Acid/Base/Vent Management Flashcards
The fastest physiological mechanism for acid base correction is:
Bicarbonate Buffering System
During aerobic metabolism cell primarily produce:
Adenosine Triphosphate
The metabolic byproduct of aerobic metabolism
CO2 and Water
The Bohr Effect:
Occurs as a result of CO2 binding with Hgb causing a decreased affinity of Hgb for oxygen
Right Shift:
HGB Releases O2 Raised Temp Raised 2-3DBG Raised Acidosis Reduced Oxygenation (BohR effect)
Left Shift:
HGB HoLds O2 Low Temp Low 2-3 DPG aLkalosis (Low Acidosis) Lots of CO
Massive transfusion causes a ___________ of 2-3 DPG
Lowering
Elimination of fixed acids occurs via
The renal system
Increased CO2 removal is facilitated by:
Bohr Effect
The majority of CO2 is transported:
as bicarbonate in plasma
The relationship of ETCO2 to PaCO2 should
demonstrate EtCO2 is slightly lower the PaCO2
**EtCO2 can NEVER be higher then the PaCO2
For every change in pH of_____ you will see a change in the K+ of _____ in the opposite direction.
0.1 and 0.6
For every _____ mmHg change in CO2, the pH will change ____ in the opposite direction.
10 and 0.08
For every change in HCO3 of ______ mEq, the pH will change _______ in the same direction.
10 and 0.15
Potassium administration:
May be given via PIV
Should not exceed 0.5-1.0 mEq/kg/hr
Typically occurs at 10-20 mEq/hr
When Glycolysis occurs you get ____ ATP
2
Byproduct of Glycolysis is ________
Pyruvic Acid
Normal Aerobic Metabolism you get ____ ATP
Byproduct ________
38
Water and CO2
Anaerobic metabolism you get as little as _____ ATP
Byproduct is ________
2-4
Lactic Acid
To decrease PaCO2
Increasing Minute Volume
Verify maximum safe Vt (keep Pplat <30-35)
Increase Rate
To increase PaCO2
Decrease Minute Volume
Decrease Rate
Decrease Vt no more than absolutely necessary
To Increase PaO2
- Verify normal/adequate Ve
- Maximize FiO2
- Add Peep
- Consider reducing I:E ratio
- Invert I:E ratio
What is the most common cause of barotrauma related to ventilators
High Plateau Pressure
Hyperthermia and acetylsalicylate poisoning both promote ______ventilation
Hyper
Renal failure is most likely to cause which acid/base disturbance?
Metabolic Acidosis
Continuous OG/NG suctioning would most likely cause which acid/base disturbance?
Metabolic Alkalosis
To assure optimal O2 delivery to the pulmonary capillaries you must have:
Adequate Alveolar Volume
Barotrauma caused by ventilators is best prevented by monitoring:
Pplat
Minute Volume Formula
Ve= (Vt x F)
Normal Ve
4-8 L/MIN
An elevated PIP with normal/unchanged Pplat suggest:
Asthma
Elevated PIP and Pplat suggest
Pneumothorax
Dead space is approximated by what formula?
33% of the tidal volume or approx 1ml/lb (ideal body weight)
Asthma patient will demonstrate on CXR:
Narrowed mediastinum
Hypodense lung fields
Blunted or Squared Costophrenic Angles
Flattened Diaphragm
Who would have a low 2-3 DPG
Multiple Transfusions
Who would have a raised 2-3 DPG
Chronic Lungers
If the K+ is high and the pt is acidic do you fix the K+?
No this is a false high.
____________ stimulates motor end plates acetylcholine receptors causing persistent depolarization
Succinylcholine
When admin a defasciculating neuromuscular blockade, the dose recommended is ____
10% normal RSI dosage of NMBA
Early Salicylate Poisoning usually presents with which ABG?
Noncomp Resp Alkalosis
If PIP does not change on a vented pt with respiratory acidosis, always____
Decrease Vt before rate
An Elevated anion gap can indicate the presence of which acid base disorder?
Metabolic Acidosis
Diarrheal dehydration can cause which acid base disturbance?
Metabolic Acidosis (esp in peds)
Metabolic alkalosis can be caused by a loss of Hydrogen Ions through the ________ and ______
Kidney and GI tract
Acute Resp Failure is defined as:
pO2 50
Hammans Sign:
Sign of Tracheobronchial Injury
Early Signs of Malignant Hyperthermia
- Increase CO2
- Tachycardia
- Muscle Rigidity
Chest Tubes are usually inserted at
4th-5th ICS Anterior Axillary Line
Causes of Metabolic Acidosis in Order of most likely to least likely.
- Lactic Acidosis
- DKA
- Renal Failure
- Toxins? (Heavy Metals Poisonings of ETOH Poisoning)
One of the Primary Poisoning that causes Metabolic Acidosis is:
Alcohol’s (Ethanol, Methanol, Anti-Freeze)
Nitrates can cause what kind of poisoning?
Cyanide
Metabolic Alkalosis
Think Electrolyte Imbalance
Too much Bicarb or not enough Acids
“Worst of the Worst”
Treatment of Metabolic Alkalosis
Identify and Correct electrolyte abnormalities
A-a gradient > _______ you have a shunt
20
Steps to Increase PaO2
- Assure adequate Alveolar Min Ventilation (assess Vt and RR) Good Value and Good Rate
- Maximize FiO2
- Add PEEP
- Invert I:E ratio
What drives a person to breath
- Excess CO2
2. Inadequate Oxygen
