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Respiratory Flashcards

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1
Q

Components of Upper Respiratory Tract

A

Sinus, nasal cavity, external nose, nostril, tongue, larynx, esophagus, trachea, pharynx, glottis, epiglottis, opening of eustachian tube

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2
Q

Components of Lower Respiratory Tract

A

Larynx, Trachea, Bronchi, Lungs

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3
Q

Central Chemoreceptors

A

In brain, respond to changes in H and arterial Co2 in CSF
Positive feedback loop

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4
Q

Dorsal and ventral respiratory neurons

A

In medulla
Control rhythm of respiration

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5
Q

Apneustic and Pneumotaxic centres

A

In pons
Affect rate and depth of respiration

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6
Q

Activation of muscles of respiration

A

Phrenic nerve

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7
Q

Peripheral Chemoreceptors

A

In carotid and aortic bodies, respond to changes in CO2, pH and O2 levels
Secondary drive

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8
Q

Low pO2 in peripheral chemoreceptors

A

Increase ventilation

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9
Q

Inspiratory muscles

A

Increase thoracic cage volume –> decreased intrathoracic pressure

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10
Q

Expiratory muscles

A

Decrease thoracic cage volume –> increased intrathoracic pressure

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11
Q

Tidal volume

A

500mL
Amount of air moved in or out each breath

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12
Q

Inspiratory Reserve Volume

A

3000mL
Max volume inspired above normal inspiration

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13
Q

Expiratory Reserve Volume

A

1100mL
Max volume expired below normal expiration

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14
Q

Residual Volume

A

Volume of air left in the lungs after maximum expiratory effort

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15
Q

Surfactant

A

Produced by type II alveolar epithelial cells
Reduces surface tension by forming a layer between aqueouss fluid lining alveoli and air

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16
Q

Bronchial Sounds

A

Heard over trachea
I:E ratio 2:3 or 1:3
Loud, harsh, high pitched

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17
Q

Broncho-vesicular sound

A

Anteriorly near 1st and 2nd IC space
Soft/breezy

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18
Q

Vesicular Sounds

A

Lungs, peripheral
Lower pitch

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19
Q

Adventitious sounds

A

Crackles, wheeze, stridor, pleural rub

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20
Q

Pulmonary Oxygen Toxicity

A

Cellular injury to lung parenchyma and airway epithelium
O2 causes thickening of intra-cellular space, loss or inhibition of surfactant
Results in ARDS, fluid leaking, and atelectasis
Depends on O2 concentration, length of exposure, underlying condition

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21
Q

Nitrogen Washout

A

Damage from deficiency of nitrogen. High concentrations of O2 causes nitrogen to be exhaled and replaced by O2 in the alveoli. Removal of O2 causes alveolar collapse and hypoxemia

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22
Q

Oxygen Induced Hypercarbia/Apnea

A

Extended time to occur
Affects pts that utilize peripheral chemoreceptors to breath
Affects hypoxic drive
COPD pts

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23
Q

Retinopathy of Prematurity

A

Insult to developing retinal vasculature from elevated PaO2 leading to abnormal blood vessel growth
Leads to separation of retina, visual impairments, blindness
Oxygen radical attack incompletely developed retinal tissue
Premature infants

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24
Q

Factors influencing affinity of HgB for O2

A

Acidity
Partial pressure of CO2
Temperature
2,3 BPG

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25
Right Shift
Acidosis Hyperthermia Hypercapnia Hypoxia Anemia Increased 2,3 BPG More oxygen available to the tissues, high affinity at lungs
26
Shift Left
Alkalosis Hypothermia Hypocapnia Decreased 2,3 BPG Carboxyhemaglobin
27
V
Wasted perfusion Anything that decreases or completely stops O2 from reaching alveoli Pulmonary oedema, COPD, asthma, FBAO
28
V>Q
Dead space, wasted ventilation Oxygen present but no pulmonary capillaries/blood for diffusion
29
Hypoxic Hypoxia
Lack of oxygen diffusion into pulmonary circulation Decreased amount inhaled Pulmonary oedema, COPD, ARDS, FBAO, drowning, high altitude
30
Anemic Hypoxia
Lack of RBC to transport O2 Will not respond to O2 therapy Low HgB, sickle cell anemia, hemorrhage, CO poisoning
31
Histotoxic Hypoxia
Inability to offload oxygen from hemoglobin Inability for cells to utilize oxygen Requires treatment of underlying cause to respond to O2 Metabolic alkalosis, cyanide poisoning
32
Stagnant Hypoxia
lack of circulating O2 Blood flow insufficient to supply tissues Treat the cause Angina, MI, crush injury, poor circulation
33
Asthma
Hyper-reactive airway to stimuli resulting in inflammation, swelling, and narrowing of trachea and bronchi
34
3 main insults causing asthmatic respiratory distress
Inflammation Bronchoconstriction Excess mucus Secretion
35
Asthma Triggers
Allergens Exercise Respiratory infeciton Nose + sinus problems Drug and food additives GERD Emotional stress
36
Early Phase Asthma
30-60 min post exposure, subsides 30-90 min late Bronchospasm Release of histamine and leukotrienes Release of inflammatory cytokines Wheezing, cough, chest tightness, dyspnea
37
Late Phase Asthma
Inflammation Histamine causes hyper-responsive airways Increased resistance causes air trapping and hyperinflation of lungs Can cause lung damage Peaks in 5-6 hours with infiltration of eosinophils, and neutrophils Within 1-2 day infiltration with monocytes and lymphocytes occurs
38
Medication Therapy of Asthma
Bronchodilators Longer acting bronchodilator Anti-inflammatory drugs Leukotriene Modifiers
39
Dexamethasone Indications
Hx of asthma/COPD or 20 pack/year Hx of smoking
40
Contraindications dexamethasone
Allergy to steroids Steroids in last 48 hours
41
Treatment Dexamethasone
PO/IM/IV 0.5mg/kg up to 8mg 1 dose
42
Permissive Hypercapnia
Tolerating higher ETCO2 instead of attempting to decrease value with aggressive ventilation
43
COPD
Chronic inflammatory lung disease causing obstructed airflow from lung
44
Chronic Bronchitis
Mucus plugging/inflammatory edema Increased airflow resistance leads to alveolar hypoventilation Increased secretions due to ongoing mucus + phlegm Hypoxemia and Hypercarbia
45
Hypoxemia
Increased RBCs without oxygen Cyanosis (blue bloater)
46
Hypercarbia
Pulmonary vascular constriction Increased RV work Right heart failure For Pulmonale
47
Emphysema
Excess loss of elastin causing lung tissue to lose elastic recoil Destruction of alveolar septum Neutrophils produce elastase that destroy elastin Pink Puffer
48
Pathology of Emphysema
Destruction of alveolar walls/septum Destruction of gas exchange surface area Distension or pulmonary air space Loss of elastic recoil
49
Emphysema vs Bronchitis
Bronchitis: irritation + inflammation of upper and lower air tracts Emphysema: alveoli, destruction of elastin, loss of ability to recoil
50
Factors affecting CO
HR Preload Afterload Contractility
51
Preload
Volume of blood in LV at diastole
52
Starlings Law
Greater the stretch, greater the contraction
53
Increases of preload
Fluid increase Vasoconstriction
54
Decreases of Preload
Fluid loss Vasodilation Loss of atrial kick
55
Afterload
Resistance LV must pump against
56
Increases of Afterload
HTN Vasoconstriction
57
Decreases of Afterload
Vasodilation
58
Contractility
Ability of heart to squeeze, strength of contraction and ejection fraction
59
Ejection fraction
Amount of blood as percent that LV pushes 50-70%
60
Decreases of Contractility
Infected tissue Ischemic tissue Acid-base imbalance Negative inotropes
61
Increases of Contractility
Sympathetic stimulation Positive inotropes (digoxin)
62
Compensatory mechanisms of CHF
SNS stimulation Myocardial hypertrophy Hormonal response
63
Left sided heart failure
Blood backs up through left atrium and into pulmonary system Pulmonary HTN Biventricular failure
64
Causes of LSHF
HTN MI Dysrhythmias Valvular disorder
65
Right Sided Heart Failure
Dereased RV Blood backs up into right atrium and venous circulation Can lead to venous congestion
66
Causes of RSHF
LVF For pulmonal RV infarction
67
Clinical Manifestations of Acute CHF
Pulmonary edema Agitation Pale/cyanosis Cold, clammy skin Severe dyspnea Tachypnea Pink, frothy sputum
68
Clinical Manifestations of Chronic CHF
Fatigue Dyspnea Tachycardia Edema Nocturia Behavioural changes Chest pain Weight change Skin changes
69
Drug Therapy Chronic CHF
ACE inhibitors Diuretics Inotropic drugs B-adrenergic drugs
70
Goal of Initial CHF therapy
Decrease intravascular volume Decrease venous return Decrease afterload Increase gas exchange and oxygenation Increase cardiac function Decrease anxiety
71
Nitroglycerin
Relaxes vascular smooth muscle Peripheral venodilation Dilation of arteriolar resistance vessels of peripheral circulation Decrease MVO2
72
Side effects of Nitro
Headache Dizziness Weakness Tachycardia Hypotension Orthostasis Skin rash Dry mouth N/V
73
Causes of PE
Trauma/travel Hypercoagulability or hormone replacement Recreational drugs Older Malignancy Birth control Obesity/obstetrical Surgery Immobilization Sickness
74
3 Types of PE
Massive Submassive Low Risk
75
Etiology of PE
DVT moves to pulmonary arterial tree causing V/Q mismatch. Increase pulmonary artery resistance leads to right ventricular failure
76
Clinical Manifestation PE
Tachypnea SOB Hypotension Tachycardia Altered LOC Anxiety Pale Cough Central cyanosis Leg pain Cardiovascular collapse S1Q3T3
77
S1Q3T3
S Wave in lead 1 Q wave in lead 3 T wave inversion lead 3
78
Immunologic Anaphylaxis
Allergen enters system and interacts with B cells, creating antibodies for the allergen
79
Non-Immunologic Anaphylaxis
Allergen interacts directly with receptors on mast cells
80
Epinephrine
Antagonist for Histamine Alpha and Beta effects Relaxes smooth muscle in GI and GU
81
Benadryl
H1 receptor antihistamine Competes for histamine receptors in CNS and PNS Sedative properties due to competitive antagonism in CNS Also acts as anti-muscarinic
82
Epiglottitis
Swelling of supraglottic area of epiglottis and pharyngeal structures Often bacterial
83
S/Sx epiglottitis
Sniffing position with inability to swallow, high fever, inspiratory stridor, retractions Children 2-6yo Quick progression
84
Croup
Inflammation of entire airway, edema in subglottic area Bacterial or viral, usually viral
85
Croup S/Sx
URTI, barking cough, low fever Children 6mth to 3 years
86
Spontaneous Pneumothorax
Sub-pleural bleb ruptures allowing air to enter pleural space
87
Simple Pneumothorax
No communication with atmosphere No mediastinum shift or hemi-diaphragm
88
Mechanism of Simple Pneumothorax
Fracture rib Increased intrathoracic pressure with closed glottis
89
Open Pneumothorax
Open defect in chest wall If >2/3 diameter of trachea then path of least resistance Paradoxical motion of affected lung Large dead space
90
Tension Pneumothorax
Trapping of air created by one way valve
91
S/Sx of Tension Pneumothorax
Decreased BS or hyper-resonance on one side Distended neck veins Hypotension tachycardia
92
Needle decompression current site
2nd intercostal space, superior aspect of 3rd rib mid clavicular line
93
PCS 5 Needle decompression
Patch removed Site anterior axilla

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