ITE Pulm Flashcards
Cormack-Lehane system
- Grade 1
Complete glottis visible
Cormack-Lehane system
- Grade 2b
Anterior glottis not visible.
Only posterior arytenoids and epiglottis visible.
Cormack-Lehane system
- Grade 3
Epiglottis, but not glottis is visible
Cormack-Lehane system
- Grade 4
Epiglottis is not visible
First line treatment for asthma exacerbation in OR
- bronchospasm
- airway inflammation
- mucous plugging
100% FIO2
then deepen the anesthetic
*Beta agonists can worsen oxygenation d/t changes in V/P mismatch
Inhaled corticosteroids for asthma treatment take ____ (time) to see significant changes
6-12 hours
- treat inflammatory component
Heliox is a ____ andis a useful adjunct in that it helps to decrease the density of delivered gases (ie: Beta2 agonists and steroids get past obstruction), resulting in less pt effort needed to get the same volume of gas.
mixture of 70% helium and 30% oxygen
How does giving a beta-2-agonist in pts having a bronchospasm worsen the oxygenation?
d/t changes in V/P mismatch
- The under-ventilated alveoli will have concomitent pulmonary vasoconstriction to decrease the amount of shunting
- When B2-agonist is used, some bronchodilation occurs, but inflammation and mucous plugging continues
- there is increased perfusion to poorly ventilated lung units -> V/Q mismatch
Bronchospasm affects ____ muscle, and nondepolarizing relaxants affect ____ muscle
smooth
skeletal
________ block occurs in 100% of patients undergoing interscalene blockade, even with dilute solns of local anesthetics and results in a ___% reduction in pulmonary function
Ipsilateral phrenic nerve block
- results in diaphragmatic paresis
Most common level for placement of interscalene block
Between Anterior and middle scalene m
- at the cricoid cartilage or C6 vertebrae lvl
- Where the cervical n roots C5-6 leave the spine
The interscalene block may spare the ____ nerve.
ulnar nerve.
Intraarterial injection of local anesthetics would cause what type of symptoms?
CNS symptoms
immediate sz
intrathecal injection of massive amts of local anesthetics would cause what type of symptoms?
total spine
LOC +
respiratory insufficiency/apnea
Foreign body in children display signs of ______, while adults often display signs of ______
Children
- air trapping: hyperinflation with obstructive emphysema
Adults
- atelectasis
Two most feared complications of mediastinal mass in anesthesia
- Complete airway obstruction w/ inability to maintain gas exchange
- Cardiovascular collapse from compression of vital structures.
GA approaches to pts with mediastinal mass
- local/regional anesthesia whenever possible
- Awake intubation.
- Secure airway beyond lesion.
- Confirm ability to ventilate and oxygenate
- Have thoracic surgeon in room during induction
- Ensure availability of rigid bronchoscopy if obstruction occurs
______ results in a flow-volume loop with an:
- expiratory phase with a quick peek followed by a much lower than normal plateau phase. *kink
- normal inspiratory phase
- Graph shifts to L
COPD
Assuming full inspiratory and expiratory efforts are made, end INSPIRATION volume is equal to ______, and end EXPIRATION is equal to ____
total lung capacity
residual volume
Examples of intrathoracic airway obstruction and extrathoracic airway obstruction
intrathoracic airway obstruction
- distal tracheal tumor
- mediastinal mass
extrathoracic airway obstruction
- vocal cord paralysis/dysfunction
- proximal tracheal tumor
- glottic strictures
What causes a flow-volume loop with plateaued AND decreased inspiratory and expiratory flows?
Fixed upper airway obstruction or fixed large airway obstruction?
A variable INTRATHORACIC airway obstruction produces a flow-volume loop with a plateaued (inspiratory/expiratory) curve.
expiratory
A variable EXTRATHORACIC airway obstruction produces a flow-volume loop with a plateaued (inspiratory/expiratory) curve.
inspiratory
FEV1/FVC <70% =
FEV1/FVC >80% =
Obstruction in adults
- Low
restrictive
- normal/increased
*80% is normal