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final rcp Flashcards

1
Q

Ventilation

A

process of moving gas into and out of the lungs

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2
Q

Respiration

A

process of moving oxygen and carbon dioxide

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3
Q

Respiratory System

A 
The upper airways
Chest wall
respiratory muscle
the lower airways
pulmonary blood vessels
supporting nerves
lymphatics
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4
Q

Sniffing position

A

extending neck and pulling chin anteriorly

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5
Q

Glottis

A

narrowest part of the adult upper airway

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6
Q

characteristics of obstructive sleep apnea

A 
obesity
fatigue
snoring
short neck
daytime sleepiness
pharyngeal muscles relax when we sleep
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7
Q

imbalance between mucus water content and airway humidity of the mucous sheet

A

thick, dehydrated
infected
immobile

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8
Q

impairment of the mucociliary clearnance system

A

air pollution
dehydration
smoking

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9
Q

neutrophillic inflammation of the airways

A

cystic fibrosis
COPD
asthma
smokers

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10
Q

BTPS

A

body temperature 37C
pressure 760
water saturation at AH 44mg/L
water vapor saturation 47mg/L

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11
Q

anatomical shunt

A

deoxygenated blood from the pulmonary arteries mixes with oxygenated blood from the pulmonary veins 1%-2%

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12
Q

Purpose of surfactant

A

reduces surface tension
reduces work of breathing
increases lung compliance

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13
Q

ACM

A 
Type 2 cells
Type 1 Cells 
basement membrane
interstitial space
capillary endothelial cell
plasma
erythrocyte
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14
Q

impact of anatomical shunt

A

systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas, gives rise to the normal PAO2

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15
Q

natural mechanism of brochodilation

A

neurotransmitter: norepinephrine

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16
Q

B2 receptors located

A

airway smooth muscle
vascular smooth muscle
submucosal glands
airway epithelium

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17
Q

parasympathetic

A

increase viscosity

thick secretions

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18
Q

sympathetic

A

thin, watery secretions

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19
Q

Phrenic nerve

A

diaphragm innervated by somatic innervation

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20
Q

primary muscles of quiet breathing

A

diaphragm
parasternal intercostals
scalenes

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21
Q

assessory muscle of inspiration and expiration

A

scalenes - inspiration
sternomastoids - inspiration
pectoralis major - inspiration
abdominals - expiration

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22
Q

thoracic cavity enlargement

A

the downward movement of the diaphragm

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23
Q

causes the flattening of the diaphragm

A

if the lungs fail to empty normally during exhalation

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24
Q

emphysema

A 
High compliance
low elasticity
low recoil force 
air trapping 
pursed lip breathing
longer expiratory time
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25
Q

pulmonary fibrosis

A 
Low compliance
high elasticity
high recoil force
rapid, shallow breathing
shorter expiratory time
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26
Q

pulmonary surfactant

A

to prevent lung collapse by lowering the surface tension in the alveoli

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27
Q

benefits of surfactant

A

reduces WOB
reduces the distending pressure required to keep small alveoli open
provides a stabilizing influence alveoli of different sizes

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28
Q

Laplaw Law

A

if the collapsing force of alveolar surface tension is opposed by an equal counter pressure, the alveolus remains in an inflated state

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29
Q

Poiseuille Law

A

16 X more work if the airway diameter is cut in half

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30
Q

Auto-PEEP

A

if the lungs do not have enough time to empty, pressure may still be positive in slowly emptying alveoli and still be positive at the end of expiration when the next inspiration begins, air trapping

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31
Q

air-trapping

A

asthma
emphysema
weak lung recoil force

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32
Q

Alveolar Ventilation

A

TV-(dead space per pound)
ex. TV = 700
weight 200 Lb
= 500

slow deep breathing will improve

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33
Q

partial pressure of oxygen in atmosphere

A

21%

149 mmHg

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34
Q

alveolar pressure

A
  • inspiration
    0 rest
    + expiration
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35
Q

hysteresis

A

lung volume is greater during deflation than inflation

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36
Q

time constants

A

compliance and airway resistance is the time constant expressed in seconds, how rapidly the source pressure and lung pressure equalize
time constant less = less compliant
time constant more = more compliant

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37
Q

surface tension

A

70%

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38
Q

normal % of the minute ventilation in dead space

A

30%-40%

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39
Q

pressure

A

pressure in lungs is above pressure in the atmosphere, this is how we breathe naturally

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40
Q

anatomical dead space

A

150mL

total volume of the conducting airways from the nose to the terminal bronchioles

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41
Q

partial pressure of inspired air

A

159mmHg

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42
Q

partial pressure of conducting airway

A

149mmHg

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43
Q

alveolar air equation

A 
PAO2 = (pressure-H2Op) X FiO2 - 40/ 0.8
ex. PAO2 = 760 - 47 X (40) - 0.8
713(.21) - 50
149.73 - 50
=99.73 mmHg
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44
Q

FICKS LAW

A

A - surface area
D - diffusion solubility
P1-P2 - diffusion gradient
T - membrane thickness

if membrane thickness increases diffusion through ACM increases

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45
Q

DLCOab

A

diffusion capacity of the lungs for carbon monoxide

normal is 20-30mL/min/mmHg
21
25

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46
Q

DLCO

A 
What affects it:
body size
age
lung volume
exercise
body position
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47
Q

oxygen is found

A

bound to hemoglobin on the erythrocyte

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48
Q

oxygen content in blood

A

Hb carries 20 m/dL of oxygen content = 100mmHg PaO2

Hb concentration of 15 g/dL

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49
Q

normal cardiac output

A

5 L/min

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50
Q

oxygen delivery to oxygen consumption

A

arterial blood deliver 1000 mL/O2/min
tissue consumes 250 mL/O2/min
25%

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51
Q

Oxygenated Hb

A

97% @ 100mmHg

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52
Q

mixed venous oxygen saturation

A

75% @ 40mmHg

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53
Q

Hb equillibrium curve

OHEC

A

steep 20-60mmHg
small changes in PaO2

flat 60-100mmHg
large changes in PaO2

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54
Q

P50 @ 27mmHg

A

left shift

  • lower P50
  • lower PCO2
  • lower 2,3 DPG
  • lower temperature
  • higher pH

right shift

  • higher P50
  • higher PCO2
  • higher 2,3 DPG
  • higher temperature
  • lower pH
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55
Q

Hb affinity for oxygen

A

increase in affinity

  • left shift OHEC curve
  • decrease P50/PO2
  • increase SO2 for every PO2

decrease affinity

  • right shift OHEC cruve
  • increase P50/PO2
  • decrease SO2 for every PO2
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56
Q

Bohr effect

A

the decreased affinity or Hb for oxygen

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57
Q

Haldane effect

A

Hb release of oxygen takes up carbon dioxide

affinity for carbon dioxide increases

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58
Q

widening of (C(a-v)O2)

A

increase in oxygen extraction, decrease in cardiac output

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59
Q

anerobic metabolism

A

oxidative metabolism in body tissues is the sole source of the blood’s CO2

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60
Q

DOcrit

A

blood fails to satisfy the demands of the tissue for oxygen
lactate produced
ion gap increases
low O2 delivery

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61
Q

carboxyhemoglobin

A

carbon monoxide poisoning

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62
Q

anemia

A

low Hb content of 5g/dL

may not look blue but is hypoxic

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63
Q

polycythemia

A

too much blood volume, thickening of blood, will look blue without being hypoxic

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64
Q

treating acute CO2 poisoning

A

an Fio2 of 1.0 (100%) greatly decreases the half life

half life = time required to cut COHb blood level in half

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65
Q

major forms of carbon dioxide transport

A

dissolved CO2 = 8%
H2CO3 = 80%
carbamino compounds = 12%

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66
Q

reaction between carbon dioxide and H2O

A

combination
slow reaction in blood plasma
faster reaction in the erythrocyte

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67
Q

chloride shift

A

HCO3 leaves the RBC and leaving the erythrocyte electropositive

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68
Q

CO2 transport in blood

A

HCO3 transports majority of the CO2 in blood

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69
Q

ventilation

A

CO2 is the main stimulus

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70
Q

buffers

A

decrease acidity as it transports CO2

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71
Q

10 fold change

A

a change in 1 pH unit corresponds to a 10 fold change in H+

10X

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72
Q

volatile acid

A

carbonic acid

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73
Q

fixed acid - nonvolatile

A

sulfuric acid
phosphoric acid
lactic acid (anaerobic)

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74
Q

20:1

A

kidneys (20) fixed

lungs (1) volatile

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75
Q

bicarbonate

A

open system
fixed (nonvolatile)
plasma bicarb
erythrocyte bicarb

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76
Q

nonbicarbonate

A 
closed system
volatile (carbonic)
fixed
hemoglobin
organic phosphates
inorganic phosphates
plasma protein
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77
Q

compensations

A

chronic acidemia
chronic alkalemia
fully compensated - pH normal, HCO3/CO2 not
partially compensated - opposite outside

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78
Q

uncompensated

A

acute acidemia

acute alkalemia

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79
Q

combined

A

both same outside normal limits

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80
Q

metabolic alkalosis

A

most complicated to treat - electrolyte imbalance

elevated HCO3 may be renal compensation for resp. acidosis

occurs: loss of fixed acid, gain of blood buffer base

causes: 
vomiting - loss of hydrochloric acid 
nasogastric suctioning 
hypochloremia 
hypokalemia (low K+) weakness
latrogenic - diuretic, low-salt diet (medically induced)
volume depletion - high urine output

compensation:
hypoventilation
-anxiety, pain, infection, fever

correction:
restore fluid/ electrolyte imbalance
-KCL infusion

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81
Q

Metabolic acidosis

A 
occurs:
accumulation of fixed acid in blood
excessive loss of HCO3 in body
-lack of blood flow
---tissue hypoxia, anaerobic metabolism, lactic acid
severe diarrhea

anion gap >16

causes:
severe diarrhea
pancreatic fistules
hyperchloremic acidosis

compensation:
hyperventilation
rapid central chemoreceptor response

manifestations:
increase in minute ventilation
- complaint of dyspnea
- extreme: stupor/ coma
- hyperpnea

Severe:
diabetic ketoacidosis
- kussmaul breathing
–deep/ gasping

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82
Q

Anion Gap

A

plasma electrolyte
determines if metabolic acidosis is caused by gain of fixed acids or loss of base (HCO3)
ignores K+

High anion gap indicates increase in fixed acid

  • lactic acid
  • ketoacid
  • uremic acid

normal anion gap indicates loss of HCO3

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83
Q

Respiratory acidosis

A

hypoventilation
hypercapnea (inadequate ventilation)

causes:
COPD (most common)
drug-induced CNS depression
extreme obesity
neurological disorder

compensation:
renal (increase in HCO3)
masks the problem by maintaining normal pH

neuromuscular weakness: shallow, rapid, short breath
CNS depression: slow, shallow, possibly apnea

increase in PaCO2:
increase ICP
myoclonus
asterixis
mental confusion

abrupt increase of PaCO2 70mmHg = coma
COPD / chronic hypercapnia can tolerate higher CO2 levels

correction:
restore ventilation
-secretion mobilization
-bronchodilator drugs
-endotracheal intubation
-mechanical ventilation
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84
Q

respiratory alkalosis

A

hyperventilation

decreased PaCO2/ hypocapnia

causes:
hypoxia
pulmonary disease
- pneumonia
- edema
CNS disease
high altitude
acute asthma
general anxiety
fever
latrogenically - agressive ventilation (medically induced)

anxiety:
panic - vision impaired / speaking difficulty
- rebreather therapy

correction:
remove stimulus causes hyperventilation
- hypoxia O2 therapy

compensation:
slow renal excretion of HCO3

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85
Q

rise in HCO3

A

every 10mmHg rise = 1 mEq/L rise in HCO3

ex. 40mmHg rises to 70mmHg = increase in 3 mEq/L

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86
Q

lab value to indicate tissue hypoxia

A

lactic acid

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87
Q

chronic hypoxemia

A

increase cardiac output
increase RBC
increase tissue perfusion

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88
Q

hypoxic hypoxia

A 
increase in PAO2
hypoventilation
shunt
V/Q mismatch
aim to ventilate alveoli
reduces O2 delivery to tissue
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89
Q

Anemic hypoxia

A

low Hb concentration
Hb not binding chemically to oxygen

CO poisoning
-reduce O2 delivery to tissue

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90
Q

stagnant hypoxia

A 
low blood flow, low BP
lung function can be normal
low oxygen delivery rate 
-shock
low blood volume
-hemorrhage
-severe dehydration
O2 therapy cardiac arrest = restore blood flow
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91
Q

histotoxic hypoxia

A 
blocked oxidative metabolism
-cyanide poisoning 
-smoke inhalation
100% oxygen inhaled
*methemoglobin
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92
Q

physiological shunt

A

in bronchial vasculature

bronchial blood flow is only 1%-2% of the cardiac output

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93
Q

catheter flow

A

right atrium (CVP) 2-4
Right ventricle S/D
Pulmonary artery 25/8 systole
PCWP 4-12

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94
Q

thermodilution

A

most useful in evaluating cardiac output

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95
Q

what substances are eliminated by the kidneys

A 
urea
creatine
uric acid
bilirubin
various toxins
foreign substances
metabolites of assorted hormones
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96
Q

what structures compose the nephron

A 
bowmans capsule
proximal convoluted tubule
loop of henle (ascending, discending)
distal convoluted tubule 
collecting duct
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97
Q

what substance is secreted at the juxatoglomerular apparatus when systemic blood pressure decreases

A

renin, an enzyme that activates angiostensin, which leads to widespread system arteriole constriction

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98
Q

what substances, when excessive, does the nephron clear from the plasma

A

sodium
potassium
chloride

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99
Q

how much of the glomerular filtrate is reabsorbed into the blood

A

99%

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100
Q

gloerular filtrate is the same as plasma except it does not contain what substances

101
Q

what substances are almost totally reabsorbed from the tubules

A

sodium
potassium
chloride
bicarbonate

102
Q

what is the most important autoregulatory mechanism of renal blood flow

A

afferent vasodilator mechanism

103
Q

what part of the nephron is highly impermeable of water

A

thick portion of the loop of henle

104
Q

assending loop of henle

105
Q

descending loop of henle

106
Q

the hormones inhibit the effects of aldosterone

A

renin secretion results in angiotensin II formation, which causes the cortex of the adrenal gland to secrete aldosterone -> ANH & BNP -> inhibit aldosterone (promote loss of Na+ in urine

107
Q

what type of urine is excreted by the kidneys, under the influence of ADH

A

low volume

high concentration

108
Q

what is the best clinical indicator of perfusion adequacy

A

urine output

109
Q

osmotic diuretic

A

mannitol - proximal tubules, elevates osmotic pressure of the filtrate, keeping water inside the tubules to be excreted as urine, decreases ICP in cerebral edema by decreasing brain swelling and ICP

diuretic

110
Q

loop diuretic

A

furosemide
-lasix

toresimide
-dernadex

ethacynic
-edearin

block Cl- and Na- out of ascending henle loop to promote diuresis (K+ loss)

useful in treating edema related to CHF and can increase urine output by 25Xs

111
Q

diuretic that is effective in treating edema of CHF

A

loop diuretic

112
Q

categories of acute renal failure

A

decreased blood supply
- heart failure, hemorrhage

intrarenal failure
- abnormalities within kidney

postrenal failure
- obstruction of urine outflow

113
Q

increased BUN, creatinine, sodium, potassium, fixed acids

A

renal failure

metabolic acidosis

114
Q

pulmonary manifestation of nephortic syndrome

A

interstitial edema
pleural effusion
pericardial effusion
ascites

115
Q

characteristics of goodpasture syndrome

A

autoimmune disease
hemoptysis
hematuria
targets kidney and lung alveoli

116
Q

normal range for BUN

A

8-20 mg/dL

117
Q

normal range for creatine

A

0.6-1.2 mg/dL

118
Q

diseases associated with increased blood creatinine

A

kidney and muscle disease

renal failure

119
Q

when BUN and creatinine are elevated in renal failure which acid-base disturbance

A

metabolic acidosis

120
Q

why is a patient gaining weight on mechanical ventilation

A

fluid retention

121
Q

causes of pulmonary edema

A 
increased hydrostatic pressure
-left ventricular failure (CHF)
-hypervolemia
-mitral stenosis 
increased capillary membrane
decreased plasma oncotic pressure
insufficent lymphatic drainage
122
Q

edema associated with high PCWP

A

cardiogenic pulmonary edema

123
Q

major effect of V/Q mismatch

124
Q

chronic hypercapnia

A

V/Q mismatch

125
Q

P(a-A)O2 when 100% oxygen is breathed

A

50-60mmHg

when breathing room aire
7-14mmHg

126
Q

conditions associated with dead space

A

pulmonary embolism
severe hypotension
alveolar overdistension
Auto-PEEP

127
Q

PaO2/PAO2

A

most reliable indicator of shunt in stable conditions

128
Q

Qt/Qs

A

most reliable indicator of shunt in unstable conditions

129
Q

Thiazides

A

chlorothiazide

inhibit reabsorption of Na+

mild

blood pressure control

130
Q

effects if acute renal failure

A
  • decreased blood supply, heart failure or hemmorrhage
  • intrarenal failure, or abnormalities with the kidneys
  • postrenal failure, obstruction of urine outflow from the kidneys
131
Q

chronic renal failure

A

decrease of number of functional nephrons

pyelonephritis - bacteria causes

arteriosclerotic - decreases renal blood flow and ichemiac nephrons

132
Q

physiological effects of chronic renal failure

A

general edema, salt and water retention
nephrotic syndrome
goodposture syndrome

metabolic acidosis because the kidneys cant excrete fixed acids

high blood concentrations of nitrogenous compounds like urea, creatine, and uric acid (uremia), phenols, sulfates, phosphates, potassium.

azotemia

patients may progress to a confused mental state that can progress to uremic coma (acidosis)

133
Q

renal clearance blood tests

A

BUN - blood urea nitrogen
pyelogram
creatinine

134
Q

PMI

A

point of maximal impact
fifth intercostal space and midclavicular line
repeated impact of heart beat on chest wall

135
Q

sympathetic receptors are mainly

A

(adrenergic) B1 - they increase myocardial force of contraction and heart rate

136
Q

parasympathetic receptors are mainly

A

(cholinergic) alpha 1 - they slow heart rate

137
Q

drugs that block Ca++

A

decrease heart force of contraction

138
Q

clinical indicator of heart attack

A

troponin 1

139
Q

all or none principle

A

if one fiber of the syncytium contract then all fibers contract

140
Q

Frank-Starling

A

the greater the diastolic volume of the heart the greater the force of contraction - increase in sarcomere length

141
Q

when does most of blood perfusion happen

A

during diastole

142
Q

preload

A

the precontraction length of the sarcomere

if preload is good you will contract well

143
Q

overdistended heart stretched

144
Q

cardiac cycle

A

0.8 seconds

145
Q

atrial kick

A

20%

80% passive

146
Q

decrease heart rate

A

vagal stimulation

147
Q

normal pulse pressure

148
Q

venous

A

veins are 64% of total blood volume

149
Q

venous return

A
  • cardiac pumping of large leg muscles
  • sympathetic venous contraction
  • cardiac pumping action
  • thoracic pump
150
Q

blood flow is determined by

A
  • driving pressure

- vascular resistance

151
Q

mean blood pressure

A

stroke volume
arterial compliance
arterial resistance

152
Q

High BP

A

systolic over 135

diastole over 90

153
Q

detrimental effects of high BP

A
  • high workload on heart, leading to heart failure

- rupture of blood vessel in brain, stroke, CVA

154
Q

venous blood flow (CVP) increases if

A
  • increased blood volume
  • venous tone increases
  • arteriolar dilation occurs
155
Q

normal RAP

156
Q

peripheral edema

A

RAP increases above 6 mmHg and effects PVP

JVD
hepatomegaly
ascites
pedal edema
anasarca
enlarged spleen
157
Q

adenosine

A

most important local vasodilator

158
Q

cycling

A

vasomotion

159
Q

oxygen demand theory

A

lack of oxygen dilates precapillary sphincters and arterioles, blood flow increases

160
Q

central control

A

autonomic system
sympathetic division
vasoconstriction/ vasodilation - depends on adrenergic receptors

161
Q

B2

A

vasodilation

162
Q

A

A

vasoconstriction

163
Q

baroreceptors

A

responsive to stretch
when stretched by high BP they send impulses to the glossopharyngeal and vagus nerve and causes vasodilation and slows the heart rate, low BP

164
Q

RAAS

A

controls low BP

holds onto fluid and stimulates renin from kidneys

165
Q

renin produces

A

angiotensin 1

166
Q

angiotensin 1

A

produces ACE

167
Q

ACE produces

A

aldosterone

168
Q

aldosterone

A

causes kidneys to reabsorb water and sodium

169
Q

ADH

A

low BP

holds onto water / fluid

raises BP

170
Q

BNP

A

response to high BP

BNP inhibits aldosterone and RAAR secretion

promotes sodium loss and decreases BP

171
Q

diagnostic marker for heart failure

A

BNP

helps differentiate between cardiac and pulmonary causes of dyspnea

172
Q

P WAVE

A

arterial depolarization

positive

173
Q

PR interval

A

AV node to bundle of His
0.12-0.20
isoelectric

174
Q

QRS

A

ventricular depolarization

less than 0.10

175
Q

ST segment

A

depressed >0.5mm = myocardial ischemia

elevated >2mm = myocardial injury

176
Q

MCV

A

60 degrees

normal axis 0-90 degrees
normal range -30 - 120 degrees

177
Q

MCV deviations

A

change in heart position
hypertrophy in one ventricle
myocardial infarction
bundle branch conduction block

178
Q

right axis deviation

A

COPD

cor pulmonale

179
Q

left axis deviation

180
Q

reading heart rate on ECG

A 
# of large squares between 2 QRS intervals
divide number of squares by 300
181
Q

12 lead ECG

A

bipolar limb leads - anterior / posterior view
uniploar limb leads - anterior / posterior view
chest leads - horizontal / sagittal view

182
Q

bipolar limb leads

A

lead 1 right arm to left arm
lead 2 right arm to left leg
lead 3 left arm to left leg

183
Q

unipolar limb leads

A

aVr right arm
aVL left arm
aVf left leg/ foot

184
Q

extreme right axis deviation

A

lead 1 negative

aVf negative

185
Q

aVf

A

90 degrees

186
Q

right axis deviation

A

lead 1 negative

aVf postive

187
Q

left axis deviation

A

lead 1 positive

aVf negative

188
Q

normal

A

lead 1 positive

aVf positive

189
Q

V1

A

fourth intercostal , right of sternum

190
Q

V2

A

fourth intercostal, left of sternum

191
Q

V4

A

fifth intercostal, midclavicular

192
Q

V3

A

between V2, V4 centered

193
Q

V5

A

fifth intercostal

194
Q

V6

A

fifth intercostal, midaxillary

195
Q

high amplitude P WAVE

A

enlarged atrium
pulmonary valve stenosis
cor pulmonale
COPD

196
Q

O2 content of 100mL of apical blood

A

20.5 mL

PO2 130 mmHg @ 100%

197
Q

O2 content of 100mL of basal blood

A

19.1

PO2 85 mmHg @ 94%

198
Q

absolute shunt

A

40 mmHg PAO2
45 mmHg PACO2
Low V/Q
zone 3 basal

199
Q

normal

A

PAO2 80-100 mmHg
PACO2 35-45 mmHg
V/Q 1:1
zone 2

200
Q

absolute dead space

A

PAO2 150 mmHg
PACO2 0

High V/Q
zone 1

201
Q

MAP

202
Q

intrapulmonary/ physiological shunt

A

pneumonia
pneumothorax
pulmonary edema
bronchial occlusion

203
Q

hallmark of intrapulmonary shunt

A

refractory hypoxemia

204
Q

shunted blood

A

can not take up oxygen or release carbon dioxide

205
Q

supraventricular (atrial) (base) arrythmias

A

sinus tachycardia
atrial fibrillation
atrial flutter
PAC

206
Q

ventricular arrythmias

A

ventricular tachycardia
torsades de pointes
ventricular fibrillation
PVC

207
Q

Brady arrythmias

A

sinus bradycardia

1,2,3 degree block

208
Q

Tachycardia

A

HR >100

Causes:
exercise
fever 
anxiety
pain
smoking
b-anergenic drugs
hypoxia
anemia
shock

treatment:
b-blocker drugs
vagal stimulation (decrease HR)

209
Q

bradycardia

A

HR < 60

causes:
normal in physically fit, or sleeping individuals
vagal stimulation
- pharynx , trachea instrumentation

symptoms:
hypotension
weakness
sweating
synscope

treatment:
atropine
pacemaker

210
Q

abnormal sinus arrythmia

A

bradycardia - expiration
tachycardia - inspiration
no treatment
non pathological

211
Q

1st degree AV block

A

conduction time is slow

PR interval >0.2 seconds

212
Q

2nd degree AV block

A

MOBITZ 1 - treated with drugs

MOBITZ 2 - pacemaker

213
Q

3rd degree AV block

A

pacemaker 15 bpm

stokes adams syndrome
- heart block, fainting, loss of consciousness

214
Q

PAC

A

compensatory pause
PWAVE close to SA +
PWAVE close to AV -

causes:
stress
alcohol
tobacco
electrolyte imbalance
sympathetic stimulation

treatment:
quinidine
verapamil

215
Q

Atrial conditions

A

CHF
mitral valve stenosis
pulmonary vascular resistance

216
Q

atrial fibrillation

A

300-600 bpm
loss of atrial kick 20%
fine F waves

causes:
increased atrial pressure
enlarged atrium
thromboembolism
longer depolarization time

treatment:
anticoagulant (do first)
Ca++ blocker
electrical cardioversion

217
Q

T wave

A

vetricular repolarization

218
Q

QT interval

A

<0.40 seconds

219
Q

atrial flutter

A

F waves saw toothed

200-350 bpm

symptoms:
palpitations
nervousness
anxiety
synscope

treatment:
Ca++ blocker
electrical cardioversion

220
Q

PVC

A

> 0.12 seconds and bizzare

single life threatening arrhythmia

causes: 
stress
tobacco
caffeine
sympathetic stimulation
diseases:
hypoxia
acidosis
hypokalemia
myocardial irritability
MULTI focal

treatment:
lidocaine
amiodarone

221
Q

VT

A

runs of PVC
110-250 bpm
may not feel a pulse - pulse deficit
treat as emergency can progress to VF

treatment:
lidocaine
amiodarone
electrical cardioversion

222
Q

torsades de pointes “ twisting of the points “

A 
causes:
electrolyte imbalance
antiarrhythmic drugs 
low Ca++
Low Mg++
223
Q

VF

A

most lethal
cardiac arrest
code blue

no drugs can treat
circus reentry mechanism
shock
CPR

224
Q

junctional escape rhythm

A

if the SA node fails to generate impulses the AV junction may assume the role of the pacemaker

225
Q

DRG

A

inspiratory neurons

primary stimulus for inspiration

226
Q

VRG

A

expiratory

227
Q

inspiration ramp signal

A

neurons that switch off

  • pneumotaxic center
  • pulmonary stretch receptors
228
Q

apneustic breathing

A

prolonged inspiratory gasps interrupted by occasional expirations

damage to pons

229
Q

pneumotaxic center

A

controls the length of inspiration

230
Q

hering-breurer deflation reflex

A

hyperpnea

increase RR

231
Q

hering-breurer inflation relflex

A

slowing adapting receptors
stretch receptors
stops further inspiration when stretched
activated by large tidal volumes of 800-1000mL

232
Q

heads paradoxical reflex

A

rapidly adapting receptors
maintains large tidal volume during exercise
prevents atelectasis
first breath of newborn

**periodic deep sighs during quiet breathing

233
Q

rapidly adapting irritant receptors

A 
vagocagel reflex
- ETT
- airway suctioning
- bronchoscopy
inhaled irritants
234
Q

sensory reflex

A

laryngospasm
bronchospasm
coughing
decrease HR

235
Q

motor reflex

A 
bronchoconstriction
coughing
sneezing 
tachypnea
narrow glottis
236
Q

central chemoreceptors

A

repsonds to H+
arrises from the reaction between dissolved CO2 and H2O in the CSF

CO2 diffuses from blood brain barrier to CSF to form H+

237
Q

CO2 diffusion

A

ventilation increases 2-3L/min for every mmHg in PaCO2 rise

238
Q

maximal hyperventilation

A

PaO2 can not rise over 130 mmHg

239
Q

peripheral chemoreceptors

A

20%-30% of ventilation responds to PaCO2 rise 5X quicker than central

240
Q

carotid bodies

A

exert much more influence over the respiratory center than aortic - high blood flow rate

glossopharyngeal - carotid
vagus - aortic

241
Q

hypoxia

A

doesnt stimulate ventilation until PaO2 decreases less than 60 mmHg or less

242
Q

normal ICP

243
Q

normal CBF`

244
Q

exercise

A

onset
period of adjustment
steady state

245
Q

J receptors

A

rapid-slow breathing , sensation of dyspnea

246
Q

cheyne-stokes

A

increase RR and volume by gradual decrease in RR to complete apnea

CHF

247
Q

biot

A

RR and tidal volume increase with volume at the same depth

lesions of the PONS

248
Q

central reflex hypernea

A

continuous deep breathing

249
Q

central reflex hypopnea

A

respiratory centers do not respond to appropriate ventilation stimuli such as CO2 - hypoventilation

brain trauma
narcotic depression

final rcp 200 (1 decks)

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