1) Pulmonology Flashcards
Intrinsic Risk Factors:
Extrinsic Risk Factors:
Most important extrinsic factor:
= Genetic predisposition; immunocompromised
= Work, Home, environment, smoking
= smoking cigs
structures make up your upper airway? Par-, Lar, Nasophar-, Orophar-pharnx
= Par-, Lar, Nasophar-, Orophar-pharnx
Upper Airway 3 responsibilities for?
= Filter, warm, Humidified
Hyoid bone F:
Broken commonly via:
= anchors tongues
= hangman’s break (Nooses)
Turbinate F:
creates turbulence; forcing dust particles laterally “filter system” w/ cilia
What tubes connects to nasopharnx
Eustaschian tubes
How much air is filtered, warmed & humidified each day?
10k gallons of air
Parasinal sinus F:
Pairs & Names:
= buffer system, changes relative weight
= 4pairs, Max, Frontal, Sphenoid, Ethoniod
Tonsils F:
= Lymphatic “trash collector”
Cancer pus in between pleura termed:
= (inpinima)
Larynx:
= adams apple, Cricothyroidr sur
Vocal cords widest at
If intubating awake PT remember:
= inhalation
= time during inhalation to avoid hitting vascular ventricular folds
Lower Airway Anatomy) Cricoid ring
Narrowest point in Aduldts vs Pedis
How many alveoli do you have in your lungs?
bronchioles streched out would be how far:
Cilia fn & triggers what if obstructed:
= only 360 degree cartilage
= Cricoid ring in PEDIs vs adults glottis
= 300 mil
= 15K miles of bronchioles
= Cilia moves up if stuck triggers cough reflex
Alvelore pores:
Dust cells:
Type 2 cells:
= “back doors” produces surfactant
= macrophages of the lungs
= are the last cells dev in ertro & produces surfactant & reason why babys have issues w/ BVM Fetal lung fluid
an atmospheric Pressure is how many ft/yards:
Pluera fluid & -neg pressure:
With what condition “can get air in but not out”
which is active & passive w/ I:E
= 33ft / 11yards
= ~⅓ of keeping negative pressure 10-15mLs
= COPD
= inhalation active & exhalation passive
Prebotzinger
VRG:
DRG:
Pontine resp:
= “SA resp node” in medulla
= transmits via phrenic
= receives input from chemoreceptors
= com/s w/ VRG to smooth out the vent
Formulas) Min Vol
Alveolar min vol =
= RR x tidal vol
= (tidal vol - dead space) x RR
Cellular asphyxiation :
CO2 attaches to hemoglobin via
CO2 doesn’t bind to
= cells stuck in 1 of the shifts causing death
= amino acid chain (carbminoacid
= hem sites
Tripoding is for
Perched lips is for
Acrocyanosis:
CAPE cyanosis :
= support upper torso becoming tired
= anatomical PeeP (3-5)
= only peripheral cyanosis
= throw a cape over cyanotic torso up
W/ COPD, need to more careful in case of
= bleps in lung & can rupture
PE common with:
PE history & S/S
Saddle embolism PE:
= immobility, planes, childbirths, long bone fracture
= Tachypnea & cardia w/ story
= emboli usually from pelvis goes to blocking both lungs
ETCO changes w/ asthma:
Status asthmaticus:
= worsens ETCO rises up again to normal as worsens, if worsens beyond rise then hypercapnic
= Resp failure imminent, Agressive w/ meds, Might give dex
Pneumonia:
Bronchial-pneumonia:
Lobar pneumonia
Interstitial pneumonia:
S/S:
= infection usually migrated from somewhere else
= Patchy consolidation >1 lobes (L 2 R 3)
= infection in 1 lobe only
= Diffuse & Bilateral
= Fever/chills, orthopnea, yellow/brown sputum, egphony
Hyperventilation 2 late severe signs are shown
= Carpoprfal spasm & Trousseau’s sign
What initiates respiratory drive
Pedis end-tidal
= Arterial CO2
= 5-7mL/kg
Phrenic nerve branches of
what nerve types tracts of heart
arm pain w/ heart injury bc:
= C3,4, 5
= Sensory & Motor
= Cervical plexus tracts w/ phrenic nerve
Emphysema :
Chronic bronchitis:
= “pink puffers” skinny
= “blue loafers” Big
Carbon monoxide poisioning colort
cherry (cherry is usually dead)
Ability to speak:
Sternal retraction seen w/:
= 1-2 word dyspnea, broken syllable dyspnea
= kids (grunting last sound “BVM”)
Egphony:
Orthopneia:
= changed tone w/ E to A test
= breathing improves standing & worsens supine
What condition is more prone to barotrauma
ARDS,
Antipyretic needed when temp >
only if fever is >101F)
Inspiratory reserve volume (IRV)=
maximum amount of air that can be inhaled after a normal inspiration (~3000mLs)
Expiratory reserve volume (ERV)=
maximum amount of air that can be exhaled after a normal expiration. (~1200mLs)
Residual Volume (RV)=
amount of air remaining in the lungs at the end of maximal expiration (~1200mLs)
Functional residual capacity (FRC)=
volume of gas that remains in the lungs at the end of normal expiration
Oxygenation 3 needs=
intact airway, adequate vent & respiration
Katabolism=
uses fat vs glucose for energy (uses 4 ATP vs. 1)
Kiesselbach area(little area)=
where 4 different arteries connect together→ super vascular
Mucus F. =
absorb energy, balance, heat dental roots
VRG ventral respiratory group=
transmits signals via the phrenic nerve & intercostal nerves
DRG dorsal respiratory group=
keeps in check w/ VRG
Pontine respiratory group=
smooths out transition of inhalation & exhalation
Oxygen molecules w/o a job become=
free radical hurting brain & cardio molecules
Schram roth test:
finger nails creates diamonds
A fig: normal, B fig: clubber
S1Q3T3 Pattern & Use
Lead 1 prominent S wave, Lead 3: Path Q & flipped T & 95% accurate 25% sensitivity w/ PEs
Tidal Volume:
= Amount of air moved in & out of lungs in
1 breath (~500 mL’s in a healthy adult)
Dead Space Volume:
= Area where there are no alveoli or gas exchange occurs in this area (~150mL)
Alveolar Volume formula:
Tidal Volume – Dead Space
How much air is filtered, warmed, & humidified daily?
= ~10,000 gallons.
Role of turbinates?
Create turbulence to filter air using cilia.
Functions of paranasal sinuses?
= Act as a buffer system, reduce skull weight, contain 4 pairs: Maxillary (largest), Frontal, Sphenoid, & Ethmoid.
Role of tonsils?
= Lymphatic tissue for immune defense; “kissing tonsils” can indicate tonsillitis.
What is BURP?
Backward, Upward, Rightward Pressure for larynx manipulation during airway procedures
Why time intubation with inhalation in awake PTs?
Vocal cords are widest during inhalation to avoid hitting vascular ventricular folds.
What do alveolar pores do?
Provide “back doors” between alveoli for air distribution, produce surfactant.
Q: Role of Type II alveolar cells?
Produce surfactant, last cells to develop in utero (issues in premature babies).
Difference between active & passive phases of breathing?
= Inhalation requires ATP (active); exhalation is passive unless in COPD or other conditions.
Q: Formula for Minute Volume?
RR × Tidal Volume.
Formula for Alveolar Minute Volume?
= (Tidal Volume - Dead Space) × RR.
Waste products of respiration?
What catalyzes CO2 + H2O → Carbonic Acid?
= Heat, water, CO2.
= Carbonic anhydrase.
Role of the phrenic nerve?
= Stimulates diaphragm, originates from C3, C4, C5.
Function of the cricoid ring?
= Only 360° cartilage, narrowest point in pediatrics, vs glottis in adults.
~ Length of bronchioles in the lungs?
~# & Length of alveoli in the lungs?
= = ~15,000 miles.
= ~300 mil; cover an area of half a tennis court.
Functions of the pleura:
= Reduce friction & Maintains ~ 1/3 of neg/ pressure (~10-15mL fluid)
V/Q Mismatch & Pathos) Causes of V problem:
Causes of Q problem:
= Ventilation issues: Obstruction, swelling, or mechanical disruption.
Perfusion issues: PE, severe hemorrhage, or shock.
Common abnormal respiratory patterns?
=
= Cheyne-Stokes, Biot’s, Kussmaul’s, Apneustic, Central neurogenic
Biot’s: Irregular pattern (↑ ICP).
Kussmaul’s: Deep & labored (DKA).
Apneustic: Gasping inspiration w/ long pauses
Cheyne-Stokes: Waxing & waning w/ apneic periods (↑ ICP).
Central neurogenic ventilation
Key features of emphysema?
Destruction of alveoli, CO2 retention, dyspnea, barrel chest, finger clubbing, hypertrophic accessory muscles.
Key features of chronic bronchitis?
Increased goblet cells, excessive mucus production, rhonchi, productive cough, “blue bloaters.”
Asthma phase 1
Asthma phase 2
= Bronchospasm w/in mins, reversible w/ bronchodilators.
= Inflammatory response 6-8 hrs later, steroids required.
What is status asthmaticus?
Severe asthma not responding to initial treatments; respiratory failure imminent.
The “F”s of a PE:
Fat, Fucked, Fractured, Flying, Feet
Why do premature infants have difficulty breathing?
Type II alveolar cells, which produce surfactant, develop late in utero, causing respiratory distress in preemies.
Ventilation:
Diffusion:
Perfusion:
= Air moving into and out of the lungs.
= Gas exchange between alveoli and blood.
= Blood flow to tissues for oxygen delivery.
How is asthma treated in an emergency?
Bronchodilators (albuterol, ipratropium), steroids (dexamethasone), magnesium sulfate, and possibly epinephrine for severe cases.
PT has Hx asthma, clear lung sounds, SpO2 WNL, onset started after running & improved w/prescribed inhaler. What is the most likely condition?
Stage 1 exercise-induced asthma.
PT presents w/hx smoking, productive cough for 3 months/year over 2 years, and cyanosis. What is the most likely condition?
Chronic bronchitis.
PT shows severe dyspnea, barrel chest, pursed-lip breathing, & weight loss. What condition does this describe?
Emphysema
Q: What are common S/S of a PT experiencing a pulmonary embolism (PE)?
Sudden onset dyspnea, pleuritic chest pain, tachycardia, hypotension, and signs of hypoxia w/o lung sounds changes.
What condition presents as diminished lung sounds, hyperresonance, tracheal deviation (late sign), and respiratory distress?
Tension pneumothorax.
PT presents w/stridor, drooling, difficulty swallowing, and a sudden onset of fever. What is the most likely condition?.
Epiglottitis
Lung Compliance:
High compliance:
Low compliance:
= The lung’s ability to stretch and expand
= Easy to inflate, <elastic recoil (EX: emphysema).
= Stiff lungs (EX: ARDS, fibrosis).
What is the function of the diaphragm during respiration?
Contracts to increase thoracic cavity volume, decreasing pressure and allowing air inflow.
What is atelectasis?
Partial or complete collapse of alveoli, often due to mucus plugging or lack of surfactant.
Acute respiratory distress syndrome (ARDS)?
Severe inflammation and fluid buildup in alveoli, causing non-cardiogenic pulmonary edema and hypoxemia.
What condition involves chronic hypoxia leading to pulmonary hypertension and right heart failure (cor pulmonale)?
COPD, specifically emphysema.
What is the role of the central chemoreceptors in respiration?
Detect changes in CO2 and pH in cerebrospinal fluid, increasing respiratory rate when CO2 rises.
How often can Epi 1:1,000 be delivered to a patient via IM who is in a severe asthma attack?
Every 3-5mins as needed
2nd stage of asthma is most likely going to respond best to the administration of:
dex & Solu
The amount of air that remains in your lungs after each breath is termed the:
Residual volume
You are called to the scene of a patient who was outside playing basketball with friends. The patient stated he had a brief coughing spell and now has become increasingly dyspneic over the last twenty minutes. Your physical assessment reveals diminished lung sounds to the patient’s right chest, a blood pressure of 138/90, a pulse rate of 110, and a ventilation rate of 26 per minute. You would most likely suspect this patient is experiencing a(n):
Spontaneous pneumo
Stretch receptors in the lung tissue send a signal to the CNS during inhalation that inhibits the stimulation of the phrenic nerve. This safety mechanism is known as the:
Hering-Beuring reflex
You are called to a local airport terminal for a patient who is complaining of dyspnea. The patient states they just flew back to the United States from Asia, and was feeling fine until they walked off the plane to claim their checked baggage. The patient states the dyspnea was an acute onset, and also complains of some chest discomfort that they describe as “sharp”. You would most likely suspect this patient is having a(n):
Pulmonary embolism
narrowest portion of the adult upper airway is the
Glottic opening
Upon arrival at a community pool you find a 20-year-old patient in obvious severe respiratory distress. The patent is only able to speak broken word sentences and does state they have a history of asthma. Besides the administration of oxygen and Albuterol via a SVN, what other medication would you want to deliver to this patient?
Epi 1:1 IM 0.3mg
The narrowest portion of the pediatric upper airway is the:
Cricoid ring
A patient is breathing normal tidal volume with a rate of 14 breaths per minute. What is their estimated alveolar minute volume?
4900mL/min
Rx of a PT w/ suspected ARDS can include:
except:
= Endotracheal intubation, CPAP if still breathtaking on own, Admin of corticosteroids
= Administration of Nitroglycerin
The correct dose of Albuterol for a patent with bronchoconstriction is:
2.5mg/3mL SVN
You are treating a patient with severe asthma that initially was tachypneic but now is becoming unresponsive and bradypneic. This patient has not responded to the administration of bronchodilators. What would you most likely expect to see on this patient’s capnogram?
The patient’s ETCO2 would start to rise to hypercarbic levels
A patient stated they were diagnosed with a disease of the lungs that dealt with the direct destruction of the alveoli. You would identify this as
Emphysema
Terbutaline can be administered to a patient who has a considerable past cardiac history, and presents with mild to moderate dyspnea from bronchoconstriction at a dose of:
0.25mg IM
A pulmonary disease that is created by the pulmonary tissue producing excessive amount of mucus is:
Chronic Bronchitis
Epi 1:1,000 can be administered to a patient for the treatment of severe bronchoconstriction at a dose of:
The correct dose of Mag Sulfate for a patient with a severe asthma attack is
= 0.01mg/kg to max 0.3mg IM
= 1-2Gs IV / 10-20mins
The most important factor that determines the ventilation rate of a patient is the amount of:
Arterial pCO2
What is considered the highest allowable PEEP setting without medical consultation?
10cm H2O
Upon arrival you find a 21-year-old patient with obvious severe respiratory distress. The patient is very tachypneic and the family tells you the patient has a long history of asthma. Your partner has connected the patient to oxygen and has also hooked up the patient to ETCO2 monitoring. What would you most likely expect to see on this patient’s capnogram?
Hypocarbia and an up-sloping of phase 3 of the capnogram waveform
What would cause a right-shift of the Oxygen Dissociation Curve?
decrease in the pH of the blood, increase in body temperature, increase in the amount of CO
Perfusion problems w/ V/Q
Ventilation problems w/ V/Q
= Acute, sudden chest pain and dyspnea from a suspected PE, Hypotension from a severe hemorrhage, Hypoperfusion from an anterior wall MI
= Trauma PT w/ suspected flail chest, PT w/ exacerbation of their COPD, Hypoxia from a asthma attack
The phrenic runs runs off the cervical spinal cord from:
C3-5
The administration of an anticholinergic medication via a SVN is useful in a patient with asthma because it: Assists in drying up secretions in the bronchiole
correct dose of Atrovent for a patent experiencing an asthma attack is:
500mcg
An unconscious patient was pulled out of his enclosed garage after he attempted to kill himself with carbon monoxide. Your partner has attached the CO-Oximeter and it shows a reading a 50% carboxyhemoglobin. You quickly identify this as:
Severe CO poisoning
Patient’s with a long history of emphysema will tend to present with pinkish skin, this is known as:
Polycythemia
If Oxygen Dissociation Curve would stay shifted too far to the right, what would this cause?
cause the hemoglobin to decrease it’s affinity towards oxygen
What would cause a left-shift of the Oxygen Dissociation Curve?
increase in the pH of the blood, decrease in the amount of CO2 & Body Temp
What ECG pattern is associated with a patient having a pulmonary embolism:
S1Q3T3
The majority of carbon dioxide that is made by our cells during metabolism is transported in the blood and to the alveoli:
as bicarbonate ions
This color of skin is associated with severe CO poisoning
Cherry Red
contraindications for the application of CPAP
Pneumothorax, Apnea, Hypotension
Stridor most likely indicates:
Swelling of the laryngeal tissues
Cor Pulmonale:
= R ventricle & maybe Atrium hypertrophy from fluid overload
Ipratropium Bromide admin note
= Anticholinergic, drys mucus for albuterol (500mcg)
ARDS Also known as
= “Noncardiogenic Pulmonary Edema”
Resp/ Corticosteroids
Dexamethasone (10 mg IV/IO) & Solu-Medrol 125-250mg IV,IM
Direct ARDS causes:
Indirect ARDS causes:
= Pneumonia, Gastric Aspiration, Near drowning, Smoke inhalation
= Sepsis, Pancreatitis, Trauma/Burns, High altitude, Blood transfusions
Cachexia
Profound weight loss (in context of cancer)
hemoglobin W/ carbon dioxide attached to it? –
hemoglobin w/ carbon monoxide?
= Carbaminohemoglobin
= Carboxyhemoglobin
Carbon Monoxide (CO) Poisoning Lvls)
Severity w/ S/S) 1. Aysymptomatic:
2. H/A, N/V, dizziness, blurred vision:
3. Confusion, syncope, chest pain, dyspnea, Tcardia/pnea, weakness:
4. Dysrhythmias, hypoBP, cardiac ischemia, palpitations, resp/ arrest, pulmonary edema, seizures, coma,
cardiac arrest
5. Dead, Cherry Pink skin
1= <15
2= Mild 20%
3= Moderate 21–40%
4= Severe 41–59%
5= Fatal/Lethal >60%
Carbon Monoxide Poisoning lethal bc:
CO hemoglobin affinity
= Odorless, tasteless, & colorless gas
= higher affinity to Hemoglobin than that of O2
Carbon Monoxide (CO) Poisoning Lvls) <15%:
–20% Mild S/S:
21–40% Moderate S/S:
41–59% Severe S/S:
>60% Fatal S/S:
= Asymptomatic normal
2= H/A, N/V, dizziness, blurred vision:
3= Confusion, syncope, chest pain, dyspnea, Tcardia/pnea, weakness
4= Dysrhythmias, hypoBP, cardiac ischemia, palpitations, resp/ arrest, pulmonary edema, seizures, coma,
cardiac arrest
5= Dead, Cherry Pink skin
Inferior Vena Cava Filter
Filter inserted via pelvis to prevent Strokes, PEs, MIs
Hyperventilation Syndrome:
Respiratory alkalosis Causes:
most common etiologies:
= inappropriate increase in RR is beyond metabolic needs
= increase in binding of ionized Ca, thus creating a relative hypocalcemia state (troussos sign)
= Anxiety and stress
Anterior portion of the nose Fn:
Lateral wall of nasal cavity is marked by
The turbinates create turbulence for:
= hair follicles that help trap large dust particles.
= 3 bony turbinates. Between each is a passageway, or meatus, that leads to the paranasal sinuses
= helping entrapment & removal of any inhaled foreign particles, such as dust.
Cilia In the nose move how & for:
When mucus & entrapped particles reach posterior of nasopharynx:
= steady posterior flow of mucus at the same time removing any entrapped particles.
= they are swallowed and removed from the body via the digestive tract.
Tonsils are:
3 types of tonsils:
= nodules of lymphoid tissue that are located in the posterior pharynx.
= pharyngeal/adenoids, palatine & lingual in Oral cavity
Globit cells produce for function of:
Larynx Cilia propels mucus toward:
Cigarette smoking major problem excluding cancer:
= Mucus to trap air contaminants, for the cilia
= the pharynx to trigger swallow reflex
= leads to destruction of the cilia, leaving the cough reflex as the only protective mechanism.
Diaphragm expansion cause:
intrapulmonic P. relation w/ atmospheric P.
= increase chest vol/ thus decrease in air pressure inside the chest cavity (intrapulmonary pressure)
= decrease to ~1-2 mmHg <atmospheric pressure creates a pressure gradient, causing air to be drawn in (inhalation). This process, known as negative pressure ventilation, is vital for effective gas exchange.
Lung perfusion depends on 3 conditions:
= Adequate blood vol/, Intact pulmonary capillaries, Efficient pumping of blood by the heart
1) Not all of the alveoli remain patent during gas exchange thus:
2) This process is referred to as:
= a small % of blood passes through alveoli w/o exchanging oxygen & carbon dioxide
= physiologic shunt (affects ~2% of the total blood flow to the lungs)
Primary accessory muscles of the neck
sternocleidomastoid and scalene muscle
gas exchange requires what 3 things
= Perfusion, ventilation, diffusion
Pleural space has a pressure between:
W/ expiration the chest wall & diaphragm:
= 4 & 8 mmHg <than atmospheric pressure.
= recoil to normal resting state, thus increases inside the chest to ~1-2 mmHg >atmospheric P
The forced expiratory volume (FEV)
Most commonly, FEV1 measures
Peak flow measures:
Both these measurements are commonly used for:
= vol/ of air exhaled over measured period of time
= air vol/ expelled in 1st sec of a forced expiration
= max/ rate of airflow during a forced expiration( Ls of air expiration per min)
= assessing PTs w/ lung diseases (COPD, asthma)
Stretch receptors are located @:
= visceral pleura, bronchi & bronchioles walls
O2 gradient provides the driving force in:
Larger difference between concentration of oxygen in the alveoli & capillaries:
= moving oxygen into the capillaries (diffusion)
= the greater the diffusion of oxygen into the bloodstream
The location where pulmonary arteries enter and pulmonary veins exit is called the:
Pulmonary hilum
Only a fraction of carbon dioxide is transported as a gas. It flows into the alveoli due to the gradient that exists between the concentrations of gases
(PCO2 of 45 mmHg in the pulmonary artery versus 40 mmHg in the alveoli).
Other meds used by PTs w/ COPD or asthma:
PTs w/ cardiac disease commonly use
= cromolyn sodium, methylxanthines (e.g., theophylline), and antibiotic agents.
= nitrates, Ca-channel blockers, diuretic agents, digoxin, and certain antiarrhythmic agents.
Pediatric PTs grunt during exhalation if:
= atelectasis is present to create physiological PeeP
Oxygen saturation is the:
Oxygen saturation formula:
= ratio of the blood’s actual oxygen content to its total oxygen-carrying capacity
= O2 content /O2 capacity×100(%)
Oxygen arterial partial pressure (PaO2) form:
Carbon Dioxide arterial partial pressure (PaCO2) form:
= 100Torr ( average = 80 - 100)
= 40torr (average = 35-45)
BAAM=
Beck Airway Airflow Monitor→ high pitch on inhale
Methemoglobin=
Methemoglobinemia=
treat w/:
= Hemoglobin not picking up ( w/ iron in ferric (Fe3+) vs oxy)
= changing color from lack of oxygenated hemoglobins
= Methylene Blue
MetHemoglobin Lvls- 1-3%:
3-15%:
15-20%:
25-50%:
50-70%:
>70%:
= Normal
= discoloration, grayish-blue
= Cyanotic, asymptomatic
= CNS H/A, N/V, Confusion, Chest pain
= AMS, delirium
= Fatal
Capnography) Height:
Length:
W/ Applying remember:
= total CO2
= time/rate
= Keep connected off of PT for 10 secs to calibrate baseline ETCO2
Oxyhemoglobin is:
Carbaminohemoglobin:
Methemoglobin:
Deoxyhemoglobin:
Carboxyhemoglobin:
Sulfhemoglobin:
Glycated Hemoglobin (HbA1c):
= oxygen carrying Hemoglobin
= carbon dioxide on hemoglobin amino-acid
= Hemoglobin not picking up ( w/ iron in ferric (Fe3+) vs oxy)
= Hemoglobin not bound to oxygen.
= Hemoglobin bound to carbon monoxide (CO).
= Hemoglobin irreversibly bound to sulfur.
= Hemoglobin bound to glucose for measuring long-term BGL control
dysarthria:
dysphonia:
aphasia:
expressive aphasia:
Receptive aphasia:
PT w/ aphasia be mistaken for:
= defective speech caused by motor deficits
= voice changes caused by vocal cord prob/s
= defective language from brain damage
= words will be garbled
= words will be clear but unrelated to your questions.
= a psych disorder b/c such difficulty speaking
Presence of Carotid bruit:
What is a carotid bruit:
= usually means= atherosclerosis
= sound of turbulent blood flow around partial vessel obstruction
adventitious lung sounds:
= crackles/rales, wheezes, rhonchi, stridor, & pleural rubs
How does CO2 get transported throughout our body:
Bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
Trachea bifurcates @?
Carina
Identify the differences between the visceral and parietal pleura
V=has no nerves P= has nerves
following would cause a right-shift of the oxygen dissociation curve:
decrease in blood pH
increase of present CO2
increase of temp
following would cause a left-shift of the oxygen dissociation curve:
Increase in blood pH
Decrease of present CO2
Decrease in temp
Phase 1 cap/ waveform:
Phase 2 cap/ waveform:
Phase 3 cap/ waveform:
Phase 4 cap/ waveform:
=Respiratory baseline
=Respiratory Upstroke
=Respiratory Plateau
=inspiratory downstroke
Capography wave forms
normal bicarbonate ion to carbonic acid ratio
20:1
Carbonic Acid-Bicarbonate Buffer system formula:
CO2 + H20 <> H2CO3 <> H + HCO3
Carbonic acid:
H2CO3
Bicarbonate ion:
HCO3
ABG normal range:
Alkalosis:
Acidosis:
= 22-26
= >26
= <22
Respiratory Acidosis:
Respiratory Alkalosis:
Metabolic Acidosis:
Metabolic Alkalosis:
= Slow breathing, high ETCO2
= Rapid breathing, low ETCO2
= Rapid deep breathing, low ETCO2
= Slow breathing, high ETCO2
Kussmaul’s sign
inhale +inthoracic Pressure pushes & JVD on inhale, Exhale decreases pressure reliefing JVD
Hyperresonance percussion sound:
= “Booming” , loud intensity, Low pitched, long duration, located in Hyperinflated-Lung
Resonance percussion sound:
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung
Flat percussion sound:
= “Extremely dull” , Soft intensity , High pitched, short duration, located in muscle & atelectasis
Clubbing fingernails:
= “finger clubs” distal phalanx of each finger is rounded and bulbous. The proximal nail feels spongy. This is caused by the chronic hypoxia found in cardiopulmonary diseases and lung cancer.
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
Pericarditis PT’s will have more pain with:
= laying down & coughing
Haldane Effect:
Influences by:
What does it do to the hemoglobin?
= Alk> Hemoglobin Loves oxy in Lungs
= -CO2, -temp, +pH -BPG 2,3, in Lungs,
= +oxy affinity
2 cyanide antidote regimens are available:
Sodium nitrite dose :
Sodium thiosulfate dose:
= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.
Boyle’s Law:
The volume of gas is inversely proportional to the pressure of it The more pressure, the less volume.
The less pressure, the more volume.
At sea level 1 atmosphere of pressure on your body
Every 33 feet under water adds another atmosphere
14.7PSI
Down 33ft 1000 vol, 66ft 500
Ascent pops lung
Henry’s Law:
The amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
Diving down puts more pressure on nitrogen to dissolve & into bloodstream
Usually compresses brain
Descent injurie w/ diving w/ ear infection or dental work
what is the cut off for using adult vs pediatric colormetric ETCO2 device
= PT’s weight is: 15 kg or below
BP form/s:
BP is related to:
= (SV x HR) x SVR or CO x SVR
= CO & peripheral resistance
Preload:
= pressure (volume) w/in the ventricles at the end of diastole & Also commonly called the end diastolic volume (frank starlings law)
What is Acute Coronary syndrome?
A spectrum of conditions caused by sudden reduced blood flow to the heart. Includes unstable angina, NSTEMI, & STEMI.
Arteriosclerosis:
= General hardening & loss of elasticity in arterial walls, often w/ age. “ARt hARd”
Atherosclerosis:
= Type of arteriosclerosis involving plaque buildup (fat, cholesterol, etc.) narrowing arteries. “fAT AThero”
How does an increase in arterial PCO2 affect blood pH?
Q: How does carbon dioxide leave the blood?
A: = CO2 moves out of the blood into alveoli due to the concentration gradient.
= decreases blood pH by increasing the concentration of hydrogen ions.
1}Arterial oxygen concentration (CaO2) calculated:
2}SaO2 represent in the CaO2 equation?
3} Hgb represent in the CaO2 equation?
4} 1.34 represent in the CaO2 equation?
5} 0.003 represent in the CaO2 equation?
6} PaO2 represent in the CaO2 equation?
1} 𝐶𝑎𝑂2=(𝑆𝑎𝑂2× 𝐻𝑔𝑏 × 1.34)+ (0.003 × 𝑃𝑎𝑂2)
CaO2=(SaO2×Hgb×1.34)+(0.003×PaO2).
2} Hemoglobin-oxygen saturation (%)
3} Amount of hemoglobin present (g/dL)
4} Amount of oxygen bound to 1 gram of hemoglobin at 1 atmosphere of pressure.
5} Oxygen dissolved in plasma (mL/g Hgb)
6} Partial pressure of oxygen dissolved in plasma
When CO2 increases in cerebrospinal fluid (CSF):
= CO2 combines w/ water to form an acid, lowering pH & increasing hydrogen ion concentration.
Enzyme facilitates CO2 & water reaction in RBC:
ions formed when carbonic anhydrase combines CO2 & water:
= Carbonic anhydrase
= Hydrogen (H+) & bicarbonate (HCO3−).
Does CO2 bind to the same hemoglobin site as oxygen?
= no, it binds to amino acid in the hemoglobin protein chain thus Carminoglobin
Why is CO2 released from hemoglobin in the lungs?
= the lower concentration of CO2 in the alveoli.
PCO2 gradient between pulmonary artery & alveoli:
Normal arterial oxygen concentration (CaO2):
Normal oxygen concentration in alveoli
Normal pulmonary arterial circulation:
CO2 pulmonary capillaries concentration gradient
CO2 pulmonary alveoli concentration gradient:
= Pulmonary artery: 45 mmHg, Alveoli: 40 mmHg
= 17 to 24 mL/dL.
= Alveoli: 104 mmHg
= Pulmonary arterial circulation: 40 mmHg
= Capillaries: 45 mmHg
= Alveoli: 40 mmHg.
How does the gradient between alveolar & capillary oxygen concentration affect oxygen transfer?
Less oxygen passes into the bloodstream as the gradient decreases.
Final concentrations of oxygen & carbon dioxide in blood leaving pulmonary capillaries?
= Oxygen: 104 mmHg, Carbon dioxide: 40 mmHg
