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Pete FFICM SOE/OSCE > Resp > Flashcards

Resp Flashcards

1
Q

Minimum staffing needs to do a perc Trachy

A

3
Two medics
One assistant

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2
Q

Cuff pressure in a perc trachy

A

20-30

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3
Q

Berlin criteria for ARDS

A

Timing - within one week of clinical insult

Chest imaging - bilateral opacities, NOT explained by effusions or collapse, and in keeping with pulmonary oedema

Origins of oedema - respiratory failure not explained by cardiac failure or fluid overload. Consider an echo

Hypoxia - PF ratio
26.6 to 39.9 mild
13.3 to 26.6 moderate
Less than 13.3 severe

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4
Q

Berlin criteria timing

A

Within one week of the clinical insult

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5
Q

Berlin criteria chest imaging

A

Bilateral opacities, not explained by effusions or collapse, and in keeping with pulmonary oedema

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6
Q

Berlin criteria hypoxia

A

PF ratio

Mild 26.6 to 39.9
Moderate 13.3 to 26.6
Severe less than 13.3

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7
Q

Moderate asthma

A

PEFR 50-75% predicted

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8
Q

Severe asthma

A 
PEFR 33-50
Resp rate more than 25
Heart rate more than 110
Low or normal pCO2
Cannot complete a sentence
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9
Q

Life threatening asthma

A 
PEFR less than 33%
Silent chest
Feeble effort
Hypotension
Arrhythmia
Bradycardia
Hypoxia less than 92% or pao2 less than 8
Hypercapnia
Altered neurological state
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10
Q

Risk factors for fatal asthma

A

Previous life threatening with acidosis or need for ventilation
Hospital admission in last year
Three or more asthma meds for chronic control
Heavy beta agonist use
Brittle asthma :
Type 1 wide PEFR variability
Type 2 sudden severe attacks despite being well controlled
Adverse psycho social circumstances - non compliance, alcohol abuse, social isolation

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11
Q

CURB 65 score

A 
Confusion
Urea more than 7
Resp rate > 30
Systolic < 90
Age> 65
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12
Q

Effusions based on protein

A

Transudate < 30g/L

Exudate > 30g/L

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13
Q

Lights criteria

A

An exudate is suggested by

Pleural to serum protein level > 0.5
Pleural to serum LDH level > 0.6
Pleural LDH level that is more than 2/3 upper limit of normal serum LDH level

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14
Q

Pleural fluid features of an empyema

A

PH less than 7.2
Glucose < 3.3
Bacteria on microscopy
Fluid LDH > 1000

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15
Q

What is compliance

A

Change in lung volume per unit change in pressure

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16
Q

What is the compliance of the lung and the chest wall

They are the same

A

200ml/cmH2O

17
Q

What is the total compliance and how is it calculated

A

100ml/cmH2O

Calculated at the sum of reciprocals

1/total = 1/chest wall + 1/lung

= 1/200 + 1/200

= 2/200

= 1/ 100

Therefore 100

18
Q

What is static compliance and how is it measured

A

Compliance in the absence of gas flow

Do an end inspiratory hold manoeuvre or add insp pause to estimate PLATAEU
Pressure

Eqn:
C= Vt/(Pplat - PEEP)

19
Q

What decreases static compliance

A

Lung parenchyma disease ARDS, pneumonia, fibrosis

Chest wall disease: kyphoscoliosis, obesity, burns

Raised IAP

20
Q

What is dynamic compliance

What is the eqn

A

Measured during rhythmic breathing

Determined by the PEAK pressure, not the plateau

Cdyn= Vt/Ppeak - PEEP

21
Q

Which compliance is smaller and why

A

Dynamic compliance is smaller

Peak (the measurement of dynamic) is higher than plateau (the static measurement)

Peak pressure represents compliance of lung, chest wall and pressure needed to overcome airway resistance

Usually dynamic is 2-3 ml/cmH2O less than static

22
Q

The difference between dynamic and static is quite small, what would make it increase

A

Obstructive airway disease, where higher pressures are needed to overcome the overcome the increased resistance

23
Q

What is the relationship between alveolar minute ventilation a PaCO2

A

Doubling the MV halves the paCO2

24
Q

What is the relationship between minute volume and pao2

A

Increasing the minute volume does little to o2, incredibly small rises, but parallel lines occur on increasing the Fio2. The o2 starts to fall when the MV drops below 5

25
Q

Relationship between PaCO2 and minute ventilation

A

Rising CO2 causes the minute volume to increase, linearly, up to a point where the resp drive is blunted.

The curve shifts right, by chronic hypercapnia, and opiate

26
Q

Relationship between PaO2 and MV

A

PaO2 has little effect on MV, EXCEPT when it falls below 8, when MV starts to increase. Curve shifts up and right in raised CO2 as it initiate the respiratory drive

27
Q

What is the oxygenation index

A

OI = FiO2 x mean airway pressure/PaO2. X 100

It is the pressure needed to maintain a given PF ratio, so that comparison between patients with same PF but different vent requirements are made

High OI is worse

28
Q

What is the Murray score and it’s components

A

Determines lung injury in ARDS

LUNG INJURY SCORE

number of involved quadrants on CXR
PF ratio
Level of PEEP
Static compliance (Vt/plat-PEEP)

29
Q

What is peak pressure

A

Maximum airway pressure measured in a resp cycle

30
Q

What is the plateau pressure

A

Airway pressure measured during inspiratory pause

31
Q

What is the significant of peak pressure

A

Pressure applied to large airways, and therefore influenced by airway resistance

32
Q

Significance of plateau pressure

A

Pressure applied to alveoli

33
Q

Criteria for readiness to wean

A

Improving clinically

Adequate oxygenation > 8kPa (Fio2<0.4, PEEP<10)

Cardiovasular stability (HR<120, minimal to no vasopressors)

Afebrile

No resp acidosis

Hb>70

GCS>12

Cough function to clear secretion

34
Q

Conditions of a RSBI

A

Spontaneously breathing

Awake

Minimal Resp Support

2 minutes on a T-piece

Second minute determines the result - RR/Tv

Results as breaths/min/L

Greater than 105 - high risk of extubation failure (95%)

Less than 100 - 80% chance of success

35
Q

Does RSBI improve outcomes

A

No

36
Q

Definition of prolonged MV

A

Ventilator support for greater than 21 days

UK definition based on invasive vent

37
Q

International concensus catergories of weaning

A

Simple, Difficult, Prolonged

Simple: Progress from wean to successful extubation at first go

Difficult: up to 3 SBTs or 7 days from first SBT prior to extubation

Prolonged: failure to extubate after at least 3 SBTs or more than 7 days following first SBT

38
Q

Maximum MRC score

A

60

39
Q

Name some of the dyshaemoglobinaemias that can cause spurious results on pulse oximetry?

A

methaemoglobinaemia, carboxyhaemoglobin
and sulfhaemoglobin

Pete FFICM SOE/OSCE (199 decks)

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