Respiratory Flashcards
(140 cards)
1
Q
What does a larger larynx correlate with?
A
Deeper Voice
2
Q
The Larynx is at what level?
A
C4-6 in most people
3
Q
Most superior region of the larynx?
A
Epiglottis
4
Q
The epiglottis is attached to what?
A
Hyoid bone
Inferior portion of the pharynx
5
Q
what are the functions of the larynx?
A
Phonation
Respiration
6
Q
Name the cartilages of the larynx?
A
Epiglottis (1)
Cricoid (1)
Thyroid membrane (1)
Arytenoids (2)
Cornicate (2)
Cuneiform (2)
7
Q
What does the thyroid membrane attach to
A
Superior Horns – attach to the hyoid bone by the lateral thyroid ligamament
Inferior horns – attach to the cricoid ligament through the cricothyroid ligament
8
Q
What do the arytenoids do?
A
Abduct and Adduct the vocal cords
9
Q
What muscle forms the bulk of the vocal folds?
A
Vocalis
10
Q
What do the lateral cricoarytenoids do?
A
Adduct the vocal cords (close)
11
Q
What do the posterior cricoarytenoids do?
A
Abduct the vocal cords (open)
12
Q
What does the cricothyroid do?
A
Tenses the vocal cords (creates pitch)
13
Q
What does the thyroarytenoid do?
A
Relaxes the vocal cords
14
Q
What is the motor innervation of the larynx?
A
Vagus nerve
Cricothyroid = External superior laryngeal branch
Everything else = Recurrent laryngeal branch
15
Q
What is the sensory innervation of the larynx above the vocal cords?
A
Internal Superior Laryngeal Nerve
16
Q
What is the sensory innervation of the larynx below the vocal cords
A
Recurrent Laryngeal NerveW
17
Q
What are the s/sx of injury to one side of the superior laryngeal nerve?
A
Hoarseness
18
Q
What happens I future is damage to one side of the superior laryngeal nerve?
A
Voice will be affected because the vocal cord cannot stretched/tensed
can also affect gag reflex
19
Q
What happens if there is damage to bilateral sides of the recurrent laryngeal nerves/
A
Respiratory compromise
20
Q
What nerve innervates the motor to the pharynx?
A
Spinal accessory
21
Q
What nerve innervates the pharynx to the sensory
A
glossopharyngeal
22
Q
What is the normal P50 on the oxyhemoglobin dissociation curve?
A
26-27 mmHg
23
Q
When the oxyhemoglobin dissociation curve shifts to the left, what happens?
A
Decreased PaCO2
Decreased H+ ions
increased pH
Decreased Temperature
Decreased 2,3, DPG
24
Q
What happens when the oxyhemoglobin curve shifts to the left?
A
Left shift increases the affinity of oxygen – locked on
Left = lungs
25
What causes the oxyhemoglobin dissociation curve to shift to the right?
Increased PaCO2
26
What happens when the oxyhemoglobin curve shifts to the right?
Readily releases to the tissues from the blood
27
What affects the oxyhemoglobin curve?
Bohr effect
Haldane effect
Hamburger effect
28
How do the Haldane and Bohr effects affect the oxyhemoglobin curve?
Bohr effect helps the metabolizing tissues release oxygen from oxyhemoglobin (O2 dissociation curve)
Haldane effect helps the lungs release carbon dioxide from carboxyhemoglobin (CO2 dissociation curve)
29
If your SaO2 is 90, what is your PaO2
60 mmHg
30
If your SaO2 is 70%, what is your PaO2?
40 mmHg
31
What is the dissolved O2 equation?
0.003 x PaO2
32
O2 bound to Hbg equation
(1.34 x Hbg) (SaO2)
33
What is the average total oxygen consumption per minute?
3-4 ml/kg/min OR around 250 ml/min
34
What is the equation for dissolved CO2
0.067xPaCo2
35
How much (on average) Co2 is produced and eliminated per minute?
200 ml/min
36
Where are the primary respiratory centers located?
In the medulla
37
What are the primary respiratory centers?
Dorsal respiratory centers
Ventral respiratory centers
38
What do the dorsal respiratory centers control?
Phrenic and External intercostals
39
What does the ventral respiratory center control?
Internal Intercostal
40
What do the central chemoreceptors in the medulla respond to?
Increase H+
Increased PaCO2 in CSF
Decreased O2 <60 mmHg
Increased PaCo2
Increased H+ ions
41
Where are the perpipheral chemoreceptors located?
Cartoid -- Glossopharyngeal nerve
Aortic -- Vagus nerve (afferent)
Stretch receptors -- vagus nerve
42
Where are the primary respiratory centers located?
in the pons
43
What are the secondary respiratory centers?
Apneustic Center
Pneumotaxic center
44
What is the apenustic center in control of?
Deep and prolonged respiration
45
What is the Pneumotaxic center in charge of?
Shutting off respiration
46
What Principe is the partial pressure of Co2 in CSF based on?
LeChatelier's Principle
a change in one variable that describes a system at equilibrium, produces a shift in the position of the equilibrium that counteracts the effect of this change
47
What is an example of Lechatiler's principle in anesthesia?
An increase in temperature will result in an increase in vapor pressure
48
Do pediatric patients have increased or decreased Pulmonary lung compliance? Chest wall compliance?
Decreased pulmonary lung compliance due to number of alveoli
Increased chest wall compliance
49
Do geriatrics have increased or decreased pulmonary lung compliance? Chest wall compliance?
Increased pulmonary lung compliance
Decreased chest wall compliance
50
What is the normal V/Q Matching?
4/5 = 80%
MV/CO
51
If your V/Q is 10/0, what does this mean?
Infinity
indicates dead space
complete ventilation, but no perfusion
Well ventilated, no perfusion
52
If your V/Q is 0/10, what does this mean?
0
Shunt
No ventilation, complete perfusion
Well Perfused, no ventilation
53
What is physiologic deadspace?
Anatomic headspace and alveolar headspace
54
What is anatomic Dead space?
conducting air passages + ETT
55
What is alveolar deadspace?
ventilation without perfusion
56
What increases deadspace?
Age
PP Vent
PE
Lugn disease
57
What is the equation for minute ventilation?
TV x RR
58
What is the equation for compliance?
Change in ventilation/ Change in perfusion
59
In the un-anesthetized patient, how does the lateral position change the V/Q matching?
nondependent lung: Decreased ventilation and perfusion in the nondependent lung
dependent lung: increased ventilation and increased perfusion
60
In the anesthetized patient, how does the V/Q matching change in the lateral decubitus position?
nondependent lung: increased ventilation, decreased perfusion
dependent lung: decreased ventilation and increased perfusion
61
What is the minimum flow according to Jackson Reese circuit?
5L/min
62
In the Bain circuit, what is the minimum flow?
70 ml/kg or 100-300 ml/kg for
63
How do you determine the PaO2 off of an anesthesia machine?
FiO2 x 5
64
How do you determine the PAO2 off of an anesthesia machine?
FiO2 x 6
65
LABEL THE DIAGRAM
A: Inspiratory Reserve Volume
B. Tidal Volume
C. Forced Vital Capacity
D. Reserve Volume
E. Inspiratory Capacity
F. Expiratory Reserve Volume
G. Vital Capacity
H. Closing Volume
I. Total Lung Capacity
66
What are some examples of Obstructive respiratory issues?
Asthma
COPD
Bronchitis
Emphysema
67
What happens in Obstructive Lung diseases in their PFTs?
Decreased FEV1
Normal FVC
Decreased FEV1/FVC (<0.8)
HARD TO GET AIR OUT
68
What are some normal PFT ratios?
FEV1 = 4L
FVC = 5L
FEV1/FVC = 0.8W
69
What is the best test to assess early stages of COPD?
small airway diseases
FEV25-75
Normal: 4.7 L/second
70
What happens in a restrictive lung disease pattern?
Hard to get air in
Decreased FEV1
Decreased FVC
Normal to high FEV1/FVC (because both are proportionately low)
71
What are some examples of airway diseases that are restrictive in nature?
Pulmonary Fibrosis
Pneumothorax
Scoliosis
72
What are some red flags on a PFT to that the patient may be moderate risk?
FEV1 <2L
FEV1/FRC <50%
MORE TESTS NEEDED, should postpone to determine best plan
73
What are some red flags in PFTs that the patient is HIGH risk?
FEV1 <1
FVC <1.5L or 20 ml/kg
FEV1/FVC <35%
74
What is hyperbaric O2 used to treat?
CO2 poisoning
Gas embolism
Anaerobic respirations (gas gangrene)
Decompression sickness (bends)
75
What are the 4 ways that CO2 is carried in blood?
Physically dissolved
Bicarbonate ions
Carbonic Acid
Protein Bound
76
CO2 is ________ more soluble than O2
20x
77
How much Co2 is produced per minute?
200 ml/min or 2.4-3.2 ml/kg/min
78
What is the Total Co2 content of arterial blood?
48 ml co2/100 ml blood
79
what is the total co2 content of venous blood?
52 ml co2/100 ml blood
80
What is the normal CO2 arterial-venous difference?
4 ml co2/100 ml
81
What is responsible for converting CO2 to HCO2
Carbonic Anhydrase
82
What receptors respond to H+ ions in the CSF?
Central chemoreceptors
83
What receptors respond to increased H+, Increased CO2 and increased HCO3 in blood?
Peripheral receptors
84
What is the primary stimulus for ventilatory response?
PaCO2
85
What cause bronchoconstriction through histamine release?
mast cells
86
What are the six anatomical characteristics of a difficult intubation?
Short muscular neck
Protruding maxillary incisors
Limited TMJ joint <40 mm
Limited cervical neck mobility
Receeding mandible
Unable to visualize uvula
87
What are the five contraindications to fiberoptic intubation
Hypoxia
Heavy Airway secretions
Bleeding not relieved with suctioning
LA allergy
Inability to cooperate
88
What is COPD?
Peranment dilation of the bronchus or group of small bronchi
airway resistance increases
compliance increases
89
How does a person with COPD breathe?
large tidal volumes
slow inspiratory flow rate
slow respiratory rate
90
What does bronchitis look like?
copious secretioons
increased Hct
larger individuals
"Blue bloaters"
91
What does emphysema look like?
coughing with exertion
scant sputum
smaller people
"Pink puffers"
92
What are the two most common reasons for pulmonary edema?
Increased in pulmonary hydrostatic pressure
Increase in permeability of alveolar-capillary membrane
93
What is the normal colloid osmotic pressure?
28W
94
hat is the normal hydrostatic pressure?
6-8 mmHg
95
What does ARDS do to the oxyhemoglobin curve?
Right to left shunt
96
What are the causes of ARDS?
Shock
Fat or air emboli
Aspiration
Burns
Sepsis
Trauma
Drug ingestion
Uremia
Pancreatitis
Massive blood transfusion
Head injury
CPB
Radiation of thorax
Drowning
97
What is the number one manifestation of ARDS?
Hypoxia
98
What are the five types of hypoxia?
Hypoxic Hypoxia (diffusional)
Anemic hypoxia (Decreased Hbg)
Secondary venous to arterial cardiac shunt
histotoxic hypoxia
hypoxia related to pulmonary disease
99
What is the number one histotoxic poisoning?
Cyanide poisoning (#1)
Toxicity
Vitamin poisoning
100
What are the s/sx of aspiration?
Wheezing
Coughing
Cyanosis
Pulmonary edema
Shock
Hypoxemia
101
What is the earliest and most reliable sign of aspiration?
hypoxemia
102
What increases your risk of aspiration (gastric symptoms)?
pH <2.5
Gastric volume >25 ml
103
What are the four causes of pulmonary restrictive disease?
acute intrinsic restrictive lung disease
chronic intrinsic restrictive lung diseases
chronic extrinsic lung diseases
disorders of the pleura or mediastinum
104
What are some examples of acute intrinsic restrictive lung diseases?
ARDS
Aspiration
CHF
105
What are some examples of chronic intrinsic restrictive lung diseases
Sarcoidosis
Drug induced
106
What are some examples of chronic extrinsic restrictive lung diseases
obesity
ascites
pregnant
107
What is sarcoidosis?
intrinsic lung disease -- restrictive
restrictive cardiomyopathy
108
what does sarcoidosis result in?
increased calcium levels
Splenomegaly
Hepatic granulomas
Optic and facial nerve involvement
109
What are some s/sx of tension pneumothorax?
hypotension
hypoxemia
tachycardia
increased CVP
increased PIP
Absence of unilateral breath sounds
tracheal shifts
asymmetric chest wall movement
110
How do you perform transtracheal jet ventilation?
through the cricothyroid membrane
111
what are the complications of transtracheal jet ventilation
barotrauma
pneumothorax
mediastinal air (emphysema)
arterial perforation
Damage to tracheal mucosa
SQ emphysema
Exhalation difficulty
Esophageal puncture
Thickened secretions
112
What are the spontaneous ventilation modes?
IMV
SIMV
MMV
PSV
HFJV
113
What ventilation modes do not support spontaneous ventilation?
CMV
AC
PCV
114
What is aminophylline?
phosphodiesterase inhibitor (PDE III)
When phosphodiesterase is inhibited:
- cAMP accumulates and bronchodilation occurs
- Also improves diaphragmatic contractility
- Xanthines cause the release of NE from sympathetic postganglionic neurons
115
What does phosphodiesterase do?
breaks down cAMP
116
What do you want to avoid with phosphodiesterase inhibitors?
Halothane
Adenosine
117
What are some examples of methylated xanthines?
Caffeine
Theophylline
118
What does Beta 2 receptor stimulation do?
activates adenylyl cyclase --> converts ATP to cAMP
Causes bronchodilation
119
What is cromolyn sodium?
mast cell stabilizer that prevents the release of histamine and bradykinin
prevents bronchospasm in asthmatics
120
what is cromolyn sodium not effective in
treating a bronchospasm once it develops -- it is a chronic drug
121
What is ipratroprium?
quaternary ammonium compound
antimuscarininc used to augment bronchodilation produced by B2 agonists
122
what does blockade of muscarinic receptors lead to?
decrease of IP
Less calcium is released from intracellular vesicles
Smooth muscle tone is reduced
123
What is doxapram?
non-xanthine central respiratory stimulant
increases tidal volumes and (smaller extent) RR
124
How does doxapram work?
through peripheral chemoreceptors to stimulate the central chemoreceptors
125
Who is doxapram not good for?
newborns because it is dissolved in benzyl alcohol
126
How do you decide the ETT size for a child?
Age/4 +4 (uncuffed)
-0.5 (cuffed)
127
How do you determine the length of an ETT from a child?
12+ age/2
128
For a child <6.5 kg, what sized LMA, cuff volume, ETT and FOB do they need?
LMA 1
Cuff volume 4cc
ETT 3.5
FOB 2.7
129
For a child <20 kg, what sized LMA, cuff volume, ETT and FOB do they need?
LMA 2
Cuff Volume 10 cc
ETT 4.5
FOB 3.5
130
For a child 20-30 kg, what sized LMA, cuff volume, ETT and FOB do they need?
LMA 2.5
Cuff volume 14cc
ETT 5.0
FOB 4.0
131
For a child >30 kg, what sized LMA, cuff volume, ETT and FOB do they need?
LMA 3, cuff volume 20 cc
ETT 6.0
FOB 5.0
132
For a normal adult (kg), what sized LMA, cuff volume, ETT and FOB do they need?
LMA 4, cuff volume 30 cc
ETT 6.0
FOB 5.0
133
For a large adult (kg), what sized LMA, cuff volume, ETT and FOB do they need?
LMA 5, cuff volume 40 cc
ETT 7.0
FOB 5.0
134
For a larger adult (kg), what sized LMA, cuff volume, ETT and FOB do they need?
LMA 6, cuff volume 50 cc
ETT 7.0
FOB 5.0
135
What are normal sterilization temperatures?
275F
135C
136
What do you need to do if your patient experiences aspiration or regurgitation?
Head Down (#1)
Disconnect circuit
Suction
Examine with bronchoscope
Xray
Abx (debatable)
physiotherapy
137
What are the differences in neonatal respiratory systems?
decreased lung compliance (less alveoli)
increased chest wall compliance (floppy ribs)
Decreased FRC (around 30 ml/kg)
Increased O2 consumption
138
What is the average O2 consumption in a neonate?
7 ml/kg/min
139
What is the average O2 consumption for an adult?
3.5 ml/kg/min
140
What is the average thyrometnal distance?
3 fingerbreadths
>6.5cm
