Pulm Pharm and Phys Flashcards

Question

Pathologic Deadspace

Answer 1

refers to additional alveolar space which is being perfused but not ventilated. In persons with respiratory disease physiologic deadspace may be as high as 10x normal anatomic deadspace. – An increased V/Q ratio indicates increased deadspace and may be caused by pulmonary emboli, hypotension, or ligation of a pulmonary vessel.

Answer 2

refers to lung that is perfused but not ventilated (right mainstem intubation) – A decreased V/Q ratio indicates increased shunt and can be caused by endobronchial intubation, mucus plug, or alveolar collapse

Answer 3

* Compliance can be expressed as how much the volume in the lungs will increase for a given increase in alveolar pressure. * Normal lungs will expand 130ml of volume for every 1cm increase in water pressure or 0.13 L/ cm H2O. * The more compliant a lung is, the greater the volume that can by inspired at a lower PIP. * The less compliant lung inspires smaller volumes at higher PIPs

Answer 4

• Normal lungs will expand _130ml_ of volume for every 1cm increase in water pressure or 0.13 L/ cm H2O.

Answer 5

At a constant temperature, pressure is inversely proportional to volume - as pressure increases, volume decreases - as pressure decreases, volume increases

Answer 6

p/v relationship when air is NOT moving - decreases w conditions that make it difficult to inflate the lung, ie: obesity, fibrosis, edema, vascular engorgement, external compression (surgeons elbow) - increases w emphysema which destroys lung tissue as wella s reduces elastic recoil, causing air trapping

Answer 7

P/V relationship when air IS moving - decreases w airway obstruction such as foreign body and bronchospasm

Answer 8

- pressur ewithin the alveoli - negative w inspiration, positive w expiration

Answer 9

- pressure in the potential space between the inside of the chest wall and lungs - lungs recoil inward and chest recoils outward - this is what fills w hemo or pneumothorax * - always negative during normal breathing* * - becomes MORE negative w inspiration and less negative w expiration* * - becomes positive w forced expiration/valsava*

Answer 10

- more nebative in the non-dependent lung

Answer 11

**_- normal V/Q:_** 0.8 or 4L/min / 5L/min = 0.8 **_- Absolute Shunt_**: V/Q = 0 no ventilation, desaturated blood from R heart returns to L w/o being oxygenated **_Absolute Dead Space_**: V/Q = infinity NO perfusion (ie: pulmonary embolus)

Answer 12

functional residual capacity, lung volume at end of normal exhalation - obese = lower FRC

Answer 13

residual volume - volume remaining after maximal exhalation

Answer 14

vital capacity - max volume of gas that can be exhaled following maximal inspiration

Answer 15

FEV1 - 4L/sec FVC - 5L/sec FEV1/FVC = 4/5 = 0.8 or 80%

Answer 16

normal 4 L/sec - forced expiratory volume in 1 sec; the volume of gas that can be exhaled within one second of beginning a force expiration

Answer 17

- normal 5L/sec - volume of gas that can be exhaled during a forced expiratory maneuver

Answer 18

ratio used to distinguish between obstructive and restrictive diseases - normal = 4/5 = 0.8 = 80%

Answer 19

midmaximal expiratory flow (MMEF) - rate of flow occuring in a forced expiratory flow from the point where 25% of the FVC has been exhaled to where 75% has been exhaled - **best test for assessing small airway disease, independent of respiratory effort!**

Answer 20

- inspiration is impaired - ie: vocal cord paralysis w inspiratory stridor, pharyngeal muscle weakness, papilloma in airway ***can be overcome by using ETT***

Answer 21

- expiration is impaired - negative pressure of inspiration keeps trachea open, PPV will be difficult if ETT does not pass obstruction, often not compensated by intubation as obstruction is past carina - usually tumors of trachea or bronchi

Answer 22

fixed large airway obstruction ie: mucous plug in ETT, kinked ETT

Answer 23

- decreased lung compliance = decreased lung volumes - alveolar ventilation is restricted - both FEV1 and FVC are **decreased** but FEV1/FVC ratio is **normal** - compliance as low as 0.02 L/cmH20 in severe dx (normal is 0.10) - types: acute intrinsic, chronic intrinsic and chronic extrinsic

Answer 24

- pathologic conditions increase airway resistance which results in a decrease in max rate of exhalation - exhalation is obstructed - intralumenal and extralumenal airflow obstruction results in air trapping - ie: COPD

Answer 25

- restrictive lung disease like pulmonary edema - water and solutes accumulate in the interstitial tissues causing lungs to become stiff - aspiration, ARDS, POPE, CHF

Answer 26

- restrictive lung dx - changes in elastic tissue in lung lead to decreased ompliance - ie: sarcoidosis, drug-induced pulm fibrosis (amiodarone, bleomycin)

Answer 27

- restrictive lung disease - disorder of the chest wall and intra-abdominal changes ie: obesity, pregnancy, kyphosis, SCI transection, muscular dystrophy

Answer 28

- dyspnea that limits activity - decrease in VC to \<15ml/kg (normal is 70) - FEV1 \<50% of predicted or \<2 L - FC \<50% of predicted

Answer 29

- treat reversible conditions preop (abx for pna, bronchodilators) - baseline ABG, pulse ox, PFTs - use large ETT (hagen-pouiselle) - use higher inspiratory pressures - smaller TV w higher rate, occasional "sigh" breaths w PIP 35-45 cmH20 - slow inspiratory flow rate - prolong inspiration time - PC vs VC - consider PEEP - consider regional (above T10 = resp block) - maintain NMB - **when in doubt, don't pull the tube out!**

Answer 30

- mediated by superior laryngeal nerve in response to irritating glottic/supraglottic stimuli such as food, blood, vomitus or foreign body - false cords and epiglottic body come together to prevent air flow and vocal sounds - deepening anesthetic won't work because you can't ventilate anyways

Answer 31

- forward displacement of jaw, PPV and 100% 02 - may need 20mg-ish of IV succx and re-intubation - can give 40-60 mg IM or sublingual

Answer 32

- post obstructive pulmonary edema - sudden onset of pulm edema following upper airway obstruction Type I: follows a sudden severe episode of upper airway obstruction Type II: develops after surgical relief of chronic upper airway obstruction - laryngospasm during intubation or after anesthesia is the most common cause of upper airway obstruction leading to POPE Type I

Answer 33

- increased venous return to RV - increases pulmonary blood flow causing elevated pulmonary capillary hydrostatic pressure - increased afterload and decreased EF and CO - decreases pulmonary interstitial pressures - increases pulmonary capillary hydrostatic pressure

Answer 34

- forced inspiratory attempts alternated w forced expiratory attempts (Valsava) creates auto-PEEP which opposes transudation of fluid in the interstitium - once obstruction is relieved, unopposed venous hydrostatic pressure leads to pulmonary edema

Answer 35

- self limited, clears within 48 hours - tx depends on severity of hypoxemia - re-establish airway (jaw thrust, chin lift) - supplemental oxygen - CPAP - reintubate and use PEEP

Answer 36

• Destructive process involving the lung parenchyma that results in loss of elastic recoil of the lungs. – Airway collapse happens during exhalation. – Increase work of breathing. • Can have relatively advanced disease with preservation of PaO2 , and usually do not retain CO2 . – “Pink Puffers” – Tendency to exhale through pursed lips to provide end-expiratory pressure.

Answer 37

– Decreased FEV1 • When FEV1 is \< 40% of normal, dyspnea is seen during ADL’s – Decrease in FEV1/FVC – Decreased FEF 25-‐75% – Diminished air flow at all volumes – Increased RV – Normal to increased FRC and TLC Radiographically you will see hyperlucency and hyperinflation (flat diaphragm)

Answer 38

emphysema radiograph - hyperlucency w hyperinflation (flat diaphragm)

Answer 39

* Follows prolonged exposure to airway irritants. * Characterized by hypersecretion of mucus and inflammatory changes in the bronchi. * Copious secretions occlude airways. * Diagnosed if a patient produces sputum 2 months out of the year for 2 years in a row. * Unlike emphysematous patients, there is a marked tendency toward decreased PaO2 early in their disease course. * CO2 diffusion is also impaired (increased PaCO2)

Answer 40

- seen in chronic bronchitis - hypoxemia and respiratory acidosis lead to pulmonary vasoconstriction and pulm HTN - may lead to cor pulmonale w RV hypertrophy and R axis deviation

Answer 41

- FEV1/FVC decreased - FEF 25-75% is decreased - increased RV - normal to increased FRC and TLC due to slowing of expiratory airflow and gas trapping behind prematurely closed airways - greater WOB at high lung volumes

Answer 42

- chronic bronchitis x-ray - non specifix w bronchial wall thickening - increased bronchovascular markings, enlarged vessels and cardiomegaly - scarring of tissue scauses irregular bronchovascular structures - maintains curvature on diaphragm vs emphysema which is flat

Answer 43

- chronic airway narrowing due to bronchial hyperactivity - exacerbations - patho not completely known, IGE mediated - increased cAMP = bronchodilation and sympathetic stimulation of B2 - increased cGMP = bronchoconstriction and PS stimulation of muscarinic

Answer 44

- asthmatic x-ray - normal cardiomediastinal contours - no pleural abnormalities, no collapse or consolidation, unremarkable x-ray

Answer 45

- bronchodilator thearpy - albuterol, metaproterenol, ceprenaline - relatively free of a1 and b1 effects

Answer 46

methylzanthines - oral or IV - inhibit breakdown of cAMP - aminophylline

Answer 47

- block the effect of ACh on bronchial smooth muscle - ipratroprium (does not have the same SE as atropine, less tachycardia)

Answer 48

- intraoperatively, volatiles provide **bronchodilation** and may attenuate regional hypoxic vasoconstriction (R to L shunt) - N20 use carefully in pts w pulmonary bulae, can cause diffusino hypoxia - opioids be very careful, extreme sensitivity, opioids will exacerbate breathing difficulties

Answer 49

- large TV (10-15 mL/kg) - Slow RR (6-10) - increased expiratory time - avoid high PIP especially w pulmonary bullae - PEEP not necessary, may impede expiratory air flow - use sigh mode - extubation, use post op vent FEV1/FVC ratio of \<0.5, pre-p[ PaCO2 of \>50

Pulm Pharm and Phys Flashcards

(73 cards)