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Cardiopulmonary A & P > Chapter 6 > Flashcards

Chapter 6 Flashcards

1
Q

RBC

A

Made by bone marrow, Adult Male: 4.7-6.1 million RBC per microliter, Adult Female 4.2-5.4 Million/ uL

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2
Q

Anemia

A

low RBC or low HCT (hematocrit)

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3
Q

Polycythemia

A

high RBC, Altitude may increase hgb, when PaO2 decreases - hgb increases

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4
Q

Hematocrit

A

Percentage of RBCs in blood volume

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5
Q

Hematocrit normal ranges

A

Adult males 42%-52%, adult females 37-47%

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6
Q

Polycethymia

A

high hematocrit

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7
Q

pH normal ranges

A

arterial 7.35-7.45, venous 7.30-7.40

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8
Q

PCO2 normal ranges

A

Arterial 35-45 mmHg, Venous 42-48mmHg!!

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9
Q

HCO2

A

Arterial 22-28 mEq/L, Venous 24-30 mEq/L

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10
Q

PO2

A

arterial 80-100 mmHg, venous 35-45 mmHg!!

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11
Q

Hemoglobin

A

Oxygen carrying component of RBC’s (report as weight / 100ml of blood

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12
Q

Hemoglobin

A

Oxygen carrying component of RBC’s (report as weight / 100ml of blood.) about 280 milion hgb, pigmented portion of RBC’s (red, significant in SaO2 measurement)

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13
Q

each RBC contains how many heme groups

A

4 that can each carry 1 molecule of O2

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14
Q

What combines with the O2

A

FE++ contains about 280 milion hgb, pigmented portion of RBC’s (red, significant in SaO2 measurement)

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15
Q

What combines with the O2

A

FE++ contains

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16
Q

Each gram of hbg can carry how much O2

A

1.34 = 20.1 vol %O2

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17
Q

PaO2 of 100=

A

0.3 mL, 100x0.003= 0.3mL

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18
Q

Oxyhemoglobin Dissociation Curve

A

percent of O2 attached to hbg in reference to PaO2 and O2 content

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19
Q

Steep Portion of curve

A

PaO2 of 40-70 mmHg

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20
Q

Upper Plateau of curve

A

> 70 mmHg

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21
Q

Lower Plateau of curve

A

anaerobic, in deep do-do!

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22
Q

Reference point on curve

A

is PaO2 at 50% hemoglobin saturation (P50), done by tonometery, not clinically practical

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23
Q

Right shifts

A

O2 readily releases

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24
Q

left shift

A

impairs O2 release

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25
Q

Oxygenation

A
  1. O2 Transport- dependant on O2 content (CaO2), cardiac output (CO or QT), Oxyhemoglobin dissociation curve 2. PaO2 normally drawn from? 3.PAO2 4. SaO2 5. A-aDO2 6. PaO2/PAO2 ratio 7. PaO2/FiO2 ratio
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26
Q

PaO2 drawn from

A

Measured from ABG sample, normal adult range 80-100mmHg, Clinically acceptable to keep in 60-80% range, higher then 125mmHg can reduce blood flow to brain and kidneys, O2 toxicity,

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27
Q

Higher than what mmHg PaO2 can cause what damage

A

125mmHg can reduce blood flow to brain and kidneys

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28
Q

PAO2 equation

A

(Pb-47) x FiO2 - (PaCO2/ 0.8), Partial pressure of alveolar O2

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29
Q

SaO2

A

Functional (oximetry), fractional (includes CoHbg, MetHbg, ect), Carbon Monoxide affinity for hbg is 210x that of O2

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30
Q

A-aDO2 or P(A-a)O2

A

indicates gas exchange efficiency

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31
Q

PaO2/PAO2 ratio

A

helpful in predicting FiO2 for desired PaO2

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32
Q

PaO2/FiO2 ratio

A

Ratio> then 200 indicate an ability to reduce FiO2 or PEEP

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33
Q

Tissue Oxygenation

A
  1. Oxygen Content % 2. Arterial-Venous Oxygen Content Difference 3. Shunt Equation 4. Oxygen Deliver 5. Oxygen Consumption 6. Oxygen Consumption index 7. Oxygen extraction ratio
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34
Q

Oxygen Content

A

Report as %. -Arterial O2 Content (CaO2) -Venous O2 Content (CvO2) - Pulmonary Capillary O2 Content (CcO2)

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35
Q

Arterial O2 Content (CaO2)

A

CaO2= (Hbg x 1.34 x SaO2) + (PaO2 x 0.003). Normal is about 20%. Hbg plays the biggest role in O2 number

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36
Q

Venous O2 content (CvO2)

A

CvO2= (Hbg x 1.34 x SvO2) + (PvO2 x 0.003). Normal is about 15%. Blood obtained from pulmonary artery. PaO2 = 45%, Sat = 75%, Tissue use = 5%

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37
Q

Pulmonary Capillary O2 content (CcO2)

A

CcO2= (Hbg x 1.34) + (PAO2 x 0.003) assuming its 100% saturated

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38
Q

Arterial- Venous Oxygen Content difference

A

amount of blood used by cells. CaO2-CvO2. Normal is about 5% (or apporoximately 250mL of O2)

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39
Q

C(a-v)O2=

A

CaO2 (left heart)- CvO2 (back to heart)

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40
Q

Shunt Equation

A

Qs/Qt= CcO2-CaO2/ CcO2 - CvO2. Calculates amount of blood that goes through lungs without picking up O2. Normal Range is below 10%. 20-30% Critical. >30% life threatening

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41
Q

Diffusion

A

from alveoli to capillary, hbg picks up O2 to tissue, creating CO2

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42
Q

1st sign of hypoxia

A

increase HR

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43
Q

Hemoglobin increases to

A

help O2 Sats (transfussion)

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44
Q

Oxygen Delivery

A

Amount of O2 delivered peripheral tissues (capillaries/cells), CO x CaO2 x 10. normal range is 550-650 ml/min/m3. decreased with low PaO2, Hbg, or cardiac output. normal response is increase in CO or increase in Hbg (exercise, high altitude)

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45
Q

Oxygen consumption

A

amount of O2 used by cells. VO2= COx (CaO2-CvO2) x 10. normal range is 2.86-4.29 ml/min/kg

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46
Q

Oxygen Consumption Index

A

VO2/BSA (body surface area). Clinically more accurate in determining O2 consumption

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47
Q

Oxygen Extraction Ratio (O2ER)

A

Amount of O2 Extracted by cells vs. amount avaliable. O2ER= CaO2 -CvO2/ CaO2. report as %. Normal range is approx 25%

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48
Q

Tissue Hypoxia

A

Hypoxic Hypoxia, Anemic Hypoxia, Circulatory Hypoxia, Histotoic Hypoxia

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49
Q

Oxygen is carried in two forms

A

Dissolved in plasma, bound to hbg

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50
Q

Dissolved in plasma

A

Gaseous form of O2 in the plasma, moves around freely, partial pressure is how its measured, PaO2, Dependent on the partial pressure available and temp of blood.

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51
Q

how many ml of O2 in 100ml blood per 1mmhg

A

0.003. Very small amount of total oxygen content is in the form of dissolved

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52
Q

Bound with hemoglobin

A

Oxygen diffuses into blood and combines with hbg.

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53
Q

normal hbg

A

12-16 g/100ml

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54
Q

Each heme/iron group can hold

A

4 oxygen molecules, when all 4 are full its 100% saturated

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55
Q

Oxyhemoglobin=

A

hemoglobin with oxygen bound

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56
Q

Deoxyhemoglobin =

A

hemoglbin without oxygen (reduced hemoglobin)

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57
Q

Each g% carries how many ml of O2

A

1.34 ml. so to calculate amount of oxygen carried by hbg (1.34 x g%hbg) saturation %

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58
Q

Total Oxygen Content equation

A

CaO2 = (1.34 x Hbg x O2 sat) + (PaO2 x 0.003)

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59
Q

Oxygen Dissociation Curve y axis

A

hbg saturation (vertical)

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60
Q

Curve X axis (horizontal)

A

PaO2

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61
Q

SaO2 over what are in the 90% or greater saturation levels

A

60mmHg

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62
Q

Curve Safety levels

A

PaO2 60, SaO2 90. below these levels the O2 content falls rapidly in relation to PaO2

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63
Q

Anemic Hypoxia

A

hbg= 8.7

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64
Q

Right Shift >

A

Decrease in pH, increase in Temp-CO2- 2,3 DBG

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65
Q

Left Shift >

A

Increase in pH- Carbon Monoxide (Carboxyhemoglobin), Decrease in Temp-2,3 DPG

66
Q

A shift to the right…

A

enhances the unloading of O2 at the cellular level. Doesnt pick up at lungs, diffuses into tissue

67
Q

a shift to the left…

A

facilitates the loading of O2 onto the hbg in the lungs (clinically harmful). Picks up at lungs, holds at tissue

68
Q

DO2=

A

CO x (CaO2 x 10). delivery decreases with decrease in any one of the above

69
Q

arterial to venous difference

A

the difference in the O2 of the blood before and after it passes the cells

70
Q

normal CaO2 is

A

20 Vol%

71
Q

Normal CvO2 is

A

15 Vol%

72
Q

so what is extracted by cells (50ml/l blood)

A

5 vol%

73
Q

febrile -> increase temp -> increase metabolism -> increase CO2 -> decrease pH =

A

Right shift

74
Q

Oxygen Consumption

A

Amount of O2 extracted by the peripheral tissue in 1 min

75
Q

Over one minute 250ml

A

5L/min x 5 vol% x 10 (normal)

76
Q

VO2 Equation

A

VO2 = CO [(CaO2-CvO2) x 10). normal 250 ml

77
Q

What causes O2 consumption to go up

A

Exercise, seizures, shivering, hyperthermia, body size

78
Q

What causes O2 consumption to go down

A

Skeletal Muscle Relaxation - induced by drugs, Peripheral Shunting- sepsis, trauma, Certain Poisons- cyanide, Hypothermia

79
Q

Cyanide

A

Lack of O2 to tissues- brain)

80
Q

Oxygen Extraction Ratio

A

The Percent of O2 taken by cells. amount extracted/ total amount available. 5 vol%/ 20 vol% = 25%= O2ER

81
Q

Normal O2ER

A

25%

82
Q

the higher the oxygen consumption the

A

higher the ratio

83
Q

Mixed Venous Oxygen Saturation

A

SvO2 monitoring used to monitor CO. Must have stable saturations and hemoglobin levels

84
Q

If saturations and hemoglobin levels are stable

A

a decrease in SvO2, CvO2, or PvO2 means an increase in O2 consumption or decrease in CO

85
Q

True Shunting

A

Doesnt respond to O2…Anatomic Shunts, Capillary shunts, absolute shunting

86
Q

Anatomic Shunts norm

A

2-5%

87
Q

Anatomic shunt veins

A

Bronchial, pleural, and thesbesian veins. Veins that feed the pulmonary system

88
Q

Anatomic shunt abnormalities

A

CHF, Intrapulmonary Fistula, Vascular Lung Tumors

89
Q

Capillary Shunts

A

Blood that goes through the lungs without exchanging gas

90
Q

Capillary shunt examples

A

alveolar collapse/atelectasis, Alveolar fluid accumulation, alveolar consolidation

91
Q

Absolute shunting

A

is refractory to oxygen therapy

92
Q

absolute shunting- increasing the FiO2 will

A

not increase the saturation in the blood that does come into contact with alveoli because it is already fully saturated.

93
Q

Alveolar collapse or atelectasis example

A

CHF

94
Q

Alveolar Consolidation example

A

pneumonia

95
Q

Shunt-Like effect (relative shunt)

A

Responds to O2. Perfusion is in excess of ventilation. easily corrected by O2 therapy

96
Q

Shunt like effect caused by

A

hypoventilation, uneven distribution of ventilation, Alveolar- capillary diffusion defects.

97
Q

During shunt like effect the alveoli are in contact with blood so

A

an increase in FiO2 will cause more O2 in blood.

98
Q

Alvolar-capillary diffusion defects

A

lose surface area

99
Q

Uneven distrubution of ventilation examples

A

chronic emphysema, bronchitis, asthma

100
Q

Normal Shunt %

A

10% or less

101
Q

Abnormal but usually not clinical significant shunt %

A

10-20%

102
Q

shunt that needs aggressive cardiopulmonary support (life threatening) %

A

30%

103
Q

Tissue Hypoxia

A
  1. Hypoxic Hypoxia 2. Anemic Hypoxia 3. Circulatory Hypoxia 4. Histotoxic Hypoxia
104
Q

Hypoxic Hypoxia

A

Inadequate O2 at the tissue cells caused by low arterial O2 tension (Low PAO2), Diffusion Impairment, Ventilation/ Perfusion mismatch (shunt-like effect), Pulmonary shunting

105
Q

Hypoxic hypoxia/ Low PAO2 caused by

A

hypoventilation, high altitude, FiO2 less than 21%

106
Q

Hypoxemia

A

low oxygen in the blood (arterial blood tension)

107
Q

Hypoxia

A

low oxygen in tissue cells

108
Q

Anemic Hypoxia

A

“think hbg” ..Low RBC=Low Hbg, 8.7, CaO2 low, PaO2 is norm, but the O2-carrying capacity of the hbg is inadequate. Decreased hbg concentration= anemia, hemorrhage. abnormal hbg= carboxyhbg, methbg

109
Q

Circulatory Hypoxia

A

Stagnant hypoxia or hypoperfusion, Slow blood flow to cells/ decrease CO. thus O2 is not adequate to meet tissue needs. caused by slow or stagnant (pooling) peripheral blood flow and arterial-venous shunts

110
Q

Histotoxic Hypoxia

A

impaired ability of the tissue cells to metabolized O2- cells cannot use O2, Cyanide poisoning, Norm blood values, Increase CvO2 because cells not using O2

111
Q

Cyanosis

A

Central and Peripheral cynosis (blood gas)

112
Q

Central Cyanosis

A

5 g% reduced hemoglobin (un-oxygenated), causes blue-grey discoloration of the mucus memranes and nailbeds

113
Q

Peripheral Cyanosis (acrocyanosis)

A

Poor perfusion (cold hands) can cause the nailbeds to look cyanotic

114
Q

Polycythemia

A

adaptive mechanism designed to increase the O2 carrying capacity of the blood

115
Q

Polycythemia does what

A

increase RBC that means more Hbg (and Hematocrit) to carry more O2

116
Q

What causes polycythemia

A

chronic hypoxemia (COPD, CHF, and high altitude), increased viscosity of blood with increased work to the heart

117
Q

Carbon Monoxide Transport

A

Carried 6 ways

118
Q

Cells consume about how much O2 and produce how much CO2

A

Cells consume about 250mL of O2 and produce 200mL of CO2

119
Q

CO2 transport, plasma-

A

1% attached to carbamino protein, 5% forms bicarbonate, 5% dissolved (whats measured in an ABG)

120
Q

CO2 transport, RBC-

A

5% dissolved in cell intracellular fluid, 21% combines with Hbg, 63% forms bicarbonate intracellular. Forms faster in cell due to carbonic anhydrase

121
Q

CO2 does what to move out CO2

A

equalizes in reverse at alveoli

122
Q

Haldane Effect

A

More oxygen less CO2, this is what helps CO2 off load at lungs and on load at cells

123
Q

H+ + HCO3 ->

A

H2CO3 -> H20 + CO2

124
Q

H+ does what to pH

A

goes down, more acidic

125
Q

Hypoxemia (Norm, mild, moderate, severe)

A

Norm 80-100 mmHg, Mild 60-80 mmHg, Moderate 40-80 mmHg, Severe <40mmHg

126
Q

O2 carry

A

50ml

127
Q

question 30

A

a

128
Q

Importance of starting CPR within the first 4 min

A

Total oxygen delivery (DO2)- the O2 supply system equation- illustrates that about 1000ml of O2 are transported to the tissue cells each min.. VO2- the O2 demand equation- illustrates that of this 1000ml, about 250ml of O2 are consumed by the tissue cells in the course of the metabolic process. 4 min= total 1000ml O2 (250ml a min)

129
Q

What happens following cardiac arrest

A

immediate stoppage of the O2 delivery system- leads to anaerobic metabolism and lactic acidosis, the sudden stoppage of transporting the tissue CO2 to the lungs for eliminatin- rapid accumulation of CO2, the abrupt drop in pH.

130
Q

Anatomic shunt exists when

A

blood frows from the right side of the heart to the left side without coming in contact with an alveolus for gas exchange. Norm 3%.

131
Q

CHF

A

certain congenital defects permit blood flow directly from the right side of the heart to the left side without going through the alveolar capillary system for gas exchange.

132
Q

Intrapulmonary Fistula in anatomic shunting

A

a right to left flow of pulm blood does not pass through the alveolar capillary system.

133
Q

Vascular Lung tumors

A

Some lung tumors can become very vascular. some permit pulmonary arterial blood to move through the tumor mass and into the pulm veins without passing through the alveolar capillary system

134
Q

Capillary shunt is commonly caused by

A
  1. alveolar collapse or atelectasis 2. alveolar fluid accumulation or 3. alveolar consolidation
135
Q

The sum of the anatomic shunt and capillary shunt is referred to as the

A

absolute or true shunt

136
Q

Clinically patients with absolute shunting respond

A

poorly to O2 therapy, because alveolar oxygen doesnt come in contact with the shunted blood.

137
Q

Absolute shunting is what to O2 therapy

A

refractory, that is , the reduced arterial O2 level produced by this form of pulm shunting cannot be treated simply by increasing the concentration of inspired O2

138
Q

When pulmonary capillary perfusion is in excess of alveolar ventilation a what is said to exist

A

relative shunt or shunt like effect.

139
Q

common causes of relative shunt include

A
  1. hypoventilation 2. Ventilation/ perfusion mismatch (chronic emphysema, bronchitis, asthma, secretions) and 3. alveolar-capillary diffusion defects (alveolar fibrosis or alveolar edema)
140
Q

End result of pulmonary shunting is

A

venous admixture

141
Q

venous admixture is the

A

mixing of shunted, non-reoxygenated blood with reoxygenated blood distal to the alveoli. losing oxygen molecules

142
Q

Venous admixture continues until

A
  1. the PO2 throughout all the plasma of the newly mixed blood is in equillibrium and 2. all of the hbg molecules carry the same number of O2 molecules. resulting in reduced PaO2 and CaO2 returning to the left side of the heart
143
Q

Hypoxemia is frequently associated with

A

hypoxia

144
Q

Hypoxia is characterized by

A

tachycardia, hypertension, peripheral constriction, dizziness, and mental confusion

145
Q

Hypoventilation caused by

A

chronic obstructive pulm disease, central nervous system depressants, head trauma, and neuromuscular disorders

146
Q

High altitude can cause what to develop

A

hypoxic hypoxia

147
Q

Diffusion impairment examples

A

Interstitual fibrosis, lung disease, pulmonary edema, pneumonconiosis

148
Q

In plasma

A

carbamino compound (bound to protein), Bicarbonate, Dissolved CO2

149
Q

In RBC

A

dissolved CO2, Carbamino-Hbg, Bicarbonate

150
Q

Dissolved CO2 in the intracellular fluid of the RBC accounts for what percent of the total CO2 released at the lungs

A

5%

151
Q

Carbamino-hbg

A

21% of the CO2 combined with hemoglobin

152
Q

When the blood pH decreases, the oxyhemoglobin dissociation curve shifts

A

right and the P50 increases

153
Q

When shunted, non reoxygenated blood mixes with reoxygenated blood distal to the alveoli (venous admixture) the

A

PO2 of the nonreoxygenated blood increases and the CaO2 of the reoxygenated blood decreases

154
Q

Normal arterial HCO3 range is

A

22-28 mEq/L

155
Q

The normal calculated anatomic shunt is about

A

2-5 percent

156
Q

in which of the following types of hypoxia is the O2 pressure of the arterial blood (PaO2) usually normal

A

Anemic hypoxia, circulatory hypoxia, histotoxic hypoxia

157
Q

If the patient normally has 12g% hbg, cyanosis will likely appear when

A

7g% hbg is saturated with O2

158
Q

The advantages of polycythemia begin to be offest by the increased blood viscosity when the hematocrit reaches about

A

55-60 Percent

159
Q

Assuming everything else remains the same, when an indiv CO decreases the

A

C(a-v)O2 increases and the SVO2 decreases

160
Q

Under norm conditions the O2ER is about

A

25 %

Cardiopulmonary A & P (5 decks)

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