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Respiratory Physiology > one lung vent, MH > Flashcards

one lung vent, MH Flashcards

1
Q

one lung ventilation is indicated for

A

thoracic surgery, VATS, trauma to chest, any approach passing through the chest (mediastinm, esophagus), or need to isolate a single lung (bleeding, infection, bronchopleural fistula)

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2
Q

one lung vent is most often accompanied by

A

pneumo

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3
Q

most used position for thoracic surgery

A

lateral ducubitus

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4
Q

dependent lung =

A

lower lung

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5
Q

non-dependent lung =

A

upper lung

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6
Q

axillary roll is placed on

A

upper chest wall (not in the axilla)

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7
Q

in the awake and lateral position the ____ lung is better perfused and ventilated

A

dependent

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8
Q

with induction of anesthesia, with a decrease in FRC, the ____ lung ventilates more

A

upper

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9
Q

why does positive pressure vent favor upper lung

A

it is more compliant

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10
Q

muscle paralysis favors vent of the ___ lung. why?

A

upper. due to abd contents pushing up more on the dependent hemidiaphragm

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11
Q

rigid bean bag hinders movement of dependent hemidiaphragm and favors ventilation of ___ lung

A

upper

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12
Q

open pneumothorax of upper lung increases ___, favoring vent of ____

A

compliance, upper lung

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13
Q

the lower lung is ___ compliant in lateral decubitus

A

less

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14
Q

zone 1 upright

A

A > a > v

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15
Q

zone 2 upright

A

a > A > v

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16
Q

zone 3 upright

A

a > v > A

** best V/Q match

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17
Q

open pneumo causes a ____ shunt

A

large R to L intrapulmonary shunt (20-30%)

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18
Q

blood flow to the non ventilated = nondependent = upper lung is ___ by hypoxic pulm vasoconstriction

A

decreased

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19
Q

HPV ___ the r to l shunt

A

improves

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20
Q

surgical compression of the upper lung can __ blood flow, ____ the shunt

A

decrease, improves

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21
Q

3 main factors that inhibit HPV

6 total

A

hypocapnia, vasodilators, inhalation agents

very high or very low PA pressures
high or evry low mixed venous PO2
Pulmonary infections

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22
Q

4 factors that decrease blood flow to dependent lung

A

high mean airway pressures in ventilated lung from PEEP, hyperventilation or increased PIP
low FIO2
vasoconstrictors
intrinsic peep from short expiratory time

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23
Q

CO2 elimination is usually not affected by one lung ventilation provided: (2 points)

A

minute ventilation is unchanged and preexisting CO2 retention was not present pre-op (COPD)

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24
Q

tidal volumes are kept roughly the same as two lung vent, around ___

A

10cc/kg. (may adjust due to changes in PIP, RR, altered to maintain normocapnia

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25
Q

ventilation can be stopped for short periods as long as

A

O2 is supplied more than consumption (250-300ml/min)

26
Q

**during apnea PCO2 increases ___ mm for the first minute and then __ mm for each additional minute

A

5, 3

27
Q

progressive resp acidosis limits apnea oxygenation technique for ___ min

A

10-20

28
Q

hypoxia during 1 lung vent - want FIO2 of

A

.8-1

29
Q

hypoxia during 1 lung vent - tidal volume

A

want 10cc/kg

30
Q

hypoxia during 1 lung vent-adjust RR to keep PaCO2 at

A

40

31
Q

hypoxia during 1 lung vent - add ___ CPAP to ___ lung

A

5, nondependent

32
Q

which double lumen tube is most commonly used

A

left

33
Q

complications of double lumen tubes

A

traumatic laryngitis, hypoxemia due to malpositioned tube, bronchial trauma from over inflation of cuff, inadvertent suturing of tube

34
Q

what is MH triggered by

A

inhaled agents (not N20) and succs

35
Q

which receptor is MH

A

ryanodine

36
Q

first & most sensitive sign of MH

A

unexplained tachycardia

37
Q

most specific sign

A

increasing ETCO2, hypercapnia, 2-3x

38
Q

other signs of MH

A

decreased sat, muscle rigidity, dysrhythmias, tachypnea, cyanosis, sweating, unstable BP, mottling, trismus after succs, darkening of blood in surgical field, decreased mixed venous sat, cola colored urine, heating and exhaustion CO2 absorber, hyperthermia

39
Q

labs of MH

A

increased K, ca, phos, CK. myogloinuria, hypoxemia

40
Q

MH acid/base

A

initial metabolic acidosis then a combined metabolic and resp acidosis

41
Q

genetic link of MH

A

familial autosomal dominant transmission with variable penetrance, on chromosome 19

42
Q

treatment of MH o2

A

100% at high flows

43
Q

drug/ dosing MH

A

dantrolene 2.5mg/kg asap then q5min until symptoms controlled or up to 10mg/kg total. must be mixed in sterile water.

44
Q

what do you give for acid/base imbalance in MH

A

1-2meq/kg then check ABG

45
Q

cooling measures for MH

A

iced IV NS 15cc/kg every 10min x3. cold body cavity lavage, cooling blanket, ice bags

46
Q

treat hyperkalemia with

A

bicarb or dextrose 25-50g and regular insulin 10-20 units IV

47
Q

treat persistent ventricular arrhythmias with

A

procainaminde 200mg IV

48
Q

want urine output to be

A

> 2cc/kg/hr

49
Q

lasix dose

A

.5-1mg/kb

50
Q

mannitol dose

A

1g/kg

51
Q

how long should you continue dantrolene

A

1mg/kg for 6-72h to prevent a recurrence

52
Q

what drug should you not give with dantrolene

A

calcium channel blockers d/t life threatening hyperkalemia and myocardial depression

53
Q

how does dantrolene work

A

inhibits ca release from the sarcoplasmic reticulum

54
Q

how does dantrolene work intracellular

A

dissociation of excitation-contraction coupling

55
Q

late complications of MH

A

renal failure, coagulopathies, pulm edema, cerebral edema, hepatic failure, left heart failure, DIC, skeletal muscle swelling,rhabdo,death

56
Q

use ketamine and pancuronium with caution because

A

the tachycardia may mask early MH

57
Q

is propofol benzos barbs narcs LA’s n2o, etomidate, ketamine, non-depolarizing agents safe during MH?

A

yes

58
Q

*gold standard pre-op test ofMH

A

muscle biopsy with halothane-caffeine contracture test -78% specific and 97% sensitive

59
Q

what syndrome is prom to MH

A

king-denborough syndrome

60
Q

does a prior uneventful anesthetic rule out MH

A

no

61
Q

Boys < 9 yrs old who experience sudden cardiac arrest after
succinylcholine in the absence of hypoxia should be treated
for

A

acute hyperkalemia

62
Q

symptoms of MH usually occur after how long from exposure

A

one hour

Respiratory Physiology (11 decks)

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