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Cardio A&P Test 4 > Ppt 13 > Flashcards

Ppt 13 Flashcards

1
Q

Normal alveolar ventilation is

A

4L/min (ventilation)

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2
Q

Normal pulmonary capillary blood flow is

A

5 L/min (perfusion)

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3
Q

Average ratio of ventilation to perfusion or V/Q ratio

A

4:5 or .8

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4
Q

The alveoli in the upper apices of lungs receive more ventilation and less blood flow so the v/q is

A

Higher than .8 ex.( V6/Q4= 1.5)

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5
Q

Lower regions of the lung have lower ventilation and increased blood flow so v/q ratio is

A

Lower than .8 (example V4/Q6=0.67

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6
Q

How does the ratio(V/Q ) change from top of lung to bottom?

A

Decreases from top to bottom

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7
Q

PAO2 determined by

A

Amount of oxygen entering the alveoli(ventilation)

It’s removal by capillary blood flow(perfusion)

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8
Q

PACO2 determines by

A

Amount of carbon dioxide that diffuses into the alveoli from capillary blood(perfusion)

It’s removal from alveoli by ventilation(ventilation)

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9
Q

High V/Q >.8 is

A

Increase in ventilation or decrease in perfusion.

PAO2 increases

PACO2 decreases

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10
Q

When the V/Q is high the PAO2 rises because

A

It doesn’t diffuse quickly as it’s being delivered via ventilation

PACO2 decreases because ventilation is increased blowing off the CO2

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11
Q

Low V/Q < 0.8

A

Decrease in ventilation or increase in perfusion

PAO2 decreases

PACO2 increases

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12
Q

With low V/Q the PAO2 drops because

A

It’s diffusion into the capillaries faster than being ventilated

The PACO2 rises because it’s diffusion go to the alveoli faster than it’s washed out by ventilation

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13
Q

Mixing of PcO2 and PcCO2 occurs

A

In the pulmonary veins

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14
Q

Higher the v/q in upper lungs has what ph

A

Higher more alkalotic

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15
Q

Lower v/q in lower lungs has what kind of ph

A

Lower or more acidotic

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16
Q

Increase in v/q leads to

A

Dead space ventilation

Dead space= ventilated but not perfumed

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17
Q

Factors that cause low perfusion but normal ventilation or high v/q

A

Pulmonary embolism

Low cardiac output

Blockage in pulmonary artery

Pressure on pulmonary vessel

Emphysema

Cardiac arrest

Pulmonary htn

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18
Q

Factors that decrease v/q very little ventilation but normal blood flow

A

Shunt-perfused but not ventilated

Obstructive disorders- bronchitis, asthma

Restrictive- pneumonia, silicosis, pulmonary fibrosis

Hypoventilation

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19
Q

VA/QC Ratio Hypothetical Extremes

A
  • If blood flow to an alveolus ceases, hypothetically PAO2  until equals PIO2 (i.e., O2 cannot be taken up by alveolus and CO2 is not removed):
  • If ventilation to alveolus is blocked, hypothetically PAO2  until equals PvO2
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20
Q

Absolute shunt (v/q= 0)

A

No ventilation but there is perfusion

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21
Q

Relative shunt

A

V/Q is greater than 0 but less than 1

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22
Q

Shunting diseases =

A

Decrease in V/Q =P(A-a)O2

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23
Q

Absolute dead space

A

Normal ventilation but no perfusion

V\Q = Infinity

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24
Q

High V/Q

A

Blood flow is low ventilation is high

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25
Q

Low V/Q

A

Ventilation is low blood flow is high

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26
Q

Absolute shunt

A

Right to left shunt(venous admixture)

Anatomical

Atelectasis or pneumonia( Intrapulmonary)

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27
Q

Ventilation perfusion mismatch

A

Most common cause of hypoxemia

Responds to O2

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28
Q

Causes of dead space

A

High ventilation

Low blood flow ( shock, embolism, over-distended alveoli)

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29
Q

Shunt( low PAO2)

A

Pulmonary vasoconstriction

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30
Q

Dead space ( low PaCO2) upper lungs

A

Alveolar duct constriction

Increased airway resistance

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31
Q

P(A-a)O2. ( A-a gradient)

A

Most common index of oxygen transfer efficiency

Increased A-a gradient= increased physiological shunting

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32
Q

PAO2/PAO2( a-A ratio)

A

More stable than A-a when fio2 changes

Normal is 0.75 to 0.95

Used to predict fio2 to achieve desired PaO2

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33
Q

Capnogram

A

Waveform produced

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34
Q

Capnometry

A

Numerical display of ETCO2 value

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35
Q

Capnogram provides

A

Direct measurement of partial pressure of CO2( PcO2) eliminated by lungs

I direct measurement of mixed venous blood( pvco2) from tissue to lungs

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36
Q

ETCO2 normal

A

35-45 muggy

5-6 vol%

37
Q

Normal ETCO2 to PaCO2 gradient

A

3-5 mmhg

ETCO2 will always be lower than PaCO2

38
Q

If ETCO2 to PaCO2 is high can be

A

Dead space

Ventilation but lo perfusion

39
Q

Low ETCO2=

A

Increased V/Q

40
Q

High ETCO2=

A

Decreased V/Q

41
Q

During CPR goal RTCO2 is

A

10-20 mmhg

42
Q

If less than 10mmhg on cpr

A

Poor blood flow and need to improve compressions

43
Q

Mainstream analysis

A

Sample chamber into the vent circuit at the patient wye

Gas passes through sample chamber

44
Q

Side stream analysis

A

Small bore tubing to aspirate gas from airway

Aspirated gas goes into sample chamber

Delay in analysis

45
Q

The difference between the Paco2 and Petco2 increases as the

A

Vd/vt increases

Normal 3-5 mmhg

46
Q

To calibrate or zero the unit

A

Low calibration is done by exposing unit to gas with no carbon dioxide( room air)

47
Q

Capnography waveform A to B is

A

Post inspiration no CO2 inhales gas

48
Q

Capnograph waveform B

A

Beginning of alveolar exhalation

Some co2

49
Q

Capnograph waveform B to C

A

Exhalation upstroke

Deadspace( anatomical gas) mixes with alveolar gas) more co2

50
Q

Capnograph waveform C to D

A

Continuation of exhalation with all alveolar gas

Plateau phase of exhaled co2 level

51
Q

D wave form

A

End expiration peak co2

This is end tidal co2

This is used to follow paco2

52
Q

Normal etco2 to paco2 gap

A

3-5

53
Q

D to E waveform

A

Inspiration phase of respiration

Zero CO2 inhaled

54
Q

Increased CO2 production to lungs

A 
Fever 
Sepsis
Hco3
Increased metabolic rate
Seizures
55
Q

Increase petco2 from alveolar ventilation

A

Respiratory depression

Paralysis

Hypoventilation

Copd

56
Q

Equipment malfunction can

A

Show increased petco2

Leak in circuit

Rebreathing of gases

57
Q

Decreased petco2

A

Cardiac arrest

Pe

Hemorrage

Hypotension

58
Q

Equipment malfunction that would cause a low co2

A

Disconnect

Esophageal intubation

Airway obstructing

Leak around et tube

59
Q

Effect of tea breathing carbon dioxide on capnogram

A

Inspiratory does not return to baseline

60
Q

Capnogram with sloping alveolar plateau( shark fin)

A

Airway obstruction

61
Q

Curare cleft in alveolar plateau

A

Dip in plateau like trying to inspire

62
Q

Stair effect on descending limb on capnogram

A

Potential pneumothorax

63
Q

Pulse ox reflects

A

Oxygenation

64
Q

Capnograph reflects

A

Ventilation

65
Q

You will see capnograph changes before

A

Pulse ox changes which can take 5 minutes

66
Q

Apnea testing

A

Desat or increase in co2

67
Q

Albumin

A

Largest protein in plasma affected by nutrition and inflammation

68
Q

C-reactive protein( crp)

A

Increases with infection and inflammation

69
Q

Esr erythrocyte sedimentation rate

A

Increases with inflammation

70
Q

Combination of inflammation and hypoalbuminemia is linked with

A

Increased morbidity, mortality, longer hospitalization

71
Q

Physical findings where cell turnover is high

A

Hair, nails, mouth gums eyes, lips

72
Q

BMR Basal metabolic rate

A

Energy expenditure

Obtained after 10 hours of fasting( indirect calorimetry)

Calories expended during rest per square meter of body

73
Q

O2 consumption

A

VO2

74
Q

Co2 production

A

VcO2

75
Q

Internal respiration( indirect calorimetry)

A

Gas exchange between systemic capillaries and cells

Normal 250 ml of O2 consumed by tissue in 1 minute

In exchange cells produce 200 ml of CO2

76
Q

Rq of carbs

A

1.0

77
Q

Rq of protein

A

0.82

78
Q

Rq of fat

A

0.7

79
Q

External respiration

A

Gas exchange between pulmonary capillaries and alveoli

80
Q

Respiratory exchange ratio( RR)

A

Quantity of O2 and CO2 exchanged during one minute

81
Q

Normally RR and RQ are

A

Equal

82
Q

Low V/Q or shunt have what effect in P(A-a)O2

A

Raises it

83
Q

Most common index of oxygen transfer efficiency

A

P(A-a)O2 or A-a gradient

84
Q

Capnogram that doesn’t return to baseline

A

Rebreathing co2

85
Q

Shark fin or steep slope plateau

A

Airway obstruction ( bronchospasm, asthma/copd, slow alveolar co2 emptying.

86
Q

Strip effect on the descending limb on capnogram

A

Potential pneumothorax

87
Q

Changing v/q ratios ok PAO2 and PACO2 is summarized on what diagrams

A

O2-CO2

88
Q

Side stream sample flow can decrease tidal volume and aspirate how much

A

50-250 ml/min

89
Q

Capnogram b to c exhalation upstroke

A

Deadspace gas mixes with alveolar gas

Cardio A&P Test 4 (2 decks)

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