NCE Flashcards
↑PVR
Hypoxia
Low FiO2 < 30%
Acidosis ↓pH ↑H+
Hypercarbia ↑CO2
PEEP ↑ITP or airway pressures
Mechanical ventilation
Light anesthesia/pain
Surgical stress SNS stimulation
Vasoconstrictors
HPV response to atelectasis
Trendelenburg
Nitrous oxide N2O
Desflurane & Ketamine
Hypothermia
↓PVR
Hyperoxia ↑PaO2
↑FiO2 100%
Alkalosis ↑pH ↓H+
Hypocarbia ↓CO2
Hyperventilation
No PEEP ↓ITP
Low airway pressures
Spontaneous ventilation
Deep anesthesia
Vasodilators iNO, NTG, PDEi, PGE1, PGI2, CCBs, ACEi
Pulmonary Vascular Resistance
PVR = [(Mean PAP - PAOP) / CO] x 80
Normal 150-250 dynes/sec/cm
Acidosis
↑CBF ↑ICP
↑P50 (R shift)
↑SNS tone ↑dysrhythmias risk ↓contractility
↑PVR
Hyperkalemia
Anion Gap
= Na+ - (Cl¯ - HCO3¯)
Normal 8-12 mEq/L
When to calculate the anion gap?
Metabolic acidosis
Metabolic Acidosis
Normal AG Causes
HARDUP
Loss HCO3¯ or ECF dilution
NS hyperchloremia
Hypoaldosteronism
Acetazolamide
Renal tubular necrosis
Diarrhea
Uretosigmoid fistula
Pancreatic fistula
Metabolic Acidosis
Elevated AG Causes
MUDPILES
> 12 mEq/L
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Isoniazid
Lactate ↓DO2, sepsis, cyanide poisoning
Ethanol or ethylene glycol
Salicylates inhibit the Krebs cycle
Alkalosis
↓CBF ↓ICP
↓P50 (L shift)
↓coronary blood flow
↑dysrhythmias risk
↓PVR
Hypokalemia
↑ionized Ca2+
Metabolic Alkalosis
Causes
Loops diuretics
Vomiting
Antacids
Hyperaldosteronism
Oxyhemoglobin Curve
Left Shift
Alkalosis ↑pH ↓H+
Hypocarbia ↓CO2
↓2,3 DPG
Hypothermia
Fetal/Met/CO Hgb
Lungs
HaLdane
Oxyhemoglobin Curve
Right Shift
Acidosis ↓pH ↑H+
Hypocarbia ↑CO2
↑2,3 DPG
Hyperthermia
Tissues
Bohr O2 offloading
PAO2
Alveolar O2 partial pressure
= FiO2 x (760 - 47 mmHg) - [PaCO2 / RQ]
CO2 Production
200 mL/min
O2 Consumption
250 mL/min
OR
3.5 mL/kg/min
How does body temperature affect O2 consumption?
Direct correlation
↓core body temperature ↓O2 consumption
Every 1°C ↓5-7%
Acute Hypercarbia
↑CO2 10 mmHg > 40 ↓pH 0.08
Chronic Hypercarbia
↑CO2 10 mmHg > 40 ↓pH 0.03
Hypoxia Causes:
- Hypoxic mixture
- Hypoventilation
- Diffusion limitation
- V/Q mismatch
- Shunt
↓FiO2
Normal A-a gradient
+FiO2
Hypoxemic mixture
O2 pipeline failure
High altitude
Hypoventilation
Normal A-a gradient
+FiO2
Opioid overdose
Residual anesthetic agent or NMB
Neuromuscular disease
Obesity hypoventilation
V/Q Mismatch
Most common hypoxemia cause***
↑A-a gradient
+FiO2
COPD
OLV
Impaired HPV
Embolism - air, gas, amniotic fluid
Diffusion Impairment
↑A-a gradient
+ FiO2
Pulmonary fibrosis
Emphysema
Intestitial lung disease
Shunt
↑A-a gradient
FiO2 does NOT help
Atelectasis
Pneumonia
Bronchial intubation
Intercardiac shunt
Anatomic shunt
What inhibits HPV?
Volatiles MAC > 1.5
Hypoxia
Alkalosis ↑pH ↓H+ ↓CO2
Hypocarbia/hyperventilation
Vasodilators - PDEi or SNP
Vasoconstrictors
Excessive PEEP ↑VT
Hypervolemia LAP > 25
Hemodilution
Hypothermia
SpO2:PaO2
SpO2 80 : PaO2 50 mmHg
70 : 40
60 : 30
Soda Lime Reaction
CO2 + H2O → H2CO3 (carbonic acid)
H2CO3 + 2NaOH (sodium hydroxide) → Na2CO3 (sodium carbonate) + H2O + heat
Na2CO3 + Ca(OH)2 → CaCO3 (calcium carbonate) + 2NaOH
Soda Limb
Absorption Capacity
26L CO2 per 100g absorbent
How does soda lime neutralize CO2?
NaOH = weak base
CO2 = acid
KOH
Potassium hydroxide
Dessication → CO & compound A
Amsorb
Ca(OH)2
No CO
NO compound A
Expensive $$$
Low absorptive capacity
Only able to absorb 10.6L CO2 per 100g
Baralyme
Removed from the market
Sevo + baralyme → increased breathing circuit fire risk
Dead Space
Vd 2 mL/kg or 150 mL
1 Atmosphere
Patm
760 mmHg
760 Torr
1 bar
100 kPa
1,033 cmH2O