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Pulmonology > Airway Obstruction + Ventilation > Flashcards

Airway Obstruction + Ventilation Flashcards

1
Q

Medullary center

Dorsal respiratory Group DRG

A

Controls inspiratory movements + timing

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2
Q

Medullary Center

Ventral respiratory group VRG

A

Controls voluntary forced exhalation + up inspiration. Inactive in quiet breathing

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3
Q

Pontine Centers

Pneumotaxic center

A
  • Coordinates speed of inhalation/ exhalation. *Sends inhibitory impulses to DRG.
  • Fine tuning of RR
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4
Q

Apneustic Center

A
  • Inspiration
  • depth of breathing
  • signals to DRG in medulla
  • stimulatory impulses to inspiratory area
  • inhibited by stretch receptors
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5
Q
  • cyclic, gradual increase then decrease

* HF, Stroke, Kidney failure, opiate, high altitude

A

Cheyne-Stokes Breathing
HYPERCAPNEA

CNS sleep apnea
2ndary

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6
Q

Central sleep apnea

Tx

A

CPAP

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7
Q

Obesity Hypoventilation

A

Gradual high PCO2, makes you sleepy

  • BMI = >35-40
  • daytime hypoventilation (UP CO2, Low O2)
  • Sleep-disordered breathing
  • hypercapnia = 20% dead in 18 months if untreated
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8
Q

Obesity Hypoventilation Syndrome (OHS)

Path

A
  • leptin deficiency/resistance (hunger UP)
  • more work load
  • upper airway obstruction

=

Poor ventilatory response

HYPERCAPNEA + HYPOXEMIA

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9
Q

Obesity-Hypoventilation Syndrome

Tx

A
  • weight loss
  • CPAP (exhalation)
  • BIPAP (inhalation + exhalation)
  • tracheostomy w/ nighttime positive pressure ventilation
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10
Q

Hyperpnia

A
  • NOT hyperventilation syndrome

* UP depth+rate of breathing = sepsis, fever, hypoxemia

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11
Q

Central Sleep Apnea

A
  • brain stop sending signals to the muscles of respiration
  • Lack of abnormal + thoracic movement
  • primary : Ondine’s Curse to Palemon
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12
Q

Apnea =

A

Cessation of breathing >10 seconds

*hypopnea = DOWN airflow w/ DOWN O2 Sat >4%

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13
Q

Apnea-hypopnea index (AHI)

A
  • severity of sleep apnea
  • 0-4 = Normal
  • 5-14 = Mild
  • 15-29 = Moderate (CPAP)
  • 30+ = Severe (CPAP)
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14
Q

*Obesity
*Loud / frequent snoring
(Only if crescendo)
*Silent Pauses in breathing
*Choking/gasping
*Daytime sleepiness/fatigue
*Unrefreshing sleep
*insomnia
*Morning headaches
(Back of head = HTN)
*nocturia (waking to urinate)

A

Sleep Disorder Breathing

Signs + Symptoms

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15
Q

Acute respiratory failure

A
  • pneumonia
  • ARDS
  • Status asthmaticus
  • Acute COPD exacerbation

VENTILATE

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16
Q

Acute on Chronic repsiratory failure

A

Hypercarbia = OHS

VENTILATE

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17
Q

pulmonary edema

A

Heart failure
Renal failure (dialysis)
VENTILATE

18
Q

Inability to protect airway

A

Coma
Seizures

VENTILATE

19
Q

Neuromusclular dysfunction

A

ALS

VENTILATE

20
Q

Stabilize chest wall after trauma

A

VENTILATE

21
Q

Mechanical ventilation makes

A

External Negative pressure => chest expands

22
Q

Bulbar polio mortality treated w/ iron lung ventilation

A

90% mortality

  • affects medulla oblongata = swallowing mechanism + breathing
  • drown in own secretions
23
Q

Pulmonary edema (fluid)

Effect on compliance curve

A

Need more pressure to even approach normal volume

Tx: positive pressure w/ tracheotomy

24
Q

Lungs full of secretions

Neg pressure ventilators?

A

NOPE, will not inflate lungs

Need positive pressure w/ tracheotomy

25
Q

ventilator measures

A

Flow + pressure

Volume calculated

26
Q

Positive pressure types

A

Volume cycled = volume constant, pressure varies w/ patient’s lung compliance

27
Q

Pressure cycled

A

Pressure constant but volume varies w/ patients lung compliance. (Dangerous, can cause barotrauma with too much inhalation)

*use w/ reduced compliance/stiff lungs

28
Q

Positive Pressure Ventilation Injury

A
  • upper airway
  • tracheomalcia
  • ventilator associated pneumonia
  • Lung parenchymal damage
  • large tidal volumes
  • Super ‘PEEP’
  • Zeep/zero peep
29
Q

Patient - ventilator interaction + asynchrony

A
  • barotrauma

* longer time on ventilator + ICU

30
Q

Expiratory Asynchrony

A

Ineffective breathing efforts
*abrupt increase in flow during expiration
From: high ventilatory requirements, autoPEEP, respiratory muscle weakness, insensitive trigger setting

31
Q

Double triggering asynchrony

A

*2 consecutive internals with interval

32
Q

*sedation + neuromuscular paralysis

A
  • daily interruption of sedation (morning)

* paralyze patient for first 48 hours

33
Q
  • Deep, rapid continuous inspirations

* no stopping between breaths

A

Kussmaul’s Respiration

*metabolic acidosis

34
Q
  • irregular respirations, quick, shallow

* irregular periods of apnea

A

Biot’s Breathing

*medulla oblongata damage/opioid use

35
Q

Apnea =

A

Cessation of breathing 10 secs

36
Q

Hypopnea =

A

Decrease in airflow w/ decrease in artery O2 sat >4%

37
Q

Apnea-Hypopnea index
(# events per hour of sleep)

  • normal
  • moderate
  • severe
A
  • normal = 0-4
  • moderate = 15-29
  • severe = 30+
38
Q

Signs

A
  • large neck
  • loud/frequent snoring
  • silent pauses in breathing
  • choking gasping
  • daytime sleepness
  • morning headaches (back of head=HTN)
  • nocturia
39
Q

Sleep disordered breathing

Long term issues

A
  • pulmonary hypertension
  • cor pulmonale
  • arrthymias
  • LHF
  • HTN
  • stroke
40
Q

Repetitive episodes of airflow reduction (hypopnea) + cessation (apnea)

A

Obstructive sleep apnea

Tx. CPAP (pressure at END of EXPIRATION)

Pulmonology (12 decks)

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