Flashcards in T2 - Blueprint (Josh) Deck (119)
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)
What would cause a V/Q less than 0.8?
less O2 going into the the blood in lungs
What would cause a V/Q more than 0.8?
less blood getting into the alveoli than normal
- Cardiogenic shock
What level of shunting is abnormal?
What level of shunting is life-threatening?
greater than 10%
greater than 30%
What is the horizontal axis of the Oxyhemoglobin curve?
PaO2 (oxygen unbound and able to get to tissue)
SaO2 (oxygen bound to Hgb)
When the Oxyhemoglobin Curve shifts right, what does this mean?
Hgb gets rid of O2 more readily
- Rise in 2,3 DPG
When the Oxyhemoglobin Curve shifts left, what does this mean?
Hgb holds on to the O2 so it doesn't perfuse to tissue
- Low CO2
- Low temp (CoLd)
- Low 2,3 DPG
- Increased Carb. Monoxide
What are two ways to estimate shunting?
A-a Gradient (10-20 mmHg normal)
PaO2/FiO2 Measurement (normal is 286)
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
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)
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
PaO2 = 80-100 mmHg
PaCO2 = 35-45 mmHg
- rises when acidic to buffer
What is a normal PETCO2?
- Partial Pressure of End Tidal CO2
***Measures amount of expired CO2 in exhaled air
What conditions raise PETCO2?
anything that reflects inadequate gas exchange or an increase in cellular metabolism (both of which increase production of CO2)
- Bronchial intubation
- Partial airway obstruction
- Increased CO and BP
What conditions lower PETOC2?
anything that reflects poor pulmonary ventilation
- Reduced CO and BP
NPO how long?
8 hrs prior
***assess gag reflex before allowing to drink
What about a fever?
mild fever around 24 hours is not uncommon
How much can be withdrawn daily?
Why do we need them to deep breath post procedure?
help expand the lungs
min of 5 L/min
***monitor for aspiration
***1/3 Vt with each breath
greater than 90%
never less than 8 L/min
What do we nee do with FiO2 amounts greater than 50%?
high flow setup
never less than 8 L/min
What is the most accurate way to deliver O2?
***ideal for CO2 retainers