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Pulmonology Flashcards

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1
Q

Acute respiratory distress syndrome

A

Non-cardiogenic pulmonary edema

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2
Q

Cor pulmonale

A

Right-heart failure

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3
Q

Hemoptysis

A

Coughing up blood

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4
Q

Orthopena

A

Difficulty breathing while lying down

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5
Q

Paroxysmal nocturnal dyspnea

A

Difficulty breathing at night

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6
Q

Positive end-expiratory pressure (PEEP)

A

Extrinsic PEEP uses an impedance valve to increase volume of air remaining in lungs at end of expiration to improve gas exchange

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7
Q

Subcutaneous emphysema

A

Crackling under the skin upon palpitation due to trapped air. Typically found in chest, neck, or face

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8
Q

Tidal volume

A

Volume of air inhaled or exhaled with each breath; normal adult tidal volume is about 500mL

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9
Q

Ventilation

A

Mechanical process that moves air in and out of lungs

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10
Q

Inspiration

A

Active process of ventilation (requires energy)

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11
Q

Exhalation

A

Passive process of ventilation

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12
Q

External respiration

A

Movement of oxygen from the alveoli into the bloodstream and movement of CO2 from the blood stream to the alveoli

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13
Q

Internal respiration

A

The exchange of gasses (O2 & CO2) between the bloodstream and the tissues in the body

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14
Q

Minute volume

A

Respiratory rate x tidal volume

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15
Q

CO2 drive

A

The primary system for monitoring breathing status

Monitors CO2 levels in blood and cerebral spinal fluid

Chemoreceptors in the brain detect increased CO2 and rapidly trigger increased respiratory rate

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16
Q

Hypoxic drive

A

Backup to CO2 drive

Monitors oxygen levels in plasma

Prolonged exposure to high concentration oxygen in hypoxia drive patients can cause respiratory depression

May be present in end-stage COPD patients

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17
Q

Acid-base disorders

A

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

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18
Q

Respiratory acidosis

A

Low pH and elevated CO2

PaCO2 greater than 45mmHg

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19
Q

Respiratory alkalosis

A

Elevated pH and low CO2

PaCO2 less than 35mmHg

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20
Q

Metabolic acidosis

A

Low pH and low HCO3

HCO3 below 22mmHg

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21
Q

Metabolic alkalosis

A

Elevated pH and elevated HCO3

HCO3 greater than 26mmHg

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22
Q

Normal arterial blood gas values

A
  • pH: 7.35-7.45
  • PaO2: 80-100 mmHg
  • PaCO2: 35-45 mmHg
  • HCO3: 22-26 mEq/L
  • SaO2: 95% or above
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23
Q

Without adequate respiration x

A
  • heart and brain become irritable almost immediately
  • brain damage within 4 min
  • permanent brain damage within 6 minutes
  • irrecoverable brain damage within 10 minutes
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24
Q

Ventilation-perfusion mismatch

V/Q mismatch or V/Q defect

A

*Occurs when lungs receive oxygen,but not adequate blood flow
-or-
when the lungs receive blood flow, but inadequate oxygen

*could be a ventilator problem or perfusion problem

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25
Mallampati score (used for oral intubation)
Class I: entire tonsil clear Class II: upper half of tonsil visible Class III: soft and hard palate visible Class IV: only hard palate visible
26
LEMONS (for difficult airway)
``` L- look externally E- evaluate 3-3-2 rule M- mallampati score O- obstruction N- neck mobility S- saturation’s ```
27
Oxygen cylinder sizes and contents
D cylinder: about 350-L ; 0.16 E cylinder: about 625-L ; 0.28 M cylinder: about 3,000-L ; 1.56
28
Atonal respiration
Slow, shallow, infrequent breaths Indicates brain anoxia
29
Biot’s respiration
Irregular pattern of rate and depth and periodic apnea Indicates increased ICP
30
Central neurological hyperventilation
Deep, rapid respiration’s Indicates increased ICP
31
Cheyenne-Stokes respiration’s
Progressively deeper and faster breaths, changing to slower and shallow breaths Indicates brain injury
32
Kussmaul respirations
Deep, gasping breaths Indicates possible DKA
33
Rales (crackles)
Fine, bubbling sound on inspiration Indicates fluid in lower airways
34
Rhonchi
Coarse sounds on inspiration Indicates inflammation or mucus in lower airways
35
Wheezes
High-pitched sound on inspiration or expiration Indicates bronchoconstriction
36
Snoring
Indicates partial airway obstruction from the tongue
37
Stridor
High-pitched sound Indicating significant upper airway obstruction (ex:foreign body, angioedema, anaphylaxis)
38
Gurgling
Indicates fluid in the upper airway
39
Pleural friction rub
Sounds like dried pieces of leather rubbing together
40
SpO2
Pulse oximetry
41
ETCO2
Capnography
42
Continuous Positive Airway Pressure (CPAP)
* Indications: alert and spontaneously breathing patients, at least 12 years, in significant respiratory distress. (Sleep apnea, COPD, pulmonary edema, CHF, pneumonia); tachypnea, SpO2 below 94%, use of accessory muscles * Contraindications: apnea, unable to follow verbal commands, suspected pneumothorax, chest trauma, tracheostomy, vomiting, GI bleeding and hypotension
43
Infarct
Area of necrosis or death
44
Pulse CO-oximetry (SpCO)
Non-invasive measurement of carbon monoxide saturation of hemoglobin
45
Pulse oximetry (SpO2)
Non-invasive measurement of oxygen saturation of hemoglobin
46
Capnography
Measure or monitoring of exhaled CO2
48
Sudden drop of ETCO2 to zero
* esophageal intubation * ventilation defect or disconnect * defect in CO2 analyzer
49
Sudden decrease of ETCO2 (not to zero)
* leak in ventilator; obstruction * partial disconnect in ventilator circuits * partial airway obstruction (secretions)
50
Exponential decrease of ETCO2
* pulmonary embolism * cardiac arrest * sudden hypotension * severe hyperventilation
51
Change in CO2 baseline
* calibration error * water droplet in analyzer * mechanical failure (ventilator)
52
Sudden increase in ETCO2
* accessing an area of lung previously obstructed * release of tourniquet * sudden increase in BP
53
Gradual lowering of ETCO2
* hypovolemia * decreasing cardiac output * decreasing body temp; hypothermia; drop in metabolism
54
FBAO
BLS: Conscious - Abdominal thrusts, alt back blows & chest thrust Unconscious - CPR ALS: *attempt to remove foreign body with laryngoscope and McGill forecps *Attempt ETT insertion to try passing tube through obstruction or forcing it into right mainstem
55
ARDS - Acute Respiratory Distress Syndrome
* a form of pulmonary edema NOT caused by poor left ventricle function - causes: sepsis, trauma, OD, drowning, toxic inhalation - s/s: decline in respiratory status; tachypnea, tachycardia, decrease in SpO2 - mgmt: monitor SpO2, sit pt upright with legs dangling, CPAP, PEEP
56
COPD
- cause: smoking and environmental toxins * incl emphysema & chronic bronchitis, increased mortality -s/s: hx of smoking, cough with increased mucus, right heart failure, JVD & pedal edema, decrease SpO2, clubbing, Ronchhi lung sounds
57
Asthma
- cause: chronic inflammatory airway disease - s/s: dyspnea, wheezing, cough, tachypnea, tachycardia, decrease SpO2, pulses paradoxus (decrease in systolic BP of at least 10mmHg during inspiration - mgmt: monitor expiratory flow rates (PEFR), aggressive use of bronchodilators to reverse bronchospasm - status asthmaticus: not reversible with bronchodilator medications, may have absent lung sounds, respiratory arrest is eminent
58
Pneumonia
*lung infection - s/s: patients with a history of CP with associated fever, chills, cough * weakness, dyspnea, pleuritic CP, abnormal lung sounds -mgmt: dehydration is common, consider use in IV fluids
59
Pulmonary embolism
-patho: blockage in pulmonary artery that decreases blood flow - s/s: possible indications of DVT (warm, swollen,lower extremity with pain upon palpitation) - tachypnea, tachycardia, acute unexplained dyspnea, cough, pleuritic CP -mgmt: O2 therapy, prepare for sudden cardiac arrest & rapid transport
60
Spontaneous pneumothorax
- patho: not related to blunt or penetrating trauma, reoccurrence rate high (50%); common in male smokers - s/s:acute onset of sharp pleuritic CP or shoulder pain, localized diminished lung sounds, tachypnea, possible subcutaneous emphysema - mgmt: monitor SpO2, O2, transport in a position of comfort
61
Hyperventilation syndrome
* hyperventilation considered significant until confirmed otherwise - s/s: tachypnea, CP, anxiety, possible carpal pedal spasms due to alkalosis & hypocalcemia - causes: anxiety, metabolic & respiratory disorders, pulmonary embolism, cardiac & CNS disorders, medication (aspirin) - mgmt: monitor SpO2, O2, transport
62
Gradual increase in ETCO2
* rising body temp * hypoventilation * CO2 absorption * partial airway obstruction (fbao); reactive airway disease
63
Processes of gas exchange
* ventilation * diffusion * perfusion
64
Residual volume
Air that remains in the lungs at all times maintaining the patency of the alveoli
65
Inspiratory reserve volume
Additional volume of air beyond the volume inspired during quiet respiration
66
Expiratory reserve volume
Amount of air that can be forcibly expired out of the lung after a normal breath
67
Diffusion
Process by which gases move between the alveoli and the pulmonary capillaries
68
Most important determinant of the ventilatory rate
Arterial PCO2 *Increase in arterial PCO2 results in a decrease in the pH of the blood
69
Perfusion
Circulation of blood through the lungs (pulmonary capillaries)
70
Lung perfusion is dependent on three conditions:
* adequate blood volume * Intact pulmonary capillaries * Efficient pumping of blood by the heart

pulmonology (1 decks)

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