Final Flashcards
where is the larynx located in an adult
anterior to 3rd to 6th vertebre
where is the larynx located at birth
c3-c4
A-O extension is usually
35 degrees
MP Class 1
full view of uvula and tonsillar pillars, soft palate
MP Class 2
partial view of uvula or uvular base, partial view of tonsils, soft palate
MP Class 3
soft palate only
MP class 4
hard palate only
MP status is based on
size of tongue and pharyngeal structures visible on mouth opening
what does the sphenopalatine ganglion (middle division of CN V) innervate
nasal mucosa, superior pharynx, uvula, tonsils
what does the Glossopharyngeal nerve (CN IX) innervate
lingual back 1/3, pharyngeal, tonsillar nerves - pray pharynx, supraglottic region
what does the internal branch of the SLN (CNX) innervate
mucous membrane above the VC’s, glottis
what does the recurrent laryngeal nerve innervate (CNX)
trachea below VC’s
SLN divides into two nerves:
Internal and external SLN
Internal SLN function
provides sensation to supraglottic and ventricle compartment
stimulation of the ____ causes laryngospasm
internal SLN
External SLN function
provides motor innervation of cricothyroid membrane
left RLN passes at
aortic arch
RLN sensory =
sensory innervation to infra glottis (below the cords)
two nerves of larynx
SLN and RLN
does RLN provide sensory, motor, or both?
both!
RLN motor
innervates all larynx except cricothyroid
stimulation of RLN causes ___ of VC
ABduction of VC
damage to RLN causes ___ of VC
ADduction
at what level does the trachea divide
carina T5-T7
trachea extends from
c6 to t5
where does gas exchange begin
respiratory bronchiole
which nerve transmits motor stimulation to diaphragm
phrenic - c3,4,5
which nerves send signals to the external intercostal muscles?
intercostal nerves T1-11
the act of inhaling is
negative pressure ventilation
TLC =
IRV+TV+ERV+RV
VC =
IRV + TV + ERV
FRC=
- ERV + RV *
IC =
TV + IRV
spirometry cannot measure___ so which two capacities cannot be determined using spirometry alone?
residual volume. FRC/TLC
3 ways to measure FRC and TLC directly
helium dilution, nitrogen washout, body plethysmography
flow volume loops
.
FEV1
.
which part of flow volume loop is effort dependent
.
fixed obstruction
.
extra thoracic obstruction
.
intra thoracic obstruction
.
surfactant lowers ___ of alveoli and lung
surface tension
poisueille’s law describes
resistance of flow in a tube
poisueille’s law - resistance is proportional to
length and viscosity
poisueille’s law - resistance is inversely proportional to
radius
*poisueille’s law reducing r by 16% will ___ the R
double
*poisueille’s law reducing r by 50% will
increase R 16-fold
what are the two mechanisms for the decrease in PVR that occurs as vascular pressures are raised
recruitment and distension
recruitment is
opening closed segments to increase capillary volume
functional capillary volume is ___ at rest, and ___ at maximal anatomical volume
70, 200
total capillary surface area almost always equals
alveolar surface area
__ % of alveolar surface area is covered by capillary bed
70-80
zone 1 pressures
PA > Pa > PV
zone 2 pressures
Pa> PA> PV
zone 3 pressures
Pa > PV > PA
as you go from zone 1 to zone 3 of the lung, v/q mismatch
decreases
reduced PAO2 causes pulm vaso___
constriction
increased PCO2 causes pulm vaso___
dilation
histamine causes pulm vaso ___
constriction
increased PA02 causes pulm vaso ___
dilation
nitric oxide causes pulm vaso ___
dilation
thromboxane, a-adrenergic catecholamines, angiotensin, prostaglandins, neuropeptides, leukotrienes, serotonin, endothelin, norepinephrine cause pulm vaso ___
constriction
prostacyclin, B-adrenergic catecholamines, acetylcholine, bradykinin, dopamine, isoproterenol cause pulm vaso___
dilation
what causes hypoxic pulmonary vasoconstriction
alveolar hypoxia
HPV is a ___ response of pulm arterioles
localized
HPV is enhanced by what two things
hypercapnia and acidosis
how does HPV balance v/q ratio
shifts flow to better ventilated pulmonary regions
normal alveolar PO2 is ___mmhg
100
normal alveolar pCO2 is ___mmhg
40
alveolar PCO2 increases in proportion to CO2 ___
excretion
PCO2 decreases in inverse to
alveolar ventilation
normal CO2 production at rest is ____ ml/min
200 ml/ min
alveolar air is expired at
end-exhalation
ficks law describes
diffusion of gas thru a tissue membrane
diffusion is proportional to
cross sectional area, partial pressure difference, gas coefficient
diffusion is inversely proportional to
tissue thickness
PVO2 =
40mmHg
PVCO2 =
46 mmhg
PACO2 =
40 mmhg
PaO2 =
100 mmHg
PaCO2 =
40 mmHg
physiologic shunt - V/Q is __ normal
below
shunt = ___ perfusion, ___ ventilation
adequate perfusion, no ventilation
the greater the shunt,
the greater the amt of blood fails to be oxygenated in the lungs
physiologic dead space. V/q is ___ normal
above
dead space = ___ ventilation and ___ perfusion
adequate ventilation, no perfusion
physiologic dead space includes
wasted ventilation and anatomical dead space.
rough rule - PaO2 40,50,60 for sat
70 80 90
hb P50 point
sat is 50 , paO2 is 27
when sat is 75 , paO2 is
40 (mixed venous blood in PA)
which is more detrimental to O2 transport: change in shape or change in position of HbO2 equilibrium curve?
shape
Hb curve to the right __ affinity for O2
decreases
Hb curve to the left __ affinity for O2
increases
how does increase in H+ affect HbO2 curve
shift right
how does increase in PCO2 affect HbO2 curve
shift right
how does increase in temp affect HbO2 curve
shift right
how does increase in 2,3, DPG affect HbO2 curve
shift right
how does decrease in PCO2 affect HbO2 curve
shift left
right shift, ___ O2
release
left shift, ___ O2
“loves” (higher affinity)
Bohr effect causes shift of curve to the
right
O2 content in blood (CaO2) formula
CaO2 = (SO2 x hb x 1.31) + (PO2 x 0.003) see slide 44
DO2 (oxygen delivery) =
CaO2 x CO
most CO2 is transported as
bicarbonate (HCO3)
DRG controls what two things
inspiration and respiratory rhythm
which 2 nerves reliever sensory info to the DRG
vagal (X) and glossopharyngeal (IX)
DRG receives signals from three sources:
peripheral chemoreceptors, baroreceptors
chemosensitive area of the brain - where is it located
ventral medulla surface
chemosensitive area of the brain is sensitive to changes in
PCO2 or H ion concentration
CO2 is highly permeable to BBB so….
blood and brain concentrations are equal
ventilation is greatly increased with blood PCO2 above
35 mmHG
change in respiration due to CO2 is 10 times less with blood Ph range between
7.3 and 7.5
peripheral chemoreceptors are found in
carotid and aortic bodies
chemoreceptors are sensitive to PaO2 from __ to ___ mmhg
60 to 30
high risk FEV1
<2L
high risk FEV1/FVC
<0.5
high risk VC
<15cc/kg in adult and <10cc/kg in child
high risk VC percentage
< 40 to 50% than predicted
intubation criteria: resp rate
> 35
intubation criteria: MIF
more neg than -20cmH20
intubation criteria: PaO2
<70 on FiO2 of 40%
intubation criteria: A-a gradient
> 350mmhg on 100% O2
intubation criteria: PaCo2
> 55
intubation criteria: vd/vt
> 0.6
intubation criteria: clinical signs
airway burn, chemical burn, epiglottis, mental status change, rapidly deteriorating pulmonary status, fatigue
extubation criteria: resp rate
<30
extubation criteria: PaO2 and PaCO2
paO2 >70, PaCO2 <55
extubation criteria: MIF
more negative than -20
extubation criteria: vital capacity
> 15 cc/kg
*an increase of Pco2 by 10mmhg causes a ___ in pH by ___
decrease 0.08
- a decrease of Pco2 by 10mmhg will ___ pH by ___
increase 0.08
A-a gradient measures
efficiency of lung
normal A-a is approx
age/3
A-a gradient is ___ with hypoventilation or low Fio2
normal
- a decrease in bicarb by 10 __ the ph by ___
decreases 0.15
- an increase in bicarb by 10 __ the ph by ___
increases 0.15
total body bicarb deficit =
base deficit x wt in kg x 0.4. usually replace half of deficit
infrared is ___nm
940 (100% sat)
infrared is for
oxyhemoglobin
red is ___nm
660
red is for
deoxyhemoglobin (50% sat)
if someone has carboxyhemoglobin, what will their pulse ox show?
100%
if someone has methemoglobinemia what will their pulse ox show
85%
what causes methemoglobinemia
nitrates, nitrites, sulfonamides, benzocaine, nitroglycerine, nitroprusside
how do you treat methemoglobinemia
low dose methylene blue or absorbic acid
capnography reliably indicates ____ intubation but does not reliably detect ___ intubation
esophageal, endobronchial
capnograph: A-B
beginnning exhalation, dead space gas
capnograph: B-C
exhalation , mixing of gases
capnograph: C-D
alveolar plateau, alveolar rich gas
capnograph: D
highest CO2
capnograph: DE
start inspiration
in the awake and lateral position, the ____ lung is better perfused and ventilated
dependent
positive pressure ventilation favors the ___ lung because it is more compliant
upper
muscle paralysis, rigid bean bag, and open ptx all favor the ___ lung
upper
factors that inhibit HPV: pulm artery pressures
very high or very low
factors that inhibit HPV: ____capnia
hypocapnia
factors that inhibit HPV: vaso___
dilators - nitroglycerin, nitroprusside, B-adrenergic agonists (dobutamine), CCB’s
inhalation agents ___ hypoxic pulmonary vasoconstriction
inhibit
pulmonary infections ___ hypoxic pulmonary vasoconstriction
inhibit
in one lung ventilation, add 5cm ___ to nondependent lung, and 5cm ___ to dependent lung
CPAP, PEEP
first and most sensitive sign of MH
unexplained tachycardia
most specific sign of MH
increasing EtCO2, hypercapnia 2-3x
MH will show an initial ___ then a combined ___
metabolic acidosis then combined metabolic and resp acidosis
what age has the highest MAC requirement
term infant to 6 months
hyperthermia ___ MAC
increases
chronic ETOH abuse ___ MAC
increases
hypernatremia __ MAC
increases
for every 1 deg C drop in body temp, MAC decreases by
2-5%
pregnancy ___ MAC
decreases
lithium ___ MAC
decreases
alpha 2 agonists and CCB’s ___ MAC
decrease
hyperthyroid or hypothyroid affect on MAC
none
4 things no affect on MAC
duration of anesthesia, gender, K, hypo/hyper carbia
second gas effect
the ability of a large volume uptake of a first gas (nitrous) to accelerate the rate of rise of the alveolar partial pressure of a concurrently administered companion gas (agent) thus speeding induction
what does nicotine stimulate
sympathetic ganglia, catecholamines released from adrenal medulla increasing HR, BP, and SVR
nicotine stimulation persists for
30 min after last cigg
advise smoking at least ___ hours prior to surgery
12
airway reactivity decreases after __ days of cessation and is near the level of a nonsmoker after __ days of cessation
2, 10
cessation of > __ weeks will reduce post-op pulm complications
8
cessation of __years reduces risk of MI to that of non-smoking population
2
vent adjustment for severe emphysema
requires longer exp times (normal I:E is 1:2, so in COPD 1:3)
a rapid correction of CO2 in someone who is a chronic retainer will cause
metabolic alkalosis
which two gases cause airway stimulation with light anesthesia
des and iso
bronchospasm - avoid ___ releasing drugs such as
histamine - pentothal, morphine, atracurium, mivacurium, neostigmine.
