Respiratory 4 Flashcards by lindsey france

Hemoglobin normally carries oxygen and carbon dioxide- what happens during carbon monoxide poisoning?

carbon monoxide binds tightly to hemoglobin and kicks off oxygen and carbon dioxide

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describe the characteristics of carbon monoxide

colorless, odorless, tasteless, non irritant gas

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what is the affinity for co to Hb compared to oxygen

250x more attracted to hemoglobin than oxygen

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CO+Hb=

HbCO-carboxyhemoglobin

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can HbCO carry 02?

no, functional anemia/anemic hypoxemia

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what if there is only a small concentration in the air of CO

CO can kill even in small concentrations

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what happens when carbon monoxide binds to one Hb site?

it increases the oxygen affinity of the remaining HB sites which causes the hemoglobin molecule to retain oxygen that would otherwise be delivered to the tissue.

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during carbon monoxide poisoning which way does the HbO curve shift

to the left- due to the 3 sites have an increase in oxygen affinity and retaining oxygen

LEFT-LOVE OF OXYGEN

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what is the result of the increase affinity between hemoglobin and oxygen during CO poisoning.

Blood oxygen content is increased! because oxygen remains on the hemoglobin- none is delivered to the tissues- HYPOXIC TISSUE INJURY

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what color do people turn with CO poisoning

Hb turns a bright red color- cadavers acquire an unnatural reddish hue

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Can a pulse Ox be reliable during CO Poisoning

NO! Pulse ox is misleading: it can’t differentiate between oxyHb and CarboxyHb

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Treatment of CO poisoning

100% 02 (will bump CO from Hb)

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S/S of CO poisoning

headache, vertigo, dyspnea, confusion, dilated pupil, convulsion and coma

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CO2 is produced in tissues and carried to the lungs. Name the 3 forms

HCO3 (90%0
carbaminohemoglobin (HbCO2)-small amount
Dissolved CO2-(is this in the plasma)?? small amount

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what is the formula for dissolved CO2 in the blood

PaCO2 x 0.067=xx/100ml blood

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explain the steps of co2 as HCO3

CO2 is produced in the tissues and diffuses into RBC

CO2+H20 (Carbonic anhydrase) form h2co3

h2co3 dissociates into h and hco3

hco3 leaves the RBC in exchange for Cl- and transported to lungs in the plasma

H is buffered inside RBC’s by deoxyHb

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explain how the lungs offload c02

HCO3 enters the RBC and Cl leaves

HCO3 bind with h= h2co3

then H20 and CO2

co2 leaves the lung and transport to the alveoli and gets breathed out

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Haldane effect

In lungs, oxygenation of Hb promotes dissociation of CO2 from Hb (Haldane effect); therefore, CO2 is released from RBCs

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Bohr effect

In peripheral tissue, increase H+ shift curve to right, unloading O2

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Central control of breathing name the structure in the brain

medullary respiratory center: located in reticular formation

Apneustic center

Pneumtaxic center

Cerebral cortex

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Dorsal Respiratory Group

(PACEMAKER)
Inspiratory Control
Receive Inputs via vagus and glossopharyngeal nerve
output to diaphragm via phrenic nerve and external intercostal nerves

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ventral respiratory group

Expiratory control
efferent via internal intercostal nerve
work only during exercise, when expiration becomes an active process

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glossopharyngeal nerve

carries signals from carotid bodies and vagus from arch of aorta and lung stretch receptors.

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Apneustic center

Located in lower pons

Stimulates inspiration, producing deep and prolonged inspiratory gasp (apneusis)

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Pneumtaxic cener

Located in upper pons Inhibits respiration, and therefore inspiratory volume and respiratory rate. Adjust rate and depth of respiration

Cerebral cortex

Voluntary breathing; hypoventilation or hyperventilation

Central Chemoreceptors are located where?

medulla

what are these chemoreceptors respond to what?

CO2, H+, 02

Central chemoreceptors are sensitive to??

PH of CSF

if central chemoreceptors sense a decrease in PH what happens?

produces hyperventilation

what does and does not cross the BBB

CO2-crosses the BBB | H+ does not cross the BBB

In CSF: CO2 + H20=

H2CO3= -H + HCO3 H acts directly on central chemoreceptors

increase pco2 and H do what to breathing

stimulate breathing

decrease pc02 and H do what do breathing

Inhibit breathing

what is the role of hyperventilation or hypoventilation

it returns the arterial PCO2 towards normal

Central Control of Breathing. Name the two structures

Brain stem and cerebral cortex

the brain stem coordinates what sensory information and sends signals to respiratory muscles

``` PC02 Lung stretch irritants muscle spindles tendons and joints ```

where are peripheral chemoreceptors found?

in the carotid and aortic bodies

what stimulates the peripheral chemoreceptors

decrease p02 increase pc02 decrease PH (increase H)

the peripheral chemoreceptors are stimulated to increase the breathing rate in metabolic acidosis breathing rate is increased Why is that?

because arterial H is increased and PH is decreased

name the last point that peripheral chemoreceptors are responsible for?

responsible to hypoxic drive to respiration

Name the 6 other type of receptors for breathing control

stretch receptors on bronchial walls irritant receptors stimulated by dust pollen J (juxtacapillary) receptors Joint and muscle receptors Brain Edema Anesthesia

Stretch receptors on bronchial walls

- Afferent via vagus nerve - When these receptors are stimulated by distension of the lungs, they produce a reflex decrease in breathing frequency (Hering-Breuer Reflex)

Irritant receptors are stimulated by?

dust, pollen

J (juxtacapillary) receptors

-Engorgement of pul. capillaries in LVH, stimulates J receptors, which then cause rapid, shallow breathing dyspnea

Right-to-left shunts

Normally occur to a small extent because 2% of the cardiac output bypasses the lungs abnormalities

what congenital anomaly creates a right to left shunt? to what % of CO is seen with congenital abnormalities

Are seen in tetralogy of Fallot May be as great as 50% of cardiac output in certain congenital

explain what is seen of PO2 in a right to left shunt

Always result in decrease arterial PO2 because of the admixture of venous blood with arterial blood

how to we determine the magnitude of a right to left shunt?

The magnitude of the right-to-left shunt can be estimated by having the patient breathe 100% O2 and measuring the degree of dilution of oxygenated arterial blood by non-oxygenated shunted (venous) blood

Left-to-right shunts

Are more common than right-to-left shunts because pressures are higher on the left side of the heart

Left to right shunts are usually caused by what?

Are usually caused by congenital abnormalities( e.g. PDA, VSD, ASD) or traumatic injury

in left to right shunt what happens to 02?

Do not result in a decrease in arterial PO2. Instead PO2 will be elevated on the right side of the heart because there has been admixture of arterial blood with venous blood

Supplemental O2

For patient with PO2 ≤ 55mmHg Hypoxic drive suppression Oxygen toxicity Parenchymal damage

Mechanical Ventilation: indication

Apnea, inadequate ventilation Severe hypoxemia despite O2 supplementation Airway protection – in coma

Cheyne-Stokes Respiration

Hypersensitivity of resp center to CO2 Period of waxing and waning of tidal volumes separated by periods of apnea Drug overdose, CHF, hypoxia

Pickwickian Syndrome

Obesity-hypoventilation syndrome The association of sleep apnea with extreme obesity is referred to as Pickwickian syndrome

Pickwickian Syndrome | Clinical signs

``` Partial airway obstruction causes snoring Hypoxia-- decrease PO2 Cyanosis Rarely hypercapnia Polycythemia Poor sleep at night Daytime sleepiness ```

Pickwickian Syndrome | treatment

Oropharyngeal appliances Positive pressure nasal mask Surgery

MAC=

Minimum Alveolar Concentration:

tell me about mac

its the concentration of anesthetic gas needed to eliminate movements among 50% of patients challenged by standardized skin incision MAC is small for potent anesthetics such as halothane and large for less potent gas such as N20

Respiratory Responses to Exercise

``` O2 consumption CO2 production Ventilation rate Arterial PO2 and PCO2 Arterial pH Venous PCO2 Pulmonary blood flow V/Q ratio ```

Cardiovascular Responses to Exercise

B. flow to skeletal m. | H.R. SV, CO

Adaptation to High Altitude

``` Alveolar PO2 Arterial PO2 Ventilation rate Arterial pH Hb Concentration 2,3-DPG Hb-O2 Curve Pul. Vascular resistance ```

Respiratory 4 Flashcards

(63 cards)