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Assessment > E4 > Flashcards

E4 Flashcards

1
Q

Cons to use of immunomodulators, drug example and administration

A

Cons:
Associated w/ anaphylaxis

Drug:
Omalizumab

Admin:
SQ q2-4 wks

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2
Q

What are 3 causes of increased airway resistance in the GETA pt

A

Reduced FRC
ET tube insertion
Circuitry

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3
Q

Fremitus differences in PNA vs pleural effusion

A

PNA
Fremitus over PNA will be pronounced

Effusion
Fremitus over effusion will be decreased

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4
Q

In trendelenburg position, what are some other factors that decrease pul compliance

A
  • Increased pulmonary blood volume

* gravitational force on the mediastinal structures are FRC

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5
Q

What is kyphosis

A

• Both are most commonly present in combination

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6
Q

Which induction medications bronchodilate

A

Propofol
Ketamine
Methohexital

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7
Q

How to perform sigh maneuver

A

Double Vt

Airway pressure 20 cmH2O

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8
Q

How does pneumoperitoneum affect ventilation (4)

A

Can cause respiratory changes when IAP > 15 mmHg

1) Lowers FRC and VC
2) promotes atelectasis formation
3) DEC respiratory compliance
4) INC peak airway pressure

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9
Q

What contributes to hypoxemia the. most?

A

Decreased FRC

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10
Q

What is the drug of choice for semtra’s triad?

A

Leukotriene inhibitors

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11
Q

When is respiratory failure most likely to occur in a pt with kyphoscoliosis

A
  • Associated w/ a VC <45% of predicted

- Scoliotic angle&raquo_space; 110 degree

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12
Q 
O2 tank
color-
pressure-
capacity-
pin position-
A 
O2 tank
color- green
pressure-1,900 psi
capacity- 660 L
pin position- 2-5
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13
Q

RV definition and volume

A

Volume of gas that remains in the lungs after complete forced expiration

CANNOT be exhanled from the lungs

Volume of alveolar gas that acts as reservoir

1200 mL

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14
Q

Primary use of corticosteroids in asthma

A

Usually inhaled
To limit systemic effects
To provide potent anti-inflammatory effects on airways

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15
Q

When N2O PSI is <745, how full is the tank?

A

25% full

397.5 L??

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16
Q

Atelectasis and MR

A

Atelectasis will ALWAYS appear

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17
Q

Surgery implications when an adult pt has just had an URI?

A

infections increase airway responsiveness for 2 weeks

Increases risk of respiratory complications post-op

May need to wait up to 8 weeks to perform elective procedures

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18
Q

MOA, example meds, and benefits/drawback of anticholinergics.

A

MOA:
antimuscarinic properties, decrease secretions

examples:
iptratropium bromide (atrovent)

benefit:
works longer
Better for larger conducting airways

drawback:
longer onset

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19
Q

How does induction of anesthesia affect pulm volumes

A

• there is a loss of inspiratory tone

Diaphragm is even more cephalad

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20
Q

MOA of leukotriene antagonists, and drug example

A

Inhibits constrictor effects of leukotrienes
leading to bronchodilation
For moderate to severe asthma

Drugs: montelukast (singulair)

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21
Q

Purpose of recruitment maneuvers?

A

open alveoli

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22
Q

What should also be considered if evidence of bronchospasm shows up intraop?

A

Consider if the pt is too light

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23
Q

What is asthma

A

 Chronic inflammatory disease

 hyper-irritability of the airways

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24
Q

CV effects of nicotine

A

stimulates adrenal medulla secretion of adrenaline
SNS stimulation (INC HR, BP, PVR)
IN myocardial contractility and O2 demand

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25
Q

8 Clinical features of asthma

A 
	Dyspnea and tachypnea 
	Chest tightness and tachycardia
	Wheezing
	Dyspnea
	Coughing
	Pulsus paradoxus 
	Visible use of accessory muscles 
	pursed lip breathing
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26
Q

Why is post-nasal drip a consideration in asthma pts

A

Its a risk factor and is worse in the morning causing airway irritability

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27
Q

Airway inflammation of airway is mediated by

A

Increase in IgE causing swelling

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28
Q

What are common causes of equipment malfunction

A

Mechanical failure of O2 delivery system, or disconnection

Improper ET position

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29
Q

What are the two types of costovertebral skeletal deformity

A

scoliosis

kyphosis

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30
Q

Considerations for induction of asthmatic patients

A
  • Block airway reflexes before DL and intubation
  • Prevent SNS response
  • Relax smooth muscle
  • Prevent release of mediators
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31
Q

What should be done if pt needs awake extubation (neuro sx)

A

BLUNT reactive airways

Use lido and opioids

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32
Q

How does induction of anesthesia affect lung volumes

A

Supine: FRC is reduced by 0.5 to 1.0 L
Induction: Decreases by 0.4-0.5 L
Paralysis: Even more reduction of vol

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33
Q

7 risk factors for asthma

A 
RSV
GERD
inhaled irritatns
post-nasal drip
Environmental
Secondhand smoke
Samter's triad
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34
Q

When leukotrienes are antagonized what pulmonary action occurs

A

bronchodilation

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35
Q

Vt definition and volume

A

Amount of gas that enters and exits the lungs during tidal breathing
500 mL

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36
Q

Use of ketorolac in asthmatic pts

A

Ketorolac increases airway resistance

avoided in ASA intolerant asthma (semtra’s triad)

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37
Q

Monitors used for smoking and pts with pulmonary problems

A

Routine
A-line, CVP, PA?
EtCO2

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38
Q

Alterations following smoking cessation at 2 to 4 weeks

A

DEC secretions

DEC airway reactivity

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39
Q

Reversibility of asthma and copd

A 
athma = reverisble
COPD = non-reversible
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40
Q

What is the mainstay of asthma treatment

A

beta-2 agnoist

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41
Q

MOA of beta-2 agonist

Purpose in asthma use

A

moa:
INC cAMP
causing smooth muscle relaxation and BRONCHIOLE dilation

Purpose:
Bronchodilate the MEDIUM/SMALL airways

Quick onset

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42
Q

Most commonly used physical exam by CRNAs

A

Inspection

Auscultation

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43
Q

Obese patients desat quickly during induction because why?

How is this countered?

A

They do not have FRC

Increase ERV and denitrogenate

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44
Q

What does CO2 retention in the asthmatic pt indicate

A
  • Elevated PaCO2 suggests
  • air trapping
  • respiratory fatigue
  • impending respiratory failure
  • Late sign
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45
Q

FVL fixed obstruction obstruction example, physiology and loop characteristics

A

Example: large goiter

Physiology:
• causes obstruction in the upper airway

FVL characteristics:
•produce plateaus in both inspiratory and expiratory section

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46
Q

How does low Vt affect lung volume ventilation

A
  • Decreases drive to breathe spontaneously during GA

- Low depth

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47
Q

4 alterations to thoracic shape

A

Pectus excavatum
Barrel Chest
Kyphosis
Scoliosis

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48
Q

Pulmonary problems r/t reduced Vt

A
  • INCREASED airway resistance d/t DEC FRC, ETT, and ventilator
  • DECREASED lung compliance d/t DEC FRC
  • DECREASED drive to breathe
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49
Q

What is restrictive lung disease

A

 Characterized by reduced lung compliance and lung volumes

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50
Q

Which medications and dosages can be given to blunt airway reactivity on extubation for an asthmatic pt

A

Lidocaine 1-1.5 mg/kg

Nebulized beta-2 agonist

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51
Q

What should be avoided in a patient w/ a highly reactive airway

A

Avoid intubation

Try to perform regional as much as possible

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52
Q

Why are inhaled irritants a contribution to asthma events? Causes and treatments preoperatively?

A
  • Dust mites, animal dander, mold, and dust
  • can be primarily ablated by
  • use of β2-adrenergic agonists immediately preoperatively
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53
Q

PFT interpretation pearls…

A

 Less than 80% predicted is abnormal

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54
Q

Anesthetic induction corresponds to around 20% of awake FRC contributes to what pulmonary complications?

A

Altered distribution of ventilation

Impaired blood O2

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55
Q

What are some extrnsic causes restrictive lung disease (5)

A 
Pregnancy
Liver failure w/ ascites
Mediastinal mass
Kyphoscoliosis
Morbid obesity
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56
Q

1 L NC FiO2 is

A

24-25%

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57
Q

3 altered lab features that occur during an asthma attack

A

Hypoxemia (PaO2 <80 mmHg)
Hyperventilation
CO2 retention

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58
Q

Ideal extubation technique for asthmatic pts

A

Deep extubation if signs of bronchospasm

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59
Q

7 Preop considerations for asthma pts

A 
Routine labs
PFT
Baseline ABG
Abstinence from smoking
Presence of URI?
Stress dose steroids
Prophylactic inhaler
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60
Q

Prevalence of atelectasis in surgical pts

A

Appearas in 90% of all anesthetized pts

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61
Q

Common auscultation errors

A
  • listening through a gown
  • Auscultating in noisy room
  • Interpreting chest hair sounds as adventitious lung sounds
  • auscultating only convenient areas
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62
Q

Closing capacity definition and volume

A

Volume above RV when small airways begin to close

Variable

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63
Q

Anesthesia considerations for pts with restrictive lung disease

A

-consider poor pulmonary compliance
-OPTIMIZE
-Don’t give too much meds
can cause depression
-Regional anesthesia concerns

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64
Q 
Air tank
color-
psi-
capacity-
pin position-
A 
Air tank
color- yellow
psi- 1,900 psi
capacity- 625 L
pin position- 1-5
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65
Q

How does paralysis affect pulm volumes? What are some components that contribute to the changes?

A
  • Furthers the DEC FRC
  • The pressure on the diaphragm HIGH
  • caused by weight of abd contents during paralysis
  • The magnitude of these changes
  • in FRC r/t paralysis depends on body habitus
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66
Q

What is the position for one lung ventilation and important considerations

A

Lateral decubitus position
PADDING high pressure areas to prevent pressure injury or nerve damade
(head, neck, shoulder, arms, legs scrotum)

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67
Q

What is the action of leukotrienes

A

1000 times more potent bronchial constriction than histamine

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68
Q

What should be done following every position change of an intubated patient?

A

Check ETT connections

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69
Q

How does anesthetic depth affect respiratory pattern

A

Inadequate (<1 MAC):
hyperventilation
Vocalization
breath-holding

At 1 MAC
Breathing patterns are regular w/ normal Vt
RR slower

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70
Q

What is scoliosis

A

scoliosis
• lateral curvature
• rotation of the vertebral column

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71
Q

PEEP use and extubation

A

Turn off PEEP p/t extubation

To determine if pt will oxygenate well w/o it

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72
Q

2 maneuvers to prevent atelectasis

A

Recruitment/Sigh maneuver

VC maneuver

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73
Q

With routine use of corticosteroids, what airway effects occur (3)

A

decrease airway reactivity
decreased inflammation
results in improved control and lung function

74
Q

Airway and breathing complications to consider for a pt who is a smoker? (6)

A 
reintubation
laryngospasm
bronchospasm
aspiration
hypoventilation
hypoxemia
75
Q

PFT results for FEV1, FEV1/FVC ratio and FVC

A

FEV1 is LOW
FVC is LOW
FEV1/FVC ratio is LOW

76
Q

Side effects of beta-2 agonist

A

tachycardia

77
Q

What occurs to PVR during asthma attack

A

PVR INCREASES

which increase workload of the RH

78
Q

Effects of lower respiratory viral infections on asthma

A

RSV infection provokes hyperreactivity for up to 6 weeks

79
Q

What interventions are appropriate for asthmatic pt intraop w/ bronchospasms?

A

Give MR
INC MAC
give beta-2 agonist

80
Q

FVL variable intrathoracic obstruction example, physiology, and loop characteristics

A

Examples:
Endobronchial tumors, tracheomalacia

Physiology:
Airway obstruction during expiration
Due to positive intrathoracic pressure that narrows airways

FVL characteristics:
Expiratory plateau

81
Q

What are some mechanisms of hypoxemia

A

Equipment malfunction
Hypoventilation
Decreased FRC

82
Q

How is closing capacity affect by age and weight

A

Closing capacity is closer to RV in younger people

It is close to or above FRC in older adults and the obese

83
Q

Surgical considerations for ped pts w/ respiratory infections

A

Complications INC 11-fold w/ URI and GETA

HIGH risk for laryngospasm and brochospasm

84
Q

At 24 hours post smoking cessation, what is the most important consideration when intubation

A

More secretions will still be increased

This cause a more reactive airway and will contribute to coughing

85
Q

If pt has dyspnea what should you ask next

A

how bad
severe w/ exertion?
Will they require postop ventilation

86
Q

Process of pathogenesis of asthma (4)

A 
•	Contraction of the smooth muscle
•	Airway edema
•	Increased capillary permeability
•	Mucous secretions
(contraction, edema, permeability, secretions)
87
Q

Different phases of EtCO2

A

Upstroke - initiation of expiration
plateau - last half of expiration
Tallest point of plateau - END TIDAL reading

88
Q

Vital capacity (VC) and volume

A

IRV + Vt + ERV

4500 mL

89
Q

What is hyper-irritability of tracheobronchial tree attributed to in asthm

A

local inflammation

provoked by exposure to irritating stimulus

90
Q

What are the two types of restrictive lung disease

A

 Intrinsic
• Inflammation or scarring of the lung parenchyma

 Extrinsic
• Disorders of the pleura, diaphragm, or chest wall that limit lung expansion

91
Q

ERV definition and volume

A

Volume in the lungs after normal end tidal expiration

1100 mL

92
Q

Minute ventilation =

A

RR x tidal volume

93
Q

Alterations following smoking cessation at 12-24 hrs

A

DECREASED carboxyhgb down from 15%
and DEC CV nicotine effects
INCREASED tissue O2
INC secretions and reactive airway

94
Q

Useful treatment for pt with kyphoscoliosis

A

Supplemental O2

Augment nocturnal ventilatory support

95
Q

Percussion of normal, vs PTX, vs PNA lung

A

Normal- resonance
PTX- Hyperresonance
PNA- Tactile fremitus

96
Q

Goal of RSI for asthmatic intubation

A

prevent aspiration and asthmatic attack

97
Q

Inspiratory capacity (IC) and volumes

A

IRV + Vt

3500 mL

98
Q

Progression of asthma treatment

A
  1. SABA (Tachycardia)
  2. 1 + ICS (low dose)
  3. 2 + LABA
  4. 3 + Leukotriene inhibitors
  5. 4 + Immunomodulator (IgE)
  6. 5 + Oral corticorticosteroid
99
Q

4 Effects of GA on smokers

A

 Atelectasis
 ↓ compliance
 ↓ FRC
 Impaired O2 exchange

100
Q

How do pts w/ restrictive lung disease compensate for reduced compliance

A

INC WOB

Hyperventilation which keeps the PaCO2 at normal levels

101
Q

Most common double-lumen tube and what is it for

A

Left

for one-lung ventilation

102
Q

Questions to consider for preop assessment

A 
ask about
dyspnea
cough
smoking
exercise tolerance 
risk factors for acute lung injury
103
Q

What is fremitus, how is it performed, when is it present on palpation?

A

Fremitus - indication of consolidation
-Generates audible sounds and vibrations–Determines underlying tissue filled with air or fluid

Performed- hands firmly held against side of chest
-have pt say “ninety-nine”

Present- pronounced in PNA

104
Q

How to blunt airway reflexes

A

Lidocaine 1mg/kg (2%) – LTA
inhaled agent – (not opioids)
Opioids

105
Q

How does supine position affect lungs

A
  • FRC decreases by 0.5 L to 1.0 L

* d/t a 4-cm cephalad (upward) displacement of diaphragm by abdominal viscera

106
Q

Effects of lateral decubitus position on pulmonary ventilation

A 
dependent lung:
•	experiences a moderate DEC FRC and 
•	is predisposed to atelectasis, 
nondependent lung:
•	may have INC FRC
107
Q

When PaCO2 has increased in restrictive lung disease, what is occurring in the disease process

A

It is very severe and advanced

108
Q

If pt has cough preop considerations should include

A

Is it product
hemoptysis or sputum
Is there need for Abx

Coughing increase airway irritability

109
Q

Effects of using PEEP

A 
INC intrathoracic pressure:
DEC VR (impedes)
DEC CO

Rapid recollapse when PEEP d/c’d

110
Q

Important consideration when preping pt for one-lung surgery

A

positioning and padding

111
Q

What is the pathophysiology of restrictive lung disease

A

reduced compliance of lung, pleura, diaphragm or chest wall

Which INC WOB

112
Q

Problem with high FiO2

A

Results in rapid reappearance of atelectasis

GETA usually just uses FiO2 0.3-0.4 and increased if PaO2 is low

113
Q

Cheyne-Stokes respirations
characteristics
causes

A

Cheyne-stokes respirations
characteristics:
Periodic breathing
Gradual hyperpnea/hypopnea then apnea

causes:
Sleep, hypoxemia, drugs
Hypoperfusion of the brain

114
Q

What are causes of mechanical failure of O2 delivery to patient

A

-ETT elbow connector disconnection-
Problem at diameter index safety system (DISS)-rare
-Empty O2 tank
-Use of nonO2 yoke for O2 take (not correct PISS positioning)
-PISS for O2 is 2-5

115
Q

Preop considerations for PFT in asthma pts

A

PFT results before and including response to bronchodilator

116
Q

What occurs with hyperventilation in the asthmatic patient

A

d/t asthma attack

• Hypocarbia and respiratory alkalosis

117
Q

Features on the EKG and CXR for acutely asthmatic pt

A

EKG and CXR = RHF

EKG = RV strain w/ RIGHT axis deviation during SEVERE attack
PVC d/t ventricular irritability

CXR = hyperinflation of the lungs

118
Q

Asthma mediators

A

Mast cell
eosinophil
macrophages
other mediators

119
Q

How does trendelenburg positioning affect lung volumes

A

• allows the abdominal contents to push the diaphragm further cephalad
• so the diaphragm does not only ventilate the lungs
-also lifts abd contents out of the thorax
• causes predisposition DEC FRC and atelectasis

120
Q

PFT influencing variables and rationale

A 
Ht: 
Tall person has larger lung volume.
Incr Age:
Volumes ↓ w/ age
Sex:
Lung volumes smaller in females
Race:
Smaller volumes in Asian, Hispanics &amp; blacks by 12-15%
121
Q

Purpose of PFT

A

 determine & categorize nature & severity of obstructive/ restrictive
Evaluation of pre-op,
-follow course of dx/ tx

122
Q

Effects of muscarinic innervation

A

increase secretions

123
Q

Why use 100% FiO2 during induction?

A

To pre-oxygenate and increase reservoir of O2 for use during apneic period

To increase time of safe apnea

124
Q

Examples of beta-2 agonists

A

short-acting (SABA) = albuterol (ventolin, proventil)

long-acting (LABA) = salmeterol (serevent)

Terbutaline

125
Q

Principles of O2 cylinder pressure and volume

A

The pressure in an O2 cylinder is directly proportional to the volume of the O2 in the cylinder

126
Q

Advantage of double-lumen tube compared to bronchial blocker

A

double lumen has suction capabilities

127
Q

Important intervention prior to intubating a pt who has stopped smoking 12-24 hrs prior to surgery

A

Blunt reactive airway reflexes very well prior to blade insertion

128
Q

Neuromuscular causes of restrictive lung disease

A

MD?

129
Q

Intrinsic causes of restrictive lung dissease

A

Pulmonary fibrosis
Aspiration PNA
Pulmonary edema
Upper airway obstruction

130
Q

Components to a physical exam?

A

inspection
palpation
percusion
auscultation

131
Q

Evidence of asthma attack intraop resulting in bronchospasm

A

INC airway pressures
UPsloping CO2
Desaturation

132
Q

Functional residual capacity (FRC) makeup and volume

A

RV + ERV

2300 mL

133
Q

8 considerations when performing inspeciton

A 
Work of breathing
Use of O2 adjunct
Assess RR
Hyperpnia
Hyperventilation
Cyanosis
Clubbing
Thoracic shape
134
Q

IRV definition and volume

A

Amount of gas that can be forcefully expired after a tidal inhalation

3000 mL

135
Q

Biot’s respirations
characteristics
causes

A 
Biots respirations
characteristics:
aka ataxic respirations
Periodic breathing
Hyperpnea and apnea

causes:
Neuro damage

136
Q

What can affect ET positioning causing hypoxemia

A
  • Esophageal intubation (no ventilation)
  • Flexion of head (causing caudal/deep ETT migration)
  • Extension of head (cephalad/upward ETT migration)
137
Q

Immunomodulators use, MOA and benefits

A

MOA:
anti-IgE antibodies

Use:
reserved for severely asthmatic with high levels of IgE

Benefits:
May decrease steroid requirements

138
Q

FVL variable extrathoracic obstruction example, physiology, and loop characteristics

A

Exmples:
VC paralysis, vocal cord neoplasms, neoplasm in the neck

Physiology:
Upper airway obstruction during inspiration
-due to generation of negative intrathoracic pressure during inspiration that pulls the extrathoracic airway closed

FVL characteristics:
Inspiratory limb of FVP plateaus

139
Q

How does depth ultimately affect the lung volumes

A

Higher the anesthetic depth the greater the pulmonary depression

140
Q

Difference in sigh and VC maneuver

A

Sigh maneuver is to reopen collapsed tissue

VC maneuver is more pressure and longer
VC is for complete reopening of all collapsed lung tissue

141
Q

Total lung capacity (TLC) makeup and volume

A

TLC = IRV + Vt + ERV + RV

5800 mL

142
Q

When would stridorous breath sounds be present? Correlate with surgical procedure and electrolyte imbalance?

A

D/T partial obstruction

Surgical correlation:
S/P thyroidectomy w/ accidental removal of PT gland
Ca++ imbalance

143
Q

When are oral or parenteral corticosteroids used/

A

Reserved for acute exacerbations

When asthma is unresponsive to maximal bronchodilator therapy

144
Q

Operative considerations for pts who currently smoke (3)

A

Do they have cough
They will have mucous hypersecretion
They may have airflow obstruction

145
Q

Examples of corticosteroids used in asthma

A

Prednisone (prelone)

Beclemethasone (vanceril)

146
Q

Alterations to FVC, RV and FRC during asthma

A

FVC = decreased during severe asthma attack

RV = markedly increased

FRC = increased d/t air trapping

147
Q

Treatments modalities for asthma

A

Remove cause

Pharmacologic

148
Q

Describe the types of asthma

A 
	Extrinsic = allergic asthma
•	Familial
•	increased levels of IgE in serum
	Intrinsic = idiosyncratic asthma
•	related to PNS abnormality
149
Q

What are patients with kyphoscoliosis at risk for

A

Developing PNA and hypoventilation

Especially when exposed to CNS depressants

150
Q

What is FEV1 and FVC

A

FEV1 = forced expiratory volume in 1 second

FVC = the total volume available that can be exhaled with maximum effort after dep inhalation

151
Q

Description of abnormal lung sounds

A

Rales/crackles
Rhonchi
Wheezing
Stridor

152
Q

What is pulsus paradoxus

Why does it occur in asthmatic pts

A
  • a fall in SBP > 10 mm Hg
  • during spontaneous inspiration
  • when BP should stay the same or slightly increase

d/t hyperinflation that decreases afterload to right ventricle

153
Q

How does surgical positioning affect lung volumes.

A

Trendelenburg&raquo_space; effect than supine
FRC MUCH more reduced
Worse

154
Q 
N2O tank
color-
psi-
capacity-
pin position-
A 
N2O tank
color- blue
psi- 745 psi
capacity- 1,590 L
pin position- 1-5
155
Q

Which anesthetic does not impair muscle tone and lead to atelectasis

A

Ketamine

156
Q

How to perform VC maneuver

A

Inflation pressure of 40 cmH2O is required for 7-8 seconds

157
Q

Most common presentation of costovertebral skeletal deformity

A

Kyphoscoliosis

158
Q

Pulmonary effects of nicotine

A

Narrowing of small airways
Higher closing volume
Hyper-irritable airways

159
Q

Postop management in pacu

A

watch for apnea or hypoventilation
respiratory depression d/t opioids or gases
residual MR blockade

160
Q

Alterations following smoking cessation at 5-8 weeks

A

DEC incidence of post-op complications

Improved:
mucociliary clearance
airway irritability
Closing volume

161
Q

Pitfalls of PFTs

A

 Testing is effort-dependent
 Use of Predicted Values
• Age, gender, height, race

162
Q

FiO2 to Liter ratio?

A

For every 1 L O2

Increase FiO2 by 2-4%

163
Q

Prevention of atelectasis during anesthesia

A

Add PEEP = 5-10 cmmHg

164
Q

Effects of beta receptor stimulation

A

Bronchodilation

via PSNS stimulation

165
Q

How do the kidney/lithotomy and prone position affect lung volumes?

A

•Kidney/lithotomy:
• also cause small DEC FRC
Prone:
• may INC FRC moderately

166
Q

Effects of GERD on asthma

A

Treatment of GERD w/ H2 (ranitidine) receptor antagonist or prokinetics
decrease morbidity and the need for asthma medications

167
Q

What is the average reduction of lung volumes w/ anesthesia

A

• corresponds to around 20% of awake FRC

168
Q

Respiratory function complications during anesthesia

A

anesthetic depth and pattern
mechanism of hypoxemia
atelectaasis
pneumoperitoneum

169
Q

Closing capacity makeup and volume

A

RV + CV

variable volume

170
Q

In the presence of cyanosis what is the hgb?

A

Deoxyhgb is 5 gm/dl

171
Q

Possible problems with the use of immunomodulator

A

caner or lymphoma

172
Q

Kussmaul respirations
characteristics
causes

A

Kussmaul respirations
characteristics:
Deep, rapid breathing
Hyperpnea

causes:
Metabolic acidosis
K-etones
U-remia
S-epsis
S-alicylates
M-ethanol
A-ldehydes
L-actic acids
173
Q

What causes closing volume to occur

A

Expiration causing the airways to narrow and deep expiration can cause them to close
Usually occurs below Vt, above RV, at the beginning of FRC

174
Q

6 Pharmacologic agent classes for asthma

A 
beta2 agonist
anticholinergic
leukotriene antagonist
corticosteroids
cromolyn sodium
immunomodulators
175
Q

Complications with the use of inhaled corticosteroids

A

osteoporosis
PNA
fungal infxn of the mouth

176
Q

Smooth muscle contraction is mediated by

A

beta and muscarinic innervation

PSNS

177
Q

What is a late sign of sever asthma attack

A

CO2 retention

178
Q

Complications associated w/ kyphoscoliosis

A

Scoliotic angle >100 may lead to

  • chronic alveolar hypoventilation
  • hypoxemia
  • Pulmonary HTN
  • cor pulmonale
179
Q

Description of normal breath sounds, I:E and location

A

Vesicular
Insp (low) > Exp (soft)
Majority of lung

Broncho-vesicular:
Insp (med) = Exp (med)
Near main stem bronchi

Bronchial
Exp (high) > Insp (loud)
Over trachea

180
Q

Use of cromoly sodium in asthma and MOA

A

Not for acute use
Prophylactic only

MOA:
Stabilizes mast cells
Which decreases IgE mediated release of histamine and leukotrienes

181
Q

How does low FRC affect lung volumes and hypoxemia in obese patients

A

FRC reduction is more pronounced than normal patients

Restrictive b/c abd is pushing up

182
Q

What is Samter’s triad

A

sensitive to NSAIDs (esp ASA)
h/o nasal polyps
h/o asthma

Assessment (3 decks)

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