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103:theme 4 > l3 > Flashcards

l3 Flashcards

1
Q

What does the rhythm generator in the medulla contain

A

inspiratory and expiratory group of neurons

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2
Q

what modifies the signals from the medulla

A

Pneumotaxis centre in the pons

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3
Q

what causes respiratory depression

A

Opiates/narcotics

Cerebral diseases

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4
Q

where does chemo sensing occur (afferent nerves)

A

Carotid-(arch-bundle of cells outside bifurcation of carotid arteries) and aortic bodies

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5
Q

what do peripheral chemoreceptors respond to and how

A

Hypoxia-increase in H+ and CO2

Response- increase ventilation only when PaO2 drops significantly

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6
Q

where and what and how-central chemoreceptors

A

Hind brain

Sense PaO2 andH+ indirectly through CSF plasma CO2 sensing

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7
Q

Efferent nerves- inspiratory muscles innervation

A

Diaphragm-phrenic nerves c3-5
External intercostal muscles- thoracic nerves t1-11
Accessory muscles in neck- Sternocleidomastoid- (XI cranial nerve & scalene muscles C3-8 )

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8
Q

where are expiratory muscles located (2)

A

Abdominal wall

External intercostal muscles

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9
Q

what do lung stretch receptors sense and via which nerve (3)

A

Vagal nerve
Lung stretch during breathing to terminate breath preventing overstretching

Sense abnormal changes in airway mechanical properties

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10
Q

what are particulate receptors

A

C-fibre neurons: activated by oedema & endogenous sensitizers= brady kinin

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11
Q

what are irritant receptors

A

Respond to punctate mechanical stimuli

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12
Q

what are steps 1 & 2 approach t ABG interpretation

A

1-examine PH PCO2 & HCO3-for academia and alkalemia

2- Determine primary process

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13
Q

What is abnormal ranges where alkalemia and academia are diagnosed

A

PH: <7.38
PH:>7.42

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14
Q

Primary processes of each acidosis and alkalosis

A

Respiratory PCo2>44
Metabolic HCO3<22

Alkalosis= resp:low PCO2<36
Met: High HCO3- >26

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15
Q

what is step 3 of ABG interpretation

A

Calculate anion gap

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16
Q

what is metabolic acidosis

A

addition of acid or loss of bicarbonate

17
Q

what constitutes as an anion gap

A

when additions of acid is called anion gap metabolic acidosis and if anion gap is greater than 12

18
Q

Main causes for metabolic anion gap acidosis

A

Glycols, oxopraone L-and D- lactate, methanol aspirin renal failure and ketoacidosis GOLD MARK

19
Q

Non-anion gap -metabolic acidosis: what is renal tubular acidosis

A

RTA_ Urinary loss of bicarbonate and hyperchloremic acidosis

20
Q

what is type 1 RTA:

A

in distal duct-inability to secrete H+ into lumen

21
Q

type 2 RTA

type 3

A

proximal duct - same as Type 1

Comb of features-rare

22
Q

Base excess

A

measure of metabolic disturbance- dose of acid required o return blood to normal PH-7. 4- under standard conds-37 degrees< and PCO2 of 40 mmHg
Base deficit is dose of alkali……………

23
Q

what is step 4 of ABG

A

Compensatory for acid-base disturbances-needs to be identified

24
Q

Primary disturbances

A 
Slower:
Respiratory acidosis- response-Retain HCO3 
respiratory alkalosis- Reduce HCO3 
Quicker 
Metabolic acidosis- Reduce CO2 
Metabolic alkalosis- retain CO2
25
Q

what is step 5 of ABG

A

Evaluate for mixed disorder

26
Q

step 5 is when you

A

think its 2> base disturbances.

27
Q

what is compensation complete

A

Close to but not normal PH

28
Q

what is step 6

A

generate differential diagnosis

29
Q

Step 6 conclusions

A

Metabolic acidosis: 1-(anion gap metabolic acidosis). 2 non ():RTA, GI los , cl- administration acetazolamide
Metabolic alkalosis:
increased aldosterone- vomiting- other causes Respiratory acidosis- retention of CO2 - increased dead space, weakness
Respiratory alkalosis:
Hyperventilation due to pain, pregnancy, respiratory centre abnormalities-hypoxemia with high altitude

30
Q

barometric pressure decreases with

A

Increasing height

31
Q

response to high altitude

A

Peripheral chemorecep: Hypoxemia
Hyperventilation increases alveolar vent rate and PACO2 decreases- resp alkalosis
reducing PACO2 leaves more O2 space in alveoli
renal compensation-excreting HCO3- returns acid base to normal

32
Q

acclimatisation to high altitude

A

Hypoxemic hypoxia: increased HB, Right shift of HB dissociation curve
vent increase - H+ PACO2 decrease and metabolic alkalosis

103:theme 4 (4 decks)

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