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BB - Respiratory Review > Final Review - Personalized Pt 2 > Flashcards

Final Review - Personalized Pt 2 Flashcards

1
Q

Oxygen used by cells at rest…

A

250 ml/min

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2
Q

Why doesnt CO2 need as large a gradient as oxygen to diffuse?

A

CO2 diffuses 20 x faster than O2

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3
Q

Hypoxic Hypoxia

A

inadequate O2 uptake

COPD

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4
Q

Stagnant/Ischemic Hypoxia

A

inadequate blood flow

clot

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5
Q

Anemic Hypoxia

A

inadequate oxygen carrying capacity

inactivated hgb

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6
Q

Histotoxic Hypoxia

A

interference with mitochondrial respiration

cyanide poisoning

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7
Q

Methods of O2 Transport

A

97% carried by RBC’s

dissolved in plasma - low capacity

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8
Q

Amount of O2 that can be dissolved in blood

A

0.0003 ml/100ml plasma

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9
Q

Hemoglobin

A

oxygen carrier protein
4 subunits, 2 alpha, 2 beta
only Fe2+ can bind to O2

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10
Q

How much O2 can 1gm of Hgb carry?

A

1.31 ml

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11
Q

Oxyhemoglobin curve axis & rightward

A

x axis = PaO2
y axis = saturation
rightward shift –> release O2 more
saturation will be less for a given PO2

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12
Q

Causes of rightward shift

A

increased CO2
increased temp
increased H+
increased 2,3 DPG

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13
Q

Average CO2 production in resting adult

A

200 ml/min

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14
Q

Mechanisms of CO2 transport

A

3% dissolved in blood
90% bicarb, HCO3 and carbonic acid
7% bound to hgb
** all reversible at lungs

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15
Q

What causes increased minute ventilation

A

hypercapnia and acidosis

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16
Q

Which materials act directly on the respiratory centers to increase strength inspiratory and expiratory motor signals?

A

carbon dioxide
hydrogen ions
**oxygen acts peripherally at carotid and aortic bodies

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17
Q

DRG

A

controls respiration at rest and provides basic rhythm

-vagal and glossopharyngeal sensory info to DRG

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18
Q

VRG

A

inactive during normal respiration
contributes to drive to increase respiration
stimulates abdominal muscles

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19
Q

Pneumotaxic Center

A

control switch off point
primarily limits inspiratory phase
also increases rate

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20
Q

Apneustic

A

works with pneumotaxic to control intensity of respiration

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21
Q

Hering-Breuer Reflex

A

protective feedback mechanism that limits overinflation

  • stretch receptors send signals via vagus nerve to DRG when TV >1.5 L
  • also increases rate
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22
Q

Chemo-Sensitive Area

A

on ventral medulla, responsive to CO2 and H+

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23
Q

Which ions can cross blood brain barrier?

A

CO2, not H+

CO2 stimulates H+ ions in CSF to stimulate resp center

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24
Q

Mountain climbing

A

adjusts in 2-3 days, loss of sensitivity to CO2, or H=, oxygen runs resp center

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25
Q

Alveolar ventilation curves

A

curves are displaced to the right at higher pH and left with lower pH

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26
Q

What controls voluntary respiration

A

cortex and higher centers

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27
Q

Is the potential for Cheyne-Stokes breathing present in everyone?

A

yes

  • low CO
  • brain damage
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28
Q

High risk PFT results

A

FEV1 <2L
FEV1/FVC < 0.5
VC <15 cc/kg in adult, <10 cc/kg in child
VC <40 - 50% predicted

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29
Q

To decrease air trapping…

A

change I:E ratio.

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30
Q

Histamine releasing drugs

A 
pentothal (STP)
Morphine 
atracurium
mivacurium
neostigmine
abx
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31
Q

Extubation criteria

A

resp rate <30
ABG on FiO2 of 40% –> PaO2 >70, PaCO2 <55
NIF more negative than -20 cm H2O
VC >15 cc/kg

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32
Q

Extubation and FEV

A

FEV >50% –> not affected
FEV 25-50% –> some hypoxemia and hypercarbia, prolonged intubation probable
FEV <25% –> may not be able to wean

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33
Q

Intubation criteria

A

RR >35, VC <15 cc/kg
oxygenation PaO2 <70 on FiO2 of 40%
PaCO2 >55
-airway burn, chemical burn, epiglotitis, etc

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34
Q

TV

A

500 ml

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35
Q

IRV

A

3 L

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36
Q

ERV

A

1.1 L

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37
Q

RV

A

1.2L

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38
Q

IC

A

3.5 L

39
Q

FRC

A

2.3 L

40
Q

VC

A

4.6 L

41
Q

TLC

A

5.8 L

42
Q

Normally, FRC represents about ___% of TLC

A

40%

43
Q

FVC

A

volume of air which can be forced exhaled out of lungs after pt has taken deepest breath possible

44
Q

FEV1

A

forced volumes in 1 second
effort dependent
3-5L
**most important clinical tool in assessing severity of airway obstructive disease

45
Q

Normal FEV1/FVC

A

75%

46
Q

Flow-Volume Loops

A

help distinguish between obstruction and generalized pulmonary disease
-extrathoracic obstruction = decreased inspiratory flow

47
Q

MVV or MBC

A

“will to live”

max amount they can exchange in 1 minute

48
Q

Carboxyhemoglobin

A

from CO poisoning, shows 100%

49
Q

Methemoglobin

A

shows 85%, absorbs equally at both wavelength
-benzocaine, NTG, nitrates
tx: methylene blue
cyanosis when 15% hgb is methgb

50
Q

Gold standard for tracheal intubation…

A

EtCO2

*will not detect endobronchial intubation

51
Q

Mainstream circuit

A

inline
connects to ETT, fast, do not need water trap
adds weight and dead space

52
Q

Sidestream

A

diverting
pumps to outside circuit, takes longer
need water trap

53
Q

dCO2

A

normal end tidal CO2 to arterial CO2 gradient
arterial is higher by 2-5 mmHg
-reflects alveolar dead space

54
Q

increase dCO2

A

increased dead space

55
Q

One lung positioning: down lung

A

dependent lung

nondependent lung = upper lung

56
Q

Where does the axillary roll go?

A

upper chest wall, no axilla

57
Q

during apnea…

A

PCO2 increases 5 mmHg for the first minute, then 3 mmHg for each additional minute

58
Q

Hypoxia during one lung ventilation

A

add 5 cm CPAP to nondependent lung
add 5 cm PEEP to dependent lung
ask surgeon to clamp nondependent PA

59
Q

double lumen tube sizes

A

women: 39 (insert 27 cm)
men: 41 (insert 29 cm)

60
Q

Left double lumen tube

A

more common, easier to place

longer bronchial, shorter tracheal

61
Q

MH

A

rare, inherited skeletal muscle syndrome, hypermetabolic rxn
triggered by volatile anesthetics, succ
ryr1 receptor

62
Q

most specific indicator of MH

A

abrupt increase in EtCO2

63
Q

earliest sign of MH

A

tachycardia

64
Q

early signs of MH

A 
abrupt increased in EtCO2
tachycardia
cardiac arrhythmias
generalized rigidity
masseter rigidity
metabolic/resp acidosis
mottling
65
Q

late signs of MH

A 
acute renal failure
circulatory failure
myoglobinuria
DIC
elevated blood creatine phosphokinase
hyperkalemia
hyperthermia
hypotension
rhabdomyolosis
cardiac arrest
66
Q

MH treatment

A

dantrolene 2.5 mg/kg q5 mins, max 10 mg/kg

67
Q

Dantrolene

A

inhibits Ca release from SR directly at ryanodine receptor

*Ca channel blockers cannot be given with dantrolene –> hyperkalemia and heart depression`

68
Q

MAC amnesia

A

25% MAC

blocks anterograde memory in 50% of pts

69
Q

MAC awake

A

50% MAC

prevents eyes opening on verbal command

70
Q

MAC intubation

A

130% MAC

prevents movement/coughing with ETT placement

71
Q

MAC Bar

A

150% MAC blocks autonomic response

72
Q

lower mac =

A

higher potency

73
Q

things that increase MAC..

A 
age - term infant at 6 mo has highest MAC requirement
hyperthermia
chronic ETOH
hypernatremia
drugs that increase SNS catecholamines
74
Q

things that decrease MAC…

A 
hypothermia
preop meds
neonates/preemies, elderly
pregnancy
hyponatremia
alpha 2 agonists, ca channel blockers
75
Q

2nd gas effect

A

ability of fast uptake of N2O to accelerate rate of rise of alveolar partial pressure of 2nd agent

76
Q

Diffusion Hypoxia

A

dilution of alveolar O2 concentration by large amount of N2O entering alveolus when N2O is d/c’d
-give 100% O2, dont extubate

77
Q

Most important for speed of induction…

A

solubility

78
Q

A larger partial pressure difference will…

A

enhance uptake and speed induction

79
Q

Nitrous Oxide

A

good analgesic, safe in MH, PONV
avoid use with closed gas spaces
PVR, esp with pulm HTN

80
Q

Halothane

A

vagal stimulation, esp >1 MAC –> pretreat with atropine
thymol preservative
sensitizes heart to catecholamines, caution w/ epi
avoid with liver dx

81
Q

Isoflurane

A

heart cases

coronary steal

82
Q

Desflurane

A

need special vaporizer
rapid wash in and wash out
not readily taken into fat

83
Q

Sevoflurane

A

good for inhalation induction
rapid induction and emergence
compound A, avoid in renal failure
keep FGF atleast 2 L/min

84
Q

Enflurane

A

can cause tonic clonic muscle activity,

avoid with renal failure and seizure pts

85
Q

COPD

A

emphysema & bronchitis

**smoking

86
Q

Chronic Bronchitis

A

symptoms- cough, sputum production, recurrent infections
mucous gland hyperplasia, mucous plugging, inflammation, edema
“blue bloaters”

87
Q

Emphysema

A 
*progressive dyspnea
structural changes
destruction of lung tissue, enlarged air spaces
*alpha 1 antitrypsin deficiency
"pink - puffer"
88
Q

Pre-Op smoking cessation

A

-advise to stop atleast 12 hrs pre-op
reactivity decreases after 2 days, after 10 near nonsmoker
cessation >8 wks = reduced post op complications

89
Q

How does smoking effect SNS…

A
  • nicotine stimulates SNS catecholamines released from adrenal medulla - increased HR, BP & SVR
  • persists 30 mins
  • pre-oxygenate well and avoid airway manipulation until deep
90
Q

Neuroaxial block >T10

A

diminished ability to cough

91
Q

COPD and interscalene block

A

frequently blocks ipsilateral phrenic nerve

92
Q

Asthma

A

hyper-reactivity

triad: wheezing, cough, dyspnea

93
Q

Asthma treatment

A 
pregnant - terbutaline
oxygen, albuterol
corticosteroids
atrovent (ipratropium bromide)
theophylline
helium
induction - ketamine, will increase secretions. pretreat with glyco
94
Q

EtCO2 phases

A

A-B (1) - exhalation of anatomic deadspace
B-C (2) - exhalation of deadspace and alveolar
C-D (3) - alveolar
D-E (4) - inspiration

BB - Respiratory Review (5 decks)

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