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1

V/Q Ratio:

Avg ventilation is ---

Avg perfusion is ---

Which means, normal V/Q Ratio is ---

V = 4 L/min

Q = 5 L/min

V/Q = 4/5 = 0.8 (more perfusion than ventilation)

2

What would cause a V/Q less than 0.8?

less O2 going into the the blood in lungs

- Shunting

3

What would cause a V/Q more than 0.8?

less blood getting into the alveoli than normal

- PE
- Cardiogenic shock

4

What level of shunting is abnormal?

What level of shunting is life-threatening?

greater than 10%

greater than 30%

5

What is the horizontal axis of the Oxyhemoglobin curve?

Vertical axis?

PaO2 (oxygen unbound and able to get to tissue)

SaO2 (oxygen bound to Hgb)

6

When the Oxyhemoglobin Curve shifts right, what does this mean?

Hgb gets rid of O2 more readily

- Hypercapnia
- Acidosis
- Rise in 2,3 DPG
- Fever

7

When the Oxyhemoglobin Curve shifts left, what does this mean?

Hgb holds on to the O2 so it doesn't perfuse to tissue

- Alkalosis
- Low CO2
- Low temp (CoLd)
- Low 2,3 DPG
- Increased Carb. Monoxide

8

What are two ways to estimate shunting?

A-a Gradient (10-20 mmHg normal)

PaO2/FiO2 Measurement (normal is 286)

9

What does a wide A-a gradient (greater than 20 mmHg) mean?

more O2 in alveoli than in arterial blood

indicating there is a lot of shunting going on

10

With V/Q Mismatch, the A-a gradient is ---

With Alveolar Hypoventilation, the A-a gradient is ---

wide (because the O2 in alveoli isn't perfusing well)

normal (because the Alveoli aren't getting O2)

11

Is this a health lung?

PaO2 = 95

FiO2 = 50%

95 divided by 0.5 = 190

not a healthy lung function

too much shunting

normal should be 286

12

ABGs:

Normal PaO2

Normal PaCO2

PaO2 = 80-100 mmHg

PaCO2 = 35-45 mmHg

13

ABGs:

Normal Bicarb

21-28 mEq/L

- rises when acidic to buffer

14

ABGs:

Normal SaO2

95-100

15

What is a normal PETCO2?

20-40 mmHg

- Partial Pressure of End Tidal CO2

***Measures amount of expired CO2 in exhaled air

16

What conditions raise PETCO2?

anything that reflects inadequate gas exchange or an increase in cellular metabolism (both of which increase production of CO2)

- Hypoventilation
- Bronchial intubation
- Partial airway obstruction
- COPD
- Fever
- Increased CO and BP

17

What conditions lower PETOC2?

anything that reflects poor pulmonary ventilation

- PE
- Apnea
- Hypothermia
- Sedation
- Sleep
- Cooling
- Reduced CO and BP

18

Bronchoscopy:

NPO how long?

8 hrs prior

***assess gag reflex before allowing to drink

19

Bronchoscopy:

What about a fever?

mild fever around 24 hours is not uncommon

20

Thoracentesis:

How much can be withdrawn daily?

1000mL

21

Thoracentesis:

Why do we need them to deep breath post procedure?

help expand the lungs

22

BNC:

Rates?

FiO2?

1-6 L/min

24-44%

23

Simple Mask:

Rates?

min of 5 L/min

***monitor for aspiration

***no humidity

24

Partial Rebreather:

Rates?

FiO2?

6-11 L/min

60-75%

***1/3 Vt with each breath

25

Nonrebreather:

Rates?

FiO2?

12-15 L/min

greater than 90%

26

Aerosol Mask

Rates?

FiO2?

never less than 8 L/min

28-100%

27

Aerosol Mask:

What do we nee do with FiO2 amounts greater than 50%?

high flow setup

28

Tracheostomy Mask/Hood:

Rates?

FiO2?

never less than 8 L/min

28-100%

29

What is the most accurate way to deliver O2?

Venturi Mask

***ideal for CO2 retainers

30

How do you determine correct placement of ETT?

End-tidal CO2 detector

Auscultate x 5

Inspect chest expansion

CXR to determine depth (3-4 cm above carina)