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BB - Respiratory Review > Final Review - Personalized Pt 2 > Flashcards

Final Review - Personalized Pt 2 Flashcards

1
Q

Oxygen used by cells at rest…

A

250 ml/min

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2
Q

Why doesnt CO2 need as large a gradient as oxygen to diffuse?

A

CO2 diffuses 20 x faster than O2

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3
Q

Hypoxic Hypoxia

A

inadequate O2 uptake

COPD

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4
Q

Stagnant/Ischemic Hypoxia

A

inadequate blood flow

clot

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5
Q

Anemic Hypoxia

A

inadequate oxygen carrying capacity

inactivated hgb

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6
Q

Histotoxic Hypoxia

A

interference with mitochondrial respiration

cyanide poisoning

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7
Q

Methods of O2 Transport

A

97% carried by RBC’s

dissolved in plasma - low capacity

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8
Q

Amount of O2 that can be dissolved in blood

A

0.0003 ml/100ml plasma

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9
Q

Hemoglobin

A

oxygen carrier protein
4 subunits, 2 alpha, 2 beta
only Fe2+ can bind to O2

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10
Q

How much O2 can 1gm of Hgb carry?

A

1.31 ml

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11
Q

Oxyhemoglobin curve axis & rightward

A

x axis = PaO2
y axis = saturation
rightward shift –> release O2 more
saturation will be less for a given PO2

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12
Q

Causes of rightward shift

A

increased CO2
increased temp
increased H+
increased 2,3 DPG

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13
Q

Average CO2 production in resting adult

A

200 ml/min

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14
Q

Mechanisms of CO2 transport

A

3% dissolved in blood
90% bicarb, HCO3 and carbonic acid
7% bound to hgb
** all reversible at lungs

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15
Q

What causes increased minute ventilation

A

hypercapnia and acidosis

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16
Q

Which materials act directly on the respiratory centers to increase strength inspiratory and expiratory motor signals?

A

carbon dioxide
hydrogen ions
**oxygen acts peripherally at carotid and aortic bodies

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17
Q

DRG

A

controls respiration at rest and provides basic rhythm

-vagal and glossopharyngeal sensory info to DRG

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18
Q

VRG

A

inactive during normal respiration
contributes to drive to increase respiration
stimulates abdominal muscles

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19
Q

Pneumotaxic Center

A

control switch off point
primarily limits inspiratory phase
also increases rate

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20
Q

Apneustic

A

works with pneumotaxic to control intensity of respiration

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21
Q

Hering-Breuer Reflex

A

protective feedback mechanism that limits overinflation

  • stretch receptors send signals via vagus nerve to DRG when TV >1.5 L
  • also increases rate
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22
Q

Chemo-Sensitive Area

A

on ventral medulla, responsive to CO2 and H+

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23
Q

Which ions can cross blood brain barrier?

A

CO2, not H+

CO2 stimulates H+ ions in CSF to stimulate resp center

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24
Q

Mountain climbing

A

adjusts in 2-3 days, loss of sensitivity to CO2, or H=, oxygen runs resp center

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25
Alveolar ventilation curves
curves are displaced to the right at higher pH and left with lower pH
26
What controls voluntary respiration
cortex and higher centers
27
Is the potential for Cheyne-Stokes breathing present in everyone?
yes - low CO - brain damage
28
High risk PFT results
FEV1 <2L FEV1/FVC < 0.5 VC <15 cc/kg in adult, <10 cc/kg in child VC <40 - 50% predicted
29
To decrease air trapping...
change I:E ratio.
30
Histamine releasing drugs
``` pentothal (STP) Morphine atracurium mivacurium neostigmine abx ```
31
Extubation criteria
resp rate <30 ABG on FiO2 of 40% --> PaO2 >70, PaCO2 <55 NIF more negative than -20 cm H2O VC >15 cc/kg
32
Extubation and FEV
FEV >50% --> not affected FEV 25-50% --> some hypoxemia and hypercarbia, prolonged intubation probable FEV <25% --> may not be able to wean
33
Intubation criteria
RR >35, VC <15 cc/kg oxygenation PaO2 <70 on FiO2 of 40% PaCO2 >55 -airway burn, chemical burn, epiglotitis, etc
34
TV
500 ml
35
IRV
3 L
36
ERV
1.1 L
37
RV
1.2L
38
IC
3.5 L
39
FRC
2.3 L
40
VC
4.6 L
41
TLC
5.8 L
42
Normally, FRC represents about ___% of TLC
40%
43
FVC
volume of air which can be forced exhaled out of lungs after pt has taken deepest breath possible
44
FEV1
forced volumes in 1 second effort dependent 3-5L **most important clinical tool in assessing severity of airway obstructive disease
45
Normal FEV1/FVC
75%
46
Flow-Volume Loops
help distinguish between obstruction and generalized pulmonary disease -extrathoracic obstruction = decreased inspiratory flow
47
MVV or MBC
"will to live" | max amount they can exchange in 1 minute
48
Carboxyhemoglobin
from CO poisoning, shows 100%
49
Methemoglobin
shows 85%, absorbs equally at both wavelength -benzocaine, NTG, nitrates tx: methylene blue cyanosis when 15% hgb is methgb
50
Gold standard for tracheal intubation...
EtCO2 | *will not detect endobronchial intubation
51
Mainstream circuit
inline connects to ETT, fast, do not need water trap adds weight and dead space
52
Sidestream
diverting pumps to outside circuit, takes longer need water trap
53
dCO2
normal end tidal CO2 to arterial CO2 gradient arterial is higher by 2-5 mmHg -reflects alveolar dead space
54
increase dCO2
increased dead space
55
One lung positioning: down lung
dependent lung | nondependent lung = upper lung
56
Where does the axillary roll go?
upper chest wall, no axilla
57
during apnea...
PCO2 increases 5 mmHg for the first minute, then 3 mmHg for each additional minute
58
Hypoxia during one lung ventilation
add 5 cm CPAP to nondependent lung add 5 cm PEEP to dependent lung ask surgeon to clamp nondependent PA
59
double lumen tube sizes
women: 39 (insert 27 cm) men: 41 (insert 29 cm)
60
Left double lumen tube
more common, easier to place | longer bronchial, shorter tracheal
61
MH
rare, inherited skeletal muscle syndrome, hypermetabolic rxn triggered by volatile anesthetics, succ ryr1 receptor
62
most specific indicator of MH
abrupt increase in EtCO2
63
earliest sign of MH
tachycardia
64
early signs of MH
``` abrupt increased in EtCO2 tachycardia cardiac arrhythmias generalized rigidity masseter rigidity metabolic/resp acidosis mottling ```
65
late signs of MH
``` acute renal failure circulatory failure myoglobinuria DIC elevated blood creatine phosphokinase hyperkalemia hyperthermia hypotension rhabdomyolosis cardiac arrest ```
66
MH treatment
dantrolene 2.5 mg/kg q5 mins, max 10 mg/kg
67
Dantrolene
inhibits Ca release from SR directly at ryanodine receptor | *Ca channel blockers cannot be given with dantrolene --> hyperkalemia and heart depression`
68
MAC amnesia
25% MAC | blocks anterograde memory in 50% of pts
69
MAC awake
50% MAC | prevents eyes opening on verbal command
70
MAC intubation
130% MAC | prevents movement/coughing with ETT placement
71
MAC Bar
150% MAC blocks autonomic response
72
lower mac =
higher potency
73
things that increase MAC..
``` age - term infant at 6 mo has highest MAC requirement hyperthermia chronic ETOH hypernatremia drugs that increase SNS catecholamines ```
74
things that decrease MAC...
``` hypothermia preop meds neonates/preemies, elderly pregnancy hyponatremia alpha 2 agonists, ca channel blockers ```
75
2nd gas effect
ability of fast uptake of N2O to accelerate rate of rise of alveolar partial pressure of 2nd agent
76
Diffusion Hypoxia
dilution of alveolar O2 concentration by large amount of N2O entering alveolus when N2O is d/c'd -give 100% O2, dont extubate
77
Most important for speed of induction...
solubility
78
A larger partial pressure difference will...
enhance uptake and speed induction
79
Nitrous Oxide
good analgesic, safe in MH, PONV avoid use with closed gas spaces PVR, esp with pulm HTN
80
Halothane
vagal stimulation, esp >1 MAC --> pretreat with atropine thymol preservative sensitizes heart to catecholamines, caution w/ epi avoid with liver dx
81
Isoflurane
heart cases | coronary steal
82
Desflurane
need special vaporizer rapid wash in and wash out not readily taken into fat
83
Sevoflurane
good for inhalation induction rapid induction and emergence compound A, avoid in renal failure keep FGF atleast 2 L/min
84
Enflurane
can cause tonic clonic muscle activity, | avoid with renal failure and seizure pts
85
COPD
emphysema & bronchitis | **smoking
86
Chronic Bronchitis
symptoms- cough, sputum production, recurrent infections mucous gland hyperplasia, mucous plugging, inflammation, edema "blue bloaters"
87
Emphysema
``` *progressive dyspnea structural changes destruction of lung tissue, enlarged air spaces *alpha 1 antitrypsin deficiency "pink - puffer" ```
88
Pre-Op smoking cessation
-advise to stop atleast 12 hrs pre-op reactivity decreases after 2 days, after 10 near nonsmoker cessation >8 wks = reduced post op complications
89
How does smoking effect SNS...
- nicotine stimulates SNS catecholamines released from adrenal medulla - increased HR, BP & SVR - persists 30 mins * pre-oxygenate well and avoid airway manipulation until deep
90
Neuroaxial block >T10
diminished ability to cough
91
COPD and interscalene block
frequently blocks ipsilateral phrenic nerve
92
Asthma
hyper-reactivity | triad: wheezing, cough, dyspnea
93
Asthma treatment
``` pregnant - terbutaline oxygen, albuterol corticosteroids atrovent (ipratropium bromide) theophylline helium induction - ketamine, will increase secretions. pretreat with glyco ```
94
EtCO2 phases
A-B (1) - exhalation of anatomic deadspace B-C (2) - exhalation of deadspace and alveolar C-D (3) - alveolar D-E (4) - inspiration

BB - Respiratory Review (5 decks)

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