases and events of the cardiac cycle
- 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
What are the different waves shown on an ECG and what do they show?
- P-wave - atrial depolarisation - QRS-wave - ventricular depolarisation - T-wave - ventricular depolarisation
47
When is coronary blood flow greatest?
during ventricular diastole
48
What is cardiac output and how is it calculated?
- how much blood the heart pumps into the circulatory system in a period of time BP = CO x TPR
49
What is stroke volume?
- volume of blood ejected from the ventricle after every beat
50
What is total peripheral resistance?
- the combined resistance of all the systemic blood vessels
51
What is hypovolaemia?
- state of decreased intravascular volume - vasoconstriction to compensate blood loss - increased heart rate - increased total peripheral resistance
52
What veins can be cannulated in the dorm of the hand?
- basilic vein - cephalic vein - dorsal venous network
53
What are the advantages and disadvantages of cannulation of the dorsal of the hand?
- advantages - access - no nearby arteries - no nearby nerves - no joints - disadvantages - small veins - susceptible to cold and anxiety - mobile veins - more painful
54
What vans can be cannulated in the cubital fossa in the forearm?
- cephalic vein - median cephalic (cubital) vein - median basilic vein - basilic vein
55
What artery is at risk when cannulating the cubital fossa?
- brachial artery
56
What are the advantages and disadvantages of cannulating the cubital fossa in the forearm?
- 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
Where should cannulation of the cubital fossa occur?
- lateral to the bicep tendon

BDS4 Sedation (9 decks)

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