Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Spring 2020 - Physiology 1 > One Lung Ventilation & Malignant Hyperthermia - Quiz 9 > Flashcards

One Lung Ventilation & Malignant Hyperthermia - Quiz 9 Flashcards

1
Q

When is One Lung Ventilation usually indicated?

A

Thoracic Surgery

VATS

Approach via Chest

Unilateral Lung Isolation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of Tubes do you use for One Lung Ventilation?

A

Double Lumen ETT

ETT w/ Bronch Blocker

Univent ETT

Endobronchial Intubation

ETT w/ Positive Pressure to One Side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common positioning for Thoracic Surgery

A

Lateral Decubitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In lateral decubitus, which lung is the Dependent lung?

A

Lower Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In lateral decubitus, which lung is the Nondependent Lung?

A

Upper Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

For thoracic surgery, how is the surgical field access povided?

A

Iatrogenic Pneumothorax of Upper Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Fluid Management for Thoracic Surgery?

A

Restrict IVF d/t risk of lower lung edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If the patient is awake and in lateral position, which lung is better Perfused & Ventilated?

A

Dependent Lung - Lower Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

After induction, which lung does positive pressure ventilation and ventilation in general favor more?

A

Upper Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What increases the Compliance & Ventilation of the upper lung in lateral position?

A

Open Pneumothorax of Upper Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lung Zone 1

A

PA > Pa > PV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lung Zone 2

A

Pa > PA > PV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lung Zone 3

A

Pa > PV > PA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes a large Right-to-Left Intrapulmonary Shunt during thoracic procedures?

A

Upper lung is not ventilating, but still perfusing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does an Increased PA-a (Alveolar to arterial) O2 gradient lead to?

A

Hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What decreases blood flow to the nonventilated upper lung and improves the Right-to-Left Shunt?

A

Hypoxic Pulmonary Vasoconstriction (HPV)

&

Surgical Compression of Upper Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What factors Inhibit Hypoxic Pulmonary Vasoconstriction (HPV)?

A

Very Low/High PAP or Mixed Venous PO2 (PVO2)

Hypocapnia

Vasodilators

Inhlation Agents

Pulmonary Infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What factors decrease blood flow to lower lung and worsens Right-to-Left shunt?

A

More blood going to Upper Lung

Increased Airway Pressures

Hyperventilation

Low FiO2

Inadequate Expiratory Time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vasoconstrictors have a greater effect on _______ vessels compared to ________ vessels

A

Vasoconstrictors have a greater effect on normoxic vessels compared to hypoxic vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CO2 elimination is not affected by one lung ventilation except for when?

A

Changes in Minute Ventilation

&

Preexisiting CO2 Retention

21
Q

What should the Tidal Volumes be for One Lung Ventilation?

A

Same as Two Lung - 7-8cc/kg

22
Q

How long can Ventilation be stopped for?

A

As long as O2 supplied is more than consumed

250-300cc/min

23
Q

How fast does PCO2 increase during Apnea?

A

5 mmHg for first minute

then

3 mmHg for each minute after

24
Q

What happens after 10-20 minutes of Apneic Oxygenation?

A

Progressive Respiratory Acidosis

25
How should you intubate to ensure proper ETT placement for one lung ventilation?
Use Fiberoptic Scope
26
What do you do for Hypoxia during One Lung Ventilation?
* 80-100% FIO2 * Check TV & ETT Placement * Keep PaCO2 @ 40 mmHg * Add 5cm CPAP to Upper Lung & 5cm PEEP to Lower Lung Slowly * Clamp Upper PA * Return to 2 Lung
27
What is the Criteria for Operability for Pneumonectomy
PreOp: FEV1 \> 2L PostOp: FEV1 \> 800 mL Split Lung PFTs if Failed
28
What are the FEV1/FVC and Max Breathing Capacity in high risk patients?
\< 50% of Predicted
29
What is the RV/TLC for High Risk Patients?
\> 50% of Predicted
30
What is the Max VO2 for High Risk Patients?
\< 10 mL/kg/min
31
What is the DLco for High Risk Patients?
\< 40% of Predicted
32
What are the Characteristics of Double Lumen ETTs?
* Left & Right Types * Sizes: 35, 37, 39 (Women), 41 (Men) * Longer, Blue Bronch Lumen * Shorter Clear Tracheal Lumen * Curved Tip
33
What are the possible complications of placing a Double lumen ETT?
Laryngitis Hypoxemia d/t Bad Position Bronch Trauma d/t overinflated cuff Accidental Suturing
34
What is the most commonly used Double Lumen ETT?
Left Double Lumen ETT - easier to place
35
What triggers Malignant Hyperthermia?
Anesthetics Gases & Succinylcholine
36
What is the first and most sensitive sign of Malignant Hyperthermia?
Unexplained Tachycardia
37
What is the most specific sign of Malignant Hyperthermia?
Increasing EtCO2 @ 2-3X
38
What is the mortality rate of Malignant Hyperthermia?
10% 70% w/o Dantrolene \<5 % w/ Early Dantrolene
39
Once symptoms of Malignant Hyperthermia are controlled, what is the dosage to continue Dantrolene?
1 mg/kg IV q6h x 72 hrs
40
If a patient is on Dantrolene, what would cause life-threatening Hyperkalemia & Cardiac Depression?
Calcium Channel Blockers
41
How does Dantrolene work?
Directly on Ryanodine Receptor preventing Calcium Release from the SR.
42
What are late signs of Malignant Hyperthermia?
Organ Failure DIC / Coagulopathy Rhabdo Edema / Swelling Death
43
A patient's tendency for fever, heat stroke, strabismus, exercise myalgia, cramping, and history of muscle diseases may indicate what?
Risk for Malignant Hyperthermia
44
What is the Gold Standard PreOp test for MH?
Halothane-Caffeine Contracture Test
45
What is King-Denborough Syndrome?
Combination of musculoskeletal diseases and deformities that makes them a risk for Malignant Hyperthermia
46
If the patient has had prior uneventful general anesthetic, does this rule out MH?
No!
47
Which age group is Malignant Hyperthermia more common in?
Children
48
When do symptoms of MH occur?
Usually within 1 Hour, but can be also be hours after exposure

Spring 2020 - Physiology 1 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions