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My Respiratory Physiology > Final > Flashcards

Final Flashcards

1
Q

Larynx vertebral location at birth vs adult?

A

C3-C4

C3-C6

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2
Q

Sphenopalatine ganglion innervation? What nerve?

A

nasal mucosa, superior pharnx, uvula, tonsils

CN V

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3
Q

Glossopharyngeal nerve innervation? What nerve?

A

oral pharynx, supraglottic region

CN IX

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4
Q

Internal branch Superior Laryngeal nerve innervation? What nerve?

A

mucus membrane above the VC’s, glottis

CN X

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5
Q

Recurrent Laryngeal nerve innervation?

A

trachea below VC’s

CN X

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6
Q

What does SLN divide into and what innervation?

A

Internal SLN - sensation to supraglottic & ventricle compartment, STIMULATION CAUSES LARYNGOSPASM

External SLN - motor innervation of cricothyroid muscle

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7
Q

____ RLN passes @ Aortic Arch
Provides ______ innervation to _______.
________ innervation to all larynx except _______ muscle

A

Left

Sensory

infraglottis

Motor

cricothyroid

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8
Q

Stimulation of what causes abduction of VC

A

RLN

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9
Q

Damage to RLN cause VC ______.

A

adduction

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10
Q

infant vs adult airway size? smallest part child vs adult?

A

4mm vs 8mm

cricoid cartilage vs vocal cords

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11
Q

Carina vertebral level and Cm from teeth?

A

T5-T7

25cm

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12
Q

What part of airway have thick O-ring?

A

Bronchioles

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13
Q

What nerve and Vertebral locations send innervation to diaphragm?

A

Phrenic nerve

C3, C4, C5

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14
Q

What nerve and Vertebral locations send innervation to external intercostal muscles?

A

Intercostal nerves (T 1-11)

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15
Q

The act of inhaling is?

A

negative-pressure ventilation

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16
Q

learn Vital capacity/lung volumes chart

A

.

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17
Q

Spirometry _________ measure Residual Volume (RV) thus Functional Residual Capacity (FRC) and Total Lung Capacity (TLC) cannot be determined using spirometry alone

A

cannot

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18
Q

FRC and TLC can be determined by?

A

1) Helium dilution
2) Nitrogen washout
3) body plethysmography

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19
Q

look at slide 20

A

.

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20
Q

surfactant functions?

A
  • Lowers surface tension of alveoli & lung
  • Increases compliance of lung
  • Reduces work of breathing
  • Promotes stability of alveoli
  • Prevents transudation of fluid into alveoli
  • Reduces surface hydrostatic pressure effects
  • Prevents surface tension forces from drawing fluid into alveoli from capillary
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21
Q

Poiseuille’s Law

A

reducing r by 16% will double the R

reducing r by 50% will increase R 16-fold

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22
Q

two mechanisms for decreased pulmonary vascular resistance as vascular pressures rise

A

recruitment and distention

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23
Q

Functional capillary volume

A 
70 ml (1 ml/kg body weight) normal volume at rest
200 ml at maximal anatomical volume
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24
Q

_____% of alveolar surface area covered by capillary bed

A

70-80%

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25
Q

look at slide 27-28

A

.

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26
Q

Vasoconstrictors?

A 
Serotonin
Thromboxane A2
Reduced PAO2
Angiotensin
Prostaglandins
Increased PCO2
Neuropeptides
Norepinephrine
Histamine
α-adrenergic catecholamines
Leukotrienes
Endothelin
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27
Q

Vasodilators?

A 
Nitric oxide
Increased PAO2
Isoproterenol
Prostacyclin
Dopamine
Acetylcholine
β-adrenergic catecholamines
Bradykinin
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28
Q

Alveolar hypoxia produces? Which is a _____________ of pulmonary arterioles caused by _____ and enhanced by _____ & _______. Is this the same or Opposite reaction of systemic circulation to hypoxia?

A

hypoxic pulmonary vasoconstriction (HPV)

Localized response

hypoxia

hypercapnia & acidosis

opposite

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29
Q

HPV is an important mechanism because? Results from decreased formation & release of ______ by pulmonary endothelium in hypoxic region.

A

Shift of flow to better ventilated pulmonary regions

Nitric Oxide

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30
Q

What causes biggest increase in pulmonary drive?

A

Hypoxia, hypercarbia

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31
Q

normal alveolar PO2?

A

100 mmHg

32
Q

Normal alveolar PCO2?

A

40 mmHg

33
Q

Alveolar air is expired at _____ of exhalation. What is expired first?

A

end

dead space

34
Q

Ficks law consists of?

A 
diffusion of gas through a tissue membrane
consists of:
-cross sectional area
-gas coefficient
-tissue thickness
35
Q

pulmonary artery (deoxygenated blood) PCO2 and PO2 values?

A

46

40

36
Q

pulmonary vein (oxygenated blood) PCO2 and PO2 values?

A

40

100

37
Q

V/Q shunt occurs when? (2)

A

V/Q is below normal

Perfusion but no ventilation (no participation in gas exchange)

38
Q

O2 sat and corresponding PaO2? 90 75 50?

A

60

40

27

39
Q

PaO2 highest in?

A

Pulmonary capillaries

40
Q

What causes a left shift in O2 curve?

A

Decreased Pco2
Decreased Temp
Decreased H+
Decreased 2,3 -DPG

41
Q

What causes a Right shift in O2 curve?

A

increased Pco2
increased Temp
increased H+
increased 2,3 -DPG

42
Q

Right shift O2 curve will have?

A

Hb has less affinity for O2, releases O2, saturation will be less for a given PO2

43
Q

Left shift O2 curve will have?

A

Hb has higher affinity for O2, binds O2, saturation will be higher for a given PO2

44
Q

O2 Content in blood (CaO2) equals? what equation?

A

The sum of O2 carried on Hb and dissolved in plasma

CaO2 = (SO2 * [Hb] * 1.31) + (PO2 * 0.003)

45
Q

Co2 transported as what in blood? (3) mostly by what?

A

Co2
Hgb + Co2
HCO3 (mostly this way)

46
Q

What controls Inspiration and respiratory rhythm? Where does it receive signals from?

A

Dorsal respiratory group (DRG)

  • Peripheral chemoreceptors
  • Baroreceptors
  • Lung receptors
47
Q

CO2 is _____ permeable to blood-brain barrier so blood & brain concentrations are equal. The released _________ in brain stimulate respiratory center activity.

A

highly

H+ ions

48
Q

Drastic _______ in ventilation caused by _______ in Pco2 (above ___ mmHg)

A

increase

increase

35

49
Q

Change in respiration is 10 times _____ with blood pH range between 7.3 and 7.5

A

less

50
Q

peripheral chemo receptors located?

A

Carotids (CN IX) and aorta (CN X)

51
Q

stimulation of chemoreceptors is by?

A

decreased arterial oxygen content

52
Q

Intubation criteria: Mechanics

A
  • RR>35
  • VC <15cc/Kg in adult or <10cc/Kg in child
  • MIF more neg. than -20cmH2O
53
Q

Intubation criteria: Oxygenation

A
  • PaO2 < 70mmHg on FiO2 of 40%

- A-a gradient > 350mmHg on 100% O2

54
Q

Intubation criteria: Ventilation

A
  • PaCO2 > 55 (except in chronic hypercarbia)

- Vd/Vt > 0.6 (remember normal dead space is 30%)

55
Q

Intubation criteria: Clinical

A 
airway burn
chemical burn
epiglottitis
mental status change
rapidly deteriorating pulmonary status
fatigue
56
Q

Extubation criteria:

A
  • VSS, awake & alert, resp. rate < 30
  • ABG on FiO2 of 40%  PaO2 >70 and PaCO2 <55
  • MIF is more negative than -20cm H2O
  • Vital capacity (VC) > 15cc/Kg
57
Q

Rule: an INCREASE of PCO2 by ___ mmHg causes a DECREASE in pH by ____ and vice versa.

A

10

0.08

58
Q

A-a gradient is? equation to figure out? Tx if abnormal?

A

a measure of efficiency of lung

approximately (Age / 3)

  • supplemental O2
  • adjust ventilation
  • tx atelectasis
  • add PEEP
  • tx underlying cause**
59
Q

A DECREASE in bicarb. by ____ mmoles DECREASES the pH by _____.

A

10

0.15

60
Q

Total body bicarb. deficit = ? usually replace __ of deficit

A

(base deficit * wt in Kg * 0.4)

½

61
Q

940nm = _____ light, oxyhemoglobin.

A

infrared

62
Q

Carboxyhemoglobin reads what on pulse ox?

A

100%

63
Q

Methemoglobin reads what on pulse ox? absorbs _______ at both wavelengths

A

85%

equally

64
Q

_____ hemoglobin and ______ do not affect pulse oximetry.

A

Fetal

bilirubin

65
Q

In the _________ position the dependent lung is better perfused (gravity) & ventilated. With induction of anesthesia, with a decrease in FRC, the ______ lung _______ more, V/Q mismatch

A

awake & lateral

upper

ventilates

66
Q

Factors that inhibit hypoxic pulmonary vasoconstriction:

A
  • Very high or very low pulmonary artery pressures
  • Hypocapnia
  • High or very low mixed venous PO2
  • Vasodilators: nitroglycerin (NTG), nitroprusside (SNP), b-adrenegic agonists (dobutamine), calcium channel blockers
  • Pulmonary infections
  • Inhalation agents
67
Q

Hypoxia during one lung ventilation:

A
  • FIO2 of 0.8 to 1.0
  • Check tidal volumes – want 10cc/Kg, suction ETT
  • Fiberoptic scope to ensure proper ETT placement
  • 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
68
Q

S/S MH:

A
  • 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)
69
Q

What will labs be during MH?

A
  • myoglobinuria
  • initial metabolic acidosis then a combined metabolic & respiratory acidosis
  • creatinine kinase (CK) > 1000 IU
  • hyperkalemia
  • hypercalcemia
  • hyperphosphatemia
  • hypoxemia
70
Q

Factors that increase MAC:

A
  • Age: term infant to 6 months of age has the highest MAC requirement**
  • Hyperthermia
  • Chronic EtOH abuse**
  • Hypernatremia
  • Drugs that increase CNS catecholamines
71
Q

Factors that decrease MAC:

A
  • Hypothermia: for every 1 deg. C drop in body temp – MAC decreases 2 to 5%
  • Preop medications
  • IV anesthetics, opioids
  • Neonate/Premature infants
  • Elderly
  • Pregnancy**
  • Acute EtOH ingestion
  • Lithium
  • Cardiopulmonary bypass (CPB)
  • Hyponatremia
  • Alpha 2 agonists
  • Calcium channel blockers
  • Severe hypoxemia – PaO2 < 38 mmHg
72
Q

Factors that have no effect on MAC:

A
  • Thyroid gland dysfunction**
  • Duration of anesthesia
  • Gender
  • Hyperkalemia
  • Hypokalemia
  • Hypocarbia
  • Hypercarbia
73
Q

Preop smoking cessation

A

-Advise stopping at least 12 hours prior to surgery
Stopped night before surgery (12-24 hrs) – will reduce COHb and nicotine levels to that of nonsmokers
-Airway reactivity decreases after 2 days of cessation and is near the level of a nonsmoker after 10 days of cessation
-Cessation of > 8 weeks will reduce post-op pulmonary complications
-Cessation of > 2 years will reduces risk of MI to that of nonsmoking population

74
Q

COPD Intraoperatively

A

-Bronchospasm: avoid *histamine releasing drugs
Pentothal (STP), Morphine (MSO4), Atracurium, Mivacurium, Neostigmine

-Tx with nebulized albuterol especially before extubation

75
Q

V/Q in physiologic shunt vs physiologic deadspace?

which has perfusion/ventilation

A

Shunt: V/Q below normal - perfusion

Deadspace: V/Q above normal - ventilation

My Respiratory Physiology (12 decks)

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