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CP Test 4 > B4-054 Respiratory Failure > Flashcards

B4-054 Respiratory Failure Flashcards

1
Q

indications for mechanical ventilation:
respiratory failure

4

A
  • hypoxia
  • hypercarbia
  • perioperative
  • metabolic
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2
Q

indications for mechanical ventilation:
upper airway obstruction

3

A
  • anaphylaxis
  • angioedema
  • trauma
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3
Q

indications for mechanical ventilation: airway protection

3

A
  • decreased GCS
  • cardiac arrest
  • prevention of aspiration
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4
Q

type 1 respiratory failure

A

hypoxemia

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5
Q

type 2 respiratory failure

A

hypercarbia

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6
Q

type 3 respiratory failure

A

perioperative

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7
Q

type 4 respiratory failure

A

metabolic

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8
Q

occurs with alveolar flooding and subsequent VQ mismatch and intrapulmonary shunt physiology

A

type 1 hypoxia

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9
Q

pulmonary edema, lung injury, pneumonia or hemorrhage can cause what type of respiratory failure?

A

type 1 hypoxia

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10
Q

low inspired oxygen
VQ mismatch
shunt
diffusion limitation

cause

A

type 1- hypoxia

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11
Q

in the case of a shunt, will supplying supplemental oxygen improve ventilation?

A

no

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12
Q
  • impaired CNS drive to breathe
  • impaired neuromuscular strength
  • impaired resistance

cause

A

type 2 hypercarbia

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13
Q

lab findings pH < 7.2 and PaCO2 >45 or significantly elevated from baseline

A

type 2 hypercarbia

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14
Q
  • atelecstasis
  • decreased airway protection
  • airway injury
  • procedural need

causes for

A

type 3 perioperative

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15
Q

hypoperfusion of respiratory muscles

can cause

A

type 4 metabolic

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16
Q

what should you do if your patient is hypoxic?

A
  • sit up
  • oxygenate
  • stimulate
  • history
  • labs/imaging
  • call for help
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17
Q

flow 1-6L
FiO2 24-45%

A

nasal cannula

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18
Q

flow 1-7 L
FiO2 30-55%

A

reservoir nasal cannula

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19
Q

flow 10-60 LPM
FiO2 21-100%

A

heated high flow cannula

he also called this comfort care

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20
Q

flow 6-10 LPM
FiO2 35-50%

A

simple face mask

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21
Q

flow 2-15 LPM
FiO2 24-60%

A

venturi mask

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22
Q

flow 10-15 LPM
FiO2 -80%

A

non rebreather

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23
Q

induction agents

4

A
  • propofol
  • ketamine
  • etomidate
  • benzodiazepines
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24
Q

blunting of airway reflexes

2

A
  • lidocaine
  • opiods
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25
Q

neuromuscular blockage

A

depolarizing vs nondepolarizing

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26
Q

GABA receptor agonist

3

A
  • propofol
  • benzos
  • etomidate
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27
Q
  • most common agent used before surgery
  • used to maintain general anesthesia before surgery
A

propofol

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28
Q

NMDA receptor antagonist

A

ketamine

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29
Q
  • decreases pain with injection of propofol and etomidate
  • causes tinnitus, perioral tingling
A

lidocaine

30
Q
  • typically IV fentanyl
  • causes respiratory depression
A

opioids

31
Q

succinylcholine is a

A

depolarizing agent

32
Q

mimics acetylcholine and produces sustained depolarization of the post junctional membrane

A

succinylcholine

33
Q

rocuronium, vecuronium, cisatracurium are

A

non depolarizing agents

34
Q

most common trigger for perioperative anaphylactic events

A

non depolarizing agents

35
Q

reversal agent for rocuronium/vecuronium

A

suggamadex

36
Q

MH trigger

A

succinylcholine

37
Q

history red flags for intubation

A
  • OSA
  • neck radiation
  • difficulty controlling secretions
38
Q

physical exam finding red flags for intubation

A
  • BMI > 30
  • neck circumference > 40
  • edentulous
  • small mouth
  • limited neck mobility
  • thyromental distance < 6
  • beard
39
Q

purpose of preoxygenation

A

breathing 100% oxygen can replace nitrogen and increase the amount of oxygen lungs can hold

40
Q

proper positioning for intubation

A
  • 35 degrees of cervical flexion
  • elevation of the head on firm cushion
41
Q
  • rapid anesthesia induction, short DOA
  • may cause respiratory depression and decreased BP
A

propofol

42
Q
  • causes hallucination, vivid dreams
  • sympathomimetic
A

ketamine

43
Q

an intrapulmonary problem associated with an A-a gradient

A

type 1 hypoxemia

44
Q
  • ventilatory problem
  • the integrity of the alveolar capillary unit is normal
  • A-a gradient normal
A

type 2 hypercarbia

45
Q

normal A-a gradient

A

(Age + 10)/4

46
Q

acute hypercapnea is always accompanied by

A

respiratory acidosis

47
Q

PaCO2> 45 mmHg

A

hypercapnea

48
Q

hypercapnic respiratory failure is typically caused by two things

A

decreased minute ventilation
increased dead space

49
Q

alveolar gas exchange is inversely related to

A

PaCO2

50
Q

a change of 10 in CO2 causes a pH change of

A

0.08

51
Q

If alveolar ventilation is reduced by half, PaCO2 will

A

double

52
Q

usually due to alveolar hypoventilation

A

respiratory acidosis

53
Q

usually due to alveolar hyperventilation

A

respiratory alkalosis

54
Q

due to:
* increased production of acids
* increased loss of bicarb
* decreased renal excretion of acids

A

metabolic acidosis

55
Q

due to:
* intracellular shift of H+ ions
* GI H+ loss
* excessive renal loss of H+

A

metabolic alkalosis

56
Q
  • causes inhibition of 11B hydroxylase resulting in short term adrenal insufficiency
  • low cortisol, hyponatremia, hyperkalema, fatigue, weakness, hypotension
A

etomidate

57
Q
  • typically given during intubation and mechanical ventilation to blunt reflexes
  • can also be given for pain control and sedation
A

fentanyl

58
Q
  • commonly used to provide rapid muscle relaxation during rapid sequence induction
  • causes depolarization of neuromuscular junction leading to paralysis
A

succ

59
Q
  • most significant side effect is MH
  • rapid elevation of temperature, muscle rigidity, metabolic acidosis, and CV instability
A

succ

60
Q

potential side effect is pseudocholinesterase deficiency causing prolonged paralysis

A

succ

61
Q
  • commonly used for induction and sedation that acts on GABA
  • short acting, rapid anesthesia, quick recovery
A

propofol

62
Q

potential side effect causing metabolic acidosis, rhabdomyolysis, hyperkalemia, cardiac dysfunctio, renal failure

A

propofol infusion syndrome

63
Q

normally respiratory muscles consume 5% of total CO, but in shock, up to […] of the CO can be redirected to respiratory muscles

A

40%

mechanical ventilation may be required just to let CO distribute properl

64
Q

acute respiratory acidosis, pH should be about

A

7.24

65
Q

acute metabolic acidosis, PCO2 should be

A

low

66
Q

metabolic alkalosis, pH should be […] and HCO3 should be […]

A

pH > 7.4
HCO3 > 24

67
Q

with chronic respiratory alkalosis, pH should be […] and HCO3 should be […]

A

pH: near normal
HCO3: low

68
Q

alveolar ventilation increases as RR

A

increases

69
Q

alveolar ventilation increases as tidal volume

A

increases

70
Q

alveolar ventilation increases as dead space

A

decreases

71
Q

opioid overdoses cause what type of respiratory failure?

A

hypercapnic

respiratory acidosis

CP Test 4 (15 decks)

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