Exam 2 big points Flashcards
Pa, Pv, PA
-Zone 1
PA > Pa > Pv1
Pa, Pv, PA
-Zone 2
Pa > PA > Pv
Pa, Pv, PA
-Zone 3
Pa > Pv > PA
V is greatest at lung _ from _ _ and Q is greatest there because of _
base
alveolar compliance
gravity
Most of the Vt distributed to the _ alveoli
dependent
Alveolar volume difference at end expiration and end inspiration is greastest at the _ (base/apex) and smallest at the _ (base/apex)
greatest difference at base
smallest difference at apex
Compliance = change in _ / change in _
change in volume / chnge in pressure
Awake lateral position:
abdominal content displaces dipahragm cephalad on the dependent side
on inspiration, diaphragm contraction makes more Vt (more ventilation) fill the dependent lung and perfusion is greater in the dependent lung
gas exchange remains efficient
What is HPV in regards to lungs?
hypoxic pulmonary vascoconstriction
-alveolar hypoxia causes pulm arteries to vasoconstrict and shunt blood from poorly ventilated area to the best ventilated areas = good, helps us do OLV effectively
Things that inhibit HPV:
-Mstenosis - increases pulm vasc pressure
MAC >1 - vasodilates pulm arteries and goes against HPV
Volume overload - peripheral vasodilation
HYPOthermia - increases pulm vasc resistance
Vasodilators -vasodilates
infection - vasodilates
metabolic alkalemia - vasodilates
vasoconstrictors- increase pulm blood flow to non ventilated lung tissue
TLC =
TLC = IRV + Vt + ERV + RV
FRC =
ERV + RV
VC =
IRV + Vt + ERV
FVC and FEV1 are low with low TLC = _ disease
obstructive
FVC and FEV1 low with high TLC = _ disease
restrictive
FEV1/FVC ratio normal =
0.7 or 0.8L
basically 4/5
Obstructive disease would have a FEV1/FVC ratio of _ (greater/less) than 0.7L
Less or = 0.7
Restrictive disease would have a FEV1/FVC ratio of _ (greater/less) than 0.7L
greater or = to 0.7
FVC =
volume of gas expired rapidly and forcefully after 1 breath
N= 5L
FEV1 =
volume of gas expired forcefully in 1sec
N=4L
DLCO =
CO diffusion capacity
-measures all factors affecting diffusion across alveolar-capillary membrane
_ test is the single strongest predictor of risk of complications and mortality after lung resection
DLCO
-predicted postop DLCO < 40% = increased risk
Increased risk of postop complications and mortality after lung resection if postop predicted DLCO is < _ %
<40%
What happens to lung volumes with anesthesia?
-VC
-ERV
-TV
-FRC
pulm compliance
decreases almost everything from loss of muscle tone
What happens to lung volumes with aneshesia
-ERV
decreases
Which of the following are examples of absolute indications for OLV?
a. infection (abscess/cyst)
b. massive hemorrhage
c. bronchopleural fistula
d. unilateral cyst or bullae
e. unitlateral lung lavage
f. video assisted thoracoscopic surgery
g. thoracic aneurysm
h. pneumonectomy
i. esophageal surgery
a-f
Average size for DLT for women is _ fr and men is _ or _ fr
women = 37fr
**men = 39 or 41fr **
Bronchial cuff on a DLT shouldnt be filled with more than _ mL of air and should be left down until isolation is needed
3mL
If having a sudden change in ventilation during a case with a DLT, suspect _, which is one of the most common issues with DLT
malpositioning
If peak pressure > 40cm H2O during OLV, suspect _ of the DLT/bronchial blocker
malpositioning
If the DLT is placed on the L sd and the tracheal lumen is clamped, the _ lung will be inflated
Left
If the L DLT is placed too deep in the L bronchus, only the _ lung will be inflated
left
If a L DLT has the bronchial lumen clamped, the _ lung will be inflated
right
Most effective maneuver to increase PaO2 during OLV is the application of _ to the _ (dependent/nondependent) lung
CPAP
nodependent
If adding CPAP to the nondependent lung isn’t helping when hypoxemic during OLV, you can add _ to the _ (ventilated/nonventilated) lung
PEEP (5-10cm H2O)
ventilated
