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4th year > SEDATION- physiology > Flashcards

SEDATION- physiology Flashcards

1
Q

How does breathing work?

A

The contraction of the diaphragm drives respiration.

  1. Inspiratory muscles contract
  2. Increase thoracic volume. Increases lung volume
  3. Thoracic pressure decreases and lung pressure decreases below atmospheric pressure
  4. Air is pushed along the pressure gradient.
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2
Q

What type of breathing is expiration?

A

passive

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3
Q

Compare quiet and more forceful breathing in terms of muscle use.

A

Quiet breathing only uses the diaphragm

Forceful breathing also uses the intercostal and accessory muscles.

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4
Q

What drives airway airflow?

A

A pressure gradient.

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5
Q

Compare the pressure gradients when inspiration and expiration occur.

A

Inspiration- Pressure in the alveolus < Pressure in atmosphere.

Expiration- pressure in Alveolus >pressure in atmosphere.

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6
Q

What is the tidal volume?

A

Air moving in and out of the mouth during quiet breathing.

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7
Q

What is the Inspiratory reserve volume?

A

Inhaling to the maximum

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8
Q

What is the expiratory reserve volume?

A

Exhaling to the maximum.

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9
Q

What is the residual volume?

A

The volume left in the lungs after maximal expiration.

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10
Q

What is the vital capacity?

A

Tidal volume + inspiratory reserve volume +expiratory reserve volume.

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11
Q

What is the total lung capacity?

A

Vital capacity + residual volume.

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12
Q

Why is the partial pressure of gases the same in the alveoli and arterial blood?

A

Because of the equilibirum of the gas exchange.

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13
Q

Compare the two divisons of the airway

A

Conducting zone- the volume here is dead space as there is no gas exchange.

Respiratory zone- Region of gas exchange.

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14
Q

How does gas exchange in the lungs occur?

A

Between the alveolar air and the pulmonary capillary blood. The gases move across the alveolar wall by diffusion- Determined by the partial pressure gradients.

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15
Q

What are V and Q

A

V- ventillation- Gas travelling through the lungs

Q- perfusion- Gas travelling through the blood.

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16
Q

Compare the transport of Oxygen, Nitrous oxide and carbon dioxide

A

Oxygen- Transported by haemoglobin- but when haemoglobin is saturated, O2 starts to be dissolved in blood.

Nitrous oxide- Dissolved in blood

Carbon dioxide-

  • As dissolved CO2
  • Combined to a protein Carbamino
  • Bicarbonate ions.
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17
Q

What is haemoglobin?

A

A globular metalloprotein with 2 alpha and 2 beta chains. It has 4 haem groups- Each contains an porphyrin ring and iron molecule (O2 attaches to)

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18
Q

When we provide individuals with pure oxygen what happens to the oxygen levels?

A

There is little increase in the oxygen bound to haemoglobin (it is saturated) The excess oxygen is dissolved in blood.

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19
Q

What does the oxygen dissociation curve show?

A

As the saturation of haemoglobin increases, the affinity of haemoglobin to oxygen decreases

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20
Q

What do we call the physiological conditions that affect the oxygen dissociation curve?

Describe these

A

Bohr shifts.

Shift to the left- Increased affinity for oxygen- Due to decreased temperature and increased pH.

Shift to the right- decreased affinity for oxygen- due to increased temperature and decreased pH.

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21
Q

How does carbon monoxide impact oxygen transportation ?

A

Carbon monoxide binds to haemoglobin and limits its ability to carry oxygen to the tissues.

22
Q

What is the propotion of gases in an oxygen:nitrous oxide mixture.

A

50/50

23
Q

What do we need to do when removing a patient from N2O?

and why?

A

Put the patient on Pure oxygen to allow N2O to diffuse out of their circulation in order to prevent diffusion hypoxia.

24
Q

How is breathing generated?

A

By the respiratory centres in the brainstem.

25
Q

How is breathing controlled?

A

It is an automatic processed controlled by voluntary muscles.

26
Q

How can we increase breathing?

A
  • Concious cerebral cortex
  • Peripheral arterial chemoerceptors- these sense reduction in O2 partial pressure or increase in CO2 partial pressure.
  • Central chemoreceptors- sense reduction in pH or increse in PCO2 in cerebral spinal fluid.
27
Q

How can our activities affect breathing control?

A

Concious inhalation - Lung stretch receptors recognise lung inflation and reduce the resiratory centres rythmn.

If we are excercising- joint and musle receptors recognise movement and stimulate the increase in respiratory rhythmn.

28
Q

What causes hypoxic hypoxia?

A

Reduced O2 reaching the alveoli

Reduced O2 diffusing into the blood.

29
Q

Anaemic hypoxia

A

Reduced O2 transport due to low haemoglobin levels.

30
Q

What is stagnant hypoxia?

A

Reduced O2 due to low blood flow

31
Q

What is cytotoxic hypoxia?

A

Reduced O2 utilisation by cells.

32
Q

What is cyanosis?

A

This is the blue coloration of skin due to increased deoxygenated blood in circulation.

33
Q

Name and compare the two types of cyanosis

A

Central cyanosis

  • all over the body.
  • Obvious in the oral mucosa.
  • Caused by a decrease in oxygen delivery to the blood (Hypoxic hypoxia)

Peripheral cyanosis -

  • Decreased oxygen in a localised area of the body
  • Stagnant hypoxia.
34
Q

Compare the two circulations of the heart.

A

Pulmonary circulation- Short one- deoxygenated blood goes to the lungs and is oxygenated.

Systemic circulation- Long one- oxygenated blood supplies to the whole body then comes back deoxygenated.

35
Q

How is blood supplied to the heart?

A

R and L coronary arteries. But lower supply during systole (as the arteries are compressed)

36
Q

Explain the conducting system of the heart.

A
  1. Sino atrial node- Contraction of the atria
  2. AV node delays transmission of the electric signal to allow the ventricles to fill with blood
  3. Electric signals travel through teh bundle of his fibres to the apex of the heart,
  4. Purkinje fibres initiate contraction of the ventricles.
37
Q

Compare how the parasympathetic and sympathetic nerve fibres innervate the heart.

A

Parasympathetic nerve fibres- act on SAN, AVN via muscarinic cholinergic receptors(neurotransmitter is acteyl choline)

Has a negative chronotropic and dromotropic effect (slows down the pacemaker & increases the delay- reducing conduction velocity)

Sympathetic nerve fibres-

Act on SAN, AVN, myocytes.

Mostly via ß-1 adrenoreceptors (neurotransmitter is noradrenaline)

Has a positive chronotropic and dromotropic effect (speeding up the pacemaker and increasing the delay- reducing conduction velocity.

Positive inotropic effect (increasing HR/Conduction velocity and contractility.

38
Q

Describe the cardiac cycle.

A

Ventricular systole (contraction)

  • Isovolumetric contraction- Contraction with no volume change in the ventricular chamber- (Closing of valve between atrium and ventricle)
  • Ejection phase- Contraction pushing the blood out of the ventricle.

Ventricular diastole (relaxation)

  • Isovolumetric relaxation-Allows the atrio-ventricular valve to open by relaxing the ventricle without changing the volume.
  • Passive filling- blood flowing from the atria to the ventricle.
  • Active filling- contraction of the atria.
39
Q

What is this and describe the different letters.

A

This is a heart wave on the electrocardiogram.

P wave- Atrial depolarisation (an increase in electrical charge towards 0 causing atrial contraction)

QRS wave- Ventricular depolarisation (increase in electrical charge resulting in contraction of the ventricles)

T wave- Ventricular repolarisation (causing relaxation of the ventricles)

40
Q

What is the ideal blood pressure?

A

120/80

(Systolic/diastolic)

41
Q

What is stroke volume and what does it depend on ?

A

How much blood is ejected from the ventricle each beat.

It depends on:

Preload

Ventricular contractility

Afterload

42
Q

Discuss preload

A

Preload is the stretching of the cardiac muscle and is measured by how much blood can fill the ventricle.

43
Q

What is afterload?

A

The leftover blood in the heart due to Total Peripheral Resistance

44
Q

Discuss the two forces that return blood to the right atrium.

A

Push force- we have momentum from systole and muscle pump (by limb muscles and venous valves)

Pull forces- the thoracic pump caused by negative intrathoracic pressure (reduced pressure draws more blood into the atrium.

45
Q

What can we use to monitor the patient’s pulse.

A

External carotid artery

Facial artery

Superficial temporal artery

Radial artery

Jugular venous pulse from the interanl jugular vein visually.

46
Q

What law is used to caluclate blood flow?

A

Poiseuille’s law.

47
Q

What is the main factor that affects blood flow and what changes this?

A

The radius of the artery.

  • Local factors- O2 /CO2/pH/ temperature/vasoactive agents
  • Sympathetic nerves (alpha and beta adrenoreceptors)
  • Hormones (Adrenaline, ADH, Angiotensin II)
48
Q

What is the total peripheral resistance?

A

The combined resistance of all the systemic blood vessels.

49
Q

What is hypovolaemia and how does the body respond to it?

A

A state of decreased intravascular volume which reduces stroke volume, cardiac output and the mean arterial pressure.

The body response is to increase HR and TPR by vasoconstriction.

50
Q

What are the signs that we have achieved sedation?

A

4th year (51 decks)

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