Resp Rapid Review Cards Flashcards
(116 cards)
1
Q
mullers maneuver
A
inhalation against a closed glottis
2
Q
valsava’s maneuver
A
exhalation against closed glottis
3
Q
upper airway extends to..
A
cricoid cartilage
4
Q
trachea ends
A
T4-T5
5
Q
both bronchi take off at 55 degree angle up to what age
A
up to 3yrs old
6
Q
how much vital capacity required for an effective cough?
A
15ml/kg
7
Q
when TPP +
when TPP -
A
airway is open
airway is closed
8
Q
increasing PaCO2 to EtCO2 gradient means waht?
A
increased dead space so decreased EtCO2
9
Q
how does PPV affect deadspace
A
it increases deadspace
10
Q
Vd/Vt ratio is spontaneous breathign vs mechanical ventilation
A
0.33 in spontaneous
0.5 in mechanical ventilation
11
Q
how does neck extension affect dead space
A
neck extension increases deadspace
12
Q
what equation do you need to calculate physiologic dead space?
A
bohr equation
Vd/Vt = (PaCO2 -PeCO2) / PaCO2
PeCO2 = exhaled gas but you can use end tidal in its place.
13
Q
what is normal V/Q ratio
A
0.8 4L/min ventilation and CO 5L/min
14
Q
base of lung vs apex for ventilation and perfusion
A
base more ventilation and more perfusion
apex higher V/Q ratio
PAO2 is higher in apex
PACO2 higher in base (more ventilation)
15
Q
what is the likley problem with V/Q mismatch
A
oxygenation is the most likely issue, lot bigger problem than CO2 elimination. CO2 retention suggests severe V/Q mismatch.
16
Q
when does surfactant production start and peak?
A
stars: 22-28 weeks
peaks: 35-36 weeks
17
Q
what contributes to anatomic shunt
A
thesbian, pleural, bronchiolar veins
18
Q
what does the alveolar gas equation actually tell you?
A
max PAO2 that can be acheived at a given FiO2
gives more context for evaluationg PAO2.
19
Q
what increases A/a gradient?
A
diffusion limitation
V/Q mismatch
shunt
20
Q
what does not effect A/a gradient?
A
hypoxic mixture
hypoventilation
21
Q
when will supplemental oxygen not raise oxygenation?
A
with a shunt
22
Q
give me the normal lung volumes
A
for 70Kg Male
IRV 3,000 (think about the bag)
TV 500
EV 1,100
RV 1,200
closing volume: varible
23
Q
normal CaO2
A
20ml/dL
24
Q
normal DO2
A
1,000mlO2/min
25
normal VO2
250ml.min or 3.5ml/kg/min
26
normal PaO2 if Hgb is fuly saturated
100
27
what is the bohr effect
increased partial pressure of CO2 and decreased pH > Hgb releases O2
Remember bOHr = oxygen + Hgb
law about how changes in acid alter bloods O2 carrying capacity.
28
Net ATP gain in each step of...
glycolysis 2ATP
krebs cycle 2 ATP
oxidative phosphorylation 34 ATP
29
3 ways CO2 transport is buffered in the blood
1. as bicarb 70%
2. bound to Hgb 23%
3. dissolved in plasma 7%
30
what converts CO2 + H2O to H2CO3?
carbonic anhydrase
31
what is the hamburger shift
every HCO3 - molecules that leaves RBC is replaced with one CL- to maintain electroneutrality
32
Bohr effect has what effect on Hgb
causes Hgb to release O2
33
haldane effect
increased CO2 loading into the blood
increased CO2 shifts CO2 curve to the right and vice versa
how changes in PO2 alter bloods carrying capacity of CO2. Explains why venous blood can carry more CO2 than arterial blood.
34
how does hypercarbia effect the heart?
cardiac depression and SNS stimulation
35
what is the main monitor of PaCO2? where is it?
cenral chemo receptor in medulla
36
secondary monitors of PaCO2
peripheral chemo receptors in cartodi bodies and transverse aortic arch
37
what may cause left shift in CO2 response curve?
hypoxemia
metabolic acidosis
surgical stimulation
intracranial HTN
38
what may shift CO2 response curve to the right?
VAs
opioids
NMBs
metabolic alkolosis
carotid endarterectomy
39
what is located in medulla resp center
DRG
VRG
40
when is the DRG and VRG active
DRG: active during inspiration
VRG: active during expiration
41
what is found in pontine resp center and where are they found?
pneumotaxic center in upper pons
apneustic center in lower pons
42
function of pneumotaxic center
inhibits the DRG
43
function of apneustic center
stimulate DRG
44
central chemoreceptors are affected in what way by profound hypocarbia nad hypoxemia
depressed
45
do central chemo receptors responsd directly or indirectly to CO2?
indirectly. CO2 > H+ & HCO3- after crossing BBB
46
PaO2 < x is considered hypoxemia
PaO2 < 60mmHg
47
what MAC level depresses the hypoxic resp drive
MAC 0.1
48
What is the hering-breur inflation reflex
hyperinflation turns off reflex
49
hering-breur deflation reflex
small lung volumes activate ^ Resp drive
50
what do J receptors do? when?
^ RR in the setting of PE or CHF
51
what causes new baby to take their first breath?
paradoxical refelx of the head
52
list some meds that do do not inhbit HPV
ketamine, propofol, and opioids
53
smooth airway innervation
no SNS, only B2 receptors
54
what is the most sensitive indicator of small airway disease?
FEF 25-75
55
what is a normal FEV1
70-80% of predicted value
56
normal FEV1/FVC ratio
75-80% predicted value
57
name a random disease that can lead to COPD
alpha 1 antitrypsin deficency
58
increasing O2 in COPD is bad because of waht two reasons
haldane effect and HPV
59
anothe way to indirectly increase I:E ratio
decrease RR
60
should you use PEEP in COPD?
yes
61
PAHTN is pressure above what?
> 25
62
CO2 production is the most with what VAs
Des > ISO >>> Sevo
63
how do you treat CO poisining?
O2
64
at what age is DLT appropriate?
>8 or >10 depending on the book
65
best indicators of PPC in pulm surgery
FEV1 < 40%
DLCO < 40%
VO2 max < 15ml/kg/min
66
mallampati scores associated with difficult intubation
3 and 4
67
inter incisor gap is normally
2-3 finger breadths or 4cm
68
thyromental distance measuring what increases chance of difficult intubation
< 6 or > 9
69
markers of difficult mask ventilation
BONES
beard
obese BMI > 26
No teeth
elderly > 55
snoring
70
difficult LMA placement indicators
RODS
restricted mouth openning
obsturction
distored airway
stiff lungs or c-spine
71
3-3-2 rule
interincisor gap > 3
thyromental distance > 3
thyrohyoid > 2
72
weird disease that can lead to angio edema
what is the tx?
C1 esterase deficiency
tx: icatibant, ecallantide, FFP or C1 esterase concentrate
73
what nerves may be injured with an LMA?
lingual, hypoglossal, and recurrent laryngeal nerves
74
LMA sizes based on weigth and max ETT that can pass
LMA 3 30-50kg 20ml 6.0 ETT
LMA 4 50-70kg 30ml 6.0 ETT
LMA 5 70-100kg 40ml 7.0 ETT
75
max PPV with different LMAs
normally 20
LMA prosal up to 30
76
what is LMA supreme
disposable LMA proseal
77
describe the LMA C-Trach
fastrach with a camera to visualze ETT going in
78
king tube things to know
only one pilot baloon
child sizes are available
only one lumen for ventilation
79
comtibute sizing
4-6ft 37
> 6ft 41
80
is combitube a secure airway?
yes
81
any child sizes for combitube?
no
82
CI to combitube
zenkes diverticulum
esophageal disease
ingestion of caustic substances
83
trigeminal nerve breakdown with associated airway innervation
V1 opthalmic (ant. ethomoidal) nares and ant 1/3 nasal septum
V2 maxillary (sphenoplatile) tubrinate and septum
V3 mandibular (lingual) ant. 2/3 of tongue
84
what does microstomia mean
small mouth
85
why is retrograde intubation bad optin in CICO
can take up to 5-7min
86
any CI for tracheostomy?
no
87
when is Cricothyrotomy CI?
less than 6-10yrs old
88
complication that can occur with LMA if patient is too light
acn lead tos walling that can cause gastric infusflation
89
could you use remifentanil for an awake fiberoptic intubation?
yes
90
first airway cartilage encountered during DL
epiglottis
corniculate
aryetnoid
cricoid
91
how to calculate TPP
TPP = alveolar pressure - intrapleural pressure
92
other names for TPP
intrathoracic pressure
intrapulmonary pressure
93
resp pressures during tidal breathing
TPP always positive to keep airways open
intrapleural pressure always negative to keep lungs inflated
alveolar pressure slightly negative during inspiration slightly positive during expiration
94
when would intrapleural pressure become positive?
except from pathologic conditions, like pneumothorax it is always negative except for forced expiration.
95
effects of adding an HME to the circuit
Increased PaCO2 and decreased PaO2
^ dead space > ^PaCO2
because of alveolar gas equation, ^ PaCO2 > PAO2 decreases > decreased PaO2
96
venous admixture = what
more shunt
97
Normal DLCO
17-25
98
what does decreased DLCO tell us
two options
decreased surface area (emphysema)
increased thickness (pulm fibrosis or pulm edema)
99
does asthma affect the alveolocapillary membrane?
no
100
what is bronchitis
inflammation and mucus production > decreased airway diameter
101
what is emphysema
decreased surface area of alveolocapillary interface and loss of elastic recoil
102
what is cor pulmonale
^PVR > RHF
103
immediately after aspiration:
chemical injury occurs immediately so no need to deep tracheal suctioning or bronchoscopy, (although it is usefull to suction out the mouth)
atelectastis will ^ pulm shunt and hypoxemia is the halmark sign of aspiration pneumonitis. PEEP is indicated to reduce shunt
104
when are abx indicated after aspiration pnuemonitis?
if pt has fever or ^ WBC for > 48hrs
105
what increases A/a gradient?
diffusion defect
V/Q mismatch
R-L shunt
supplemental oxygen will help for the top two, for R'L shunt > about 30% increased O2 wont do anything
106
situations when A/a gradient is normal
high altitude
hypoventilation
supplemental oxygen will help in both instances
107
how might hypoventilation in PACU affect anesthetic meds
hypoventilation > resp acidosis > potentiates NMBs and decreased efficacy of anticholinesterases
108
limit fluids to how much in pneumonectomy
limit crystalloid to < 3L in the first 24hrs
109
two contraindications to NPA
hx of transsphenoidal hypophysectomy and hx of previous caldwel-luc procedure
light anesthesia is not a CI, they should tolerate it better than OPA
110
LMA sizes in peds and other info
< 5kg 1 LMA 3.5 ETT
5-10 1.5 LMA 4.0 ETT
10-20 2 LMA 4.5 ETT
20-30 2.5 LMA 5.0 ETT
i think the ETTs are uncuffed??
111
which two intubation approaches have the least ammount of c-spine movement?
fiberoptic bronch and blind nasal intubation
112
Main accessory m of inspiration
external intercostal
113
internal intercostal muscles help during?
expiration
114
common comorbidites in CF
DM and hepatic cirrhosis
affects all secretory organs
115
how does PEEP affect PHTN
detrimental
116
considerations with down syndrome
big tongue
micrognathia
high archd and narrow palate
subglottic stenosis
variable airway obstruction
