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Spring 2020 - Physiology 1 > Pulmonary Function Tests - Quiz 7 > Flashcards

Pulmonary Function Tests - Quiz 7 Flashcards

1
Q

What is the FEV1 for High Risk Patients?

A

< 2 L

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2
Q

What is the FEV1/FVC for High Risk Patients?

A

< 0.5

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3
Q

What is the VC for High Risk Adults and Children?

A

Adult: <15 cc/kg

Child: < 10 cc/kg

or

VC < 40-50% than predicted

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4
Q

What is the PreOP Goal of PFTs?

A

Optimize Patient by treating Reversible Conditions

Important for Pts. w/ > 15% improvement after treatment

EX: Bronchodilators, Antibiotics, Diuretics

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5
Q

How do you manage the Ventilator Intraoperatively

A
  • Emphysema needs longer expiratory time (change I:E)
  • Monitor PIP
  • Keep EtCO2 near patient’s baseline
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6
Q

How do you manage Bronchospams Intraoperatively?

A

Neb Treatment

Avoid Histamine Releasing Drugs

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7
Q

What are some Histamine Releasing Drugs?

A

Pentothal (STP)

Morphine

Atracurium

Mivacurium

Neostigmine

ABX

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8
Q

How would an FEV1 > 50% predicted effect extubation?

A

Extubation will not be effected

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9
Q

How would an FEV1 of 25-50% + some hypoxemia & hypercarbia effect extubation?

A

Probable Prolonged Intubation

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10
Q

What considerations should you take for a patient with an FEV1 < 25% predicted?

A

Only perform Life-Saving Procedures

Regional Anesthesia

Long Term Vent

Poss. Trach

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11
Q

Extubation Criteria

A
  • VSS, Awake & Alert
  • 40% FiO2 = PaO2 > 70 & PaCO2 < 55
  • NIF < -20cm H2O
  • VC > 15 cc/kg
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12
Q

What criteria would be considered Respiratory Failure requiring Intubation?

A
  • RR > 35
  • PaCO2 > 55 mmHg
  • PaO2 < 70 on 40% FiO2
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13
Q

What A-a gradient would you consider Intubating?

A

A-a Gradient > 350 mmHg on 100% FiO2

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14
Q

At what Vital Capacity would you consider Intubating?

A

VC < 15 cc/kg

< 10 cc/kg for kids

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15
Q

At what ratio of Dead Space to Tidal Volume would you consider intubating?

A

Vd/Vt > 0.6

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16
Q

List A-I

(I is not Depicted)

A

A: Airway

B: Bone

C: Cardiac Silouette

D: Diaphragm

E & F: Equal Lung Fields

G: Gastric Bubble

H: Hilum (and Medastinum)

I: Invasive Lines (Not Shown)

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17
Q

Whats the most fundamental test of all PFTs?

A

Arterial Blood Gas

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18
Q

How soon much the blood ABG be measured after being drawn?

A

Within 15 min or glycolysis due to lacic acid

=

↓pH + ↑CO2

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19
Q

How long can you store an ABG for?

A

1-2 Hours on Ice

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20
Q

How does Heparin effect an ABG?

A

Lowers PCO2 by dilution

(Especially in Kids)

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21
Q

An increase in PCO2 by 10 mmHg would decrease in pH by ________

A

PCO2 increase by 10 = pH decrease of 0.8

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22
Q

What does the A-a Gradient measure?

A

A-a measures the difference b/t oxygen concentration in alveoli & arterial system

23
Q

How do you treat abnormal A-a gradients?

A

Treat Underlying Cause

O2, Adjust Ventilation, PEEP

24
Q

A decrease in Bicarb by 10 mmoles decreases pH by _________

A

Decrease of Bicarb by 10 decreases pH by 0.15

Replace Bicarb by half of deficit

25
What can cause Respiratory Alkalosis?
**Pregnancy** **Artificial Ventilation** Hypoxic Respiration Anxiety Kidneys **partially** fix pH
26
What can cause Metabolic Acidosis?
Low pH & Low HCO3- **Lactic Acidosis** DKA ASA Ingestion **Diarrhea**
27
What can cause Metabolic Alkalosis?
**Loss of H+ from Vomiting/NGT Suctioning** Giving too much Bicarb
28
What is Tidal Volume?
Volume Inspired/Expired w/ each normal breath 500 mL
29
What is Inspiratory Reserve Volume?
Extra Volume inspired above normal breathing. 3000 mL
30
What is Expiratory Reserve Volume?
The extra volume after normal expiration 1100 mL
31
What is Residual Volume?
Volume of air remaining after max expiration. 1200 mL
32
What is the Inspiratory Capacity
The maximum amount of air that a person can breathe in. Tidal Volume + Inspiratory Volume Reserve 3500 mL
33
What is Functional Residual Capacity?
The air in the lungs after normal expiration Expiratory Reserve Volume + Residual Volume 2300 mL
34
What is Vital Capacity?
The max amount of air a person can blow out after taking the biggest breath they can. Inspiratory Reserve Volume + Tidal Volume + Expiratory Reserve Volume 4600 mL
35
What is Total Lung Capacity?
The max volume of air the a person can breath in Vital Capacity + Residual Volume 5800 mL
36
Normally, how much is the FRC in comparison to the TLC?
40% of TLC
37
What are the techniques used to measure FRC and which is the most accurate?
* Helium Dilution * Nitrogen Washout * Body Plethysmography - sit in a sealed box and try to inhale through closed mouthpiece - more accurate
38
What is Forced Vital Capacity (FVC)?
The max amount of air a person can **forcibly** blow out after taking the biggest breath they can.
39
What is FEV1?
Volume of air **forcibly** exhaled in the first second. 3-5 L
40
What is FEV1%?
Ratio of FEV1 to FVC Normal: \> 75%
41
How does Airway Obstruction and Constricted Lungs compare to normal Flow Volumes?
* Both have reduced Total Lung Capacity & Residual Volume * Airway Obstruction - harder to get air out
42
How are FVC's different between a healthy person and a person with lung disease?
Total Volumes are not much different. ## Footnote **Major difference Amount of air each person can expire per second**
43
What is the most important clinical tool in assessing the Severity of Obstructive Airway Disease?
FEV1
44
What is the approximate FEV1% for a person with serious airway obstruction?
47% Acute Asthma: \< 20%
45
An abnormal FEV1 can indicate ______ disease, while an abnormal FVC can indicate ________ disease
Abnormal FEV1 = **Obstructive** Abnormal FVC = **Restrictive**
46
Degree of risk in Obstructive Lung Disease
FEV1/FVC Normal: \> 75% Mild: 60-75% Moderate 45-60% Severe 35-45% Extreme \< 35%
47
What helps distinguish b/t upper airway obstruction (extrathoracic) and generalized pulmonary disease (intrathoracic)?
Flow-Volume Loops
48
Extrathoracic obstruction decreases _______ flow, while Intrathoracic obstruction decreases ________ flow
Extrathoractic decreases **inspiratory flow** Intrathoracic decreases **expiratory flow**
49
Which type of lung disease when FEV1 \< FVC and the FEV1/FVC ratio is _decreased_?
Obstructive Lung Disease
50
Which type of lung disease when FVC \< FEV1 and the FEV1/FVC ratio is _increased_?
Restrictive Lung Disease
51
What is FEF25-75%?
Forced Expiratory Flow or Mid-Expiratory Flow Rate * **Effort Dependent** = Highly Variable * Indicator of Early Airway Obstruction
52
What is the "Will to Live" test?
Max Voluntary Ventilation or Max Breathing Capacity Patient breathes as hard and fast as possible x 12 seconds **Extremely Effort Dependent**
53
What does the Max Voluntary Ventilation (MVV) test for?
Breathing Motivation, Mechanics, Strength, and Endurance **Low MVV = ↑Morbidty & ↑Mortality** for thoracic Sx

Spring 2020 - Physiology 1 (24 decks)

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