ABG Resp distress, altitude, apnoea

Question 1

what should a patients PaO2 be on air

Answer 1

> 10

Question 2

what PaCO2 indicates resp acidosis (or compensation)

Answer 2

PaCO2 > 6

Question 3

what PaCO2 indicates resp alkalosis (or compensation)

Answer 3

PaCO2 <4.7

Question 4

what bicarb indicates met acidosis (or compensation)

Answer 4

<22 // OR BE <-2

Question 5

what bicarb indicates met alkalosis (or compensation)

Answer 5

bicarb >22 OR BE >+2

Question 6

how is an anion gap calculated

Answer 6

(Na + K) - (Cl + HCO3)

Question 7

what is a normal anion gap

Answer 7

4-12 (hyperCl)

Question 8

causes normal anion gap met acidosis

Answer 8

GI loss eg diarrhoea // renal tubular acidosis // acetazolamide // addisons

Question 9

causes raised anion gap met acidosis

Answer 9

lactate eg shock ,hypoxia // ketones // urate (renal failure) // slicylates or methanol

Question 10

causes met alkalosis

Answer 10

loss of H or gain of HCO3 // vomiting or aspiration // diuretics // liquorice, carbenoxolone // hypoK // hyperaldosteronism // bushings // barters // CAH

Question 11

causes resp acidosis

Answer 11

COPD // asthma, pulm oedema // benzos, opioids // neuromuscular disease // obesity hypoventilation

Question 12

causes resp alkalosis

Answer 12

anxiety + hyperventilation // PE // salicylate // CNS eg stroke, SAH, encephalitis // altitude // pregnant

Question 13

what is acute resp distress sydnrome (ARDS)

Answer 13

increase alveolar capillary permeability –> fluid in alveoli (non-cardiac oedema)

Question 14

causes ARDS

Answer 14

infection eg sepsis, pneumonia // massive blood transfusion // smoke inhalation // trauma // pancreatitis // cardio-pulm bypass

Question 15

features ARDS

Answer 15

SOB // RR // bilateral crackles // low O2

Question 16

1st line invx ARDS

Answer 16

ABG + CXR

Question 17

diagnostic criteria ARDS

Answer 17

acute clinical picture // pulm oedema // non-cardiogenic // pO2/FiO2 <40 (300 mmHg)

Question 18

how do you test for non-cardiogenic cause of oedema

Answer 18

pulmonary artery wedge pressure

Question 19

mx ARDS

Answer 19

ITU // ventilation // maybe vasopressors // prone position

Question 20

3 main types of altitude related disorder

Answer 20

acute mountain sickness // pulm oedema (HAPE) // cerebral oedema (HACE)

Question 21

what causes high altitude syndromes

Answer 21

chronic hypobaric hypoxia

Question 22

what altitude causes acute mountain sickness + what symptoms are seen

Answer 22

2500-300m // headache, nausea, fatigue

Question 23

prophylaxis with AMS

Answer 23

acetazolamide

Question 24

when does HAPE + HACE develop

Answer 24

over 4000m

Question 25

features + mx HACE

Answer 25

headache + ataxia + papilloedema // descent + dexamethasone

Question 26

features + mx HAPE

Answer 26

pulm oedema // descent + O2 + nifedipine, dexamethasone, acetazolamide, PDV inhibitor

Question 27

what is Atelectasis

Answer 27

post op complication –> bronchial secretions –> alveolar collapse –> resp difficulty

Question 28

features Atelectasis

Answer 28

SOB + hypoxia 72 hours post-op

Question 29

mx Atelectasis

Answer 29

position upright + physio

Question 30

RF sleep apnoea

Answer 30

obese // macroglossie eg acromegaly, hypothyroid, amyloid // large tonsils // Marfans

Question 31

symptoms sleep apnea

Answer 31

day time naps // compensated resp acidosis // HTN!!!

Question 32

assessment of sleepiness sleep apnoea

Answer 32

Epworth sleepiness scale // multiple sleep latency test

Question 33

diagnosis sleep apnoea

Answer 33

sleep study (polysomnography)

Question 34

ABG Resp distress, altitude, apnoea mx sleep apnoea

Answer 34

weight loss // CPAP