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High Acuity > Oxygenation and Ventilation > Flashcards

Oxygenation and Ventilation Flashcards

1
Q

Gas Exchange

A

oxygen transport to the cells and carbon dioxide transport away from cells through ventilation and diffusion

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2
Q

Ventilation

A

movement of atmospheric air higher in oxygen into the lungs and the removal of the carbon dioxide produced by metabolism.

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3
Q

Diffusion

A

the movement of gases down their concentration gradients across the alveolar and capillary membranes

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4
Q

Perfusion

A

the arterial blood flow through the tissues

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5
Q

PO2 and PCO2 of venous blood

A

PO2 = 40
PCO2 = 46

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6
Q

PO2 and PCO2 at alveoli

A

PO2 = 100
PCO2 = 40

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7
Q

PO2 and PCO2 at end capillary

A

PO2 = 100
PCO2 = 40

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8
Q

4 Steps of Cardiopulmonary Circulation

A
  1. Pulmonary Gas Exchange: ventilation, diffusion, perfusion
  2. Oxygen Delivery: effected by cardiac output, HgB levels, SaO2, PaO2
  3. Oxygen extraction at the tissue level
  4. Oxygen consumption by the mitochondria
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9
Q

What 4 factors effect oxygen delivery?

A
  1. cardiac output
  2. hemoglobin levels
  3. SaO2
  4. PaO2
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10
Q

Respiration

A

Sequence of events that results in exchange of O2 and CO2 between atmosphere and body cells

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11
Q

Ventilation is what we think of as _______ and stimulated by ________

A

breathing

nerves

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12
Q

External respiration

A

Gas exchange between lungs and blood

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13
Q

Internal respiration

A

Exchange of gasses between blood and tissue cells

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14
Q

Cellular respiration

A

Cells using oxygen for activities - metabolism

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15
Q

Ventilation

A

Flow of air in and out of the alveoli
* Inspiration & expiration

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16
Q

Ventilation requires intact:

A
  1. CNS (brain and spinal cord) neurons,
  2. diaphragm,
    3, skeletal muscle (i.e. intercostal muscles),
  3. chest thorax
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17
Q

In ventilation, air flows from _______ to _______ pressure

A

Air flows from higher to lower pressure

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18
Q

Capnography

A

Non-invasive measurement of CO2 concentration in expired gasses
* Amount of CO2 exhaled
* Continuous bedside monitoring

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19
Q

Diffusion

A

Movement of gasses (O2 & CO2) across a permeable membrane from an area of higher pressure to an area of lower pressure

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20
Q

What 2 places does diffusion occur?

A
  1. Alveoli: pulmonary circulation (alveolar capillary membrane)
  2. Capillary: tissue/cells
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21
Q

Diffusion is dependent on what 3 things?

A
  • Differences in pressures
  • Surface area
  • Thickness of wall
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22
Q

Normal Female Hemoglobin

A

120-150 mg/dL

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23
Q

Normal Male Hemoglobin

A

135-170 mg/dL

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24
Q

Hemoglobin

A

major component of RBCs - A major carrier of oxygen in blood and an important factor in tissue oxygenation– has affinity (attraction) for oxygen

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25
Q

What is Sa02

A

Percentage of oxygen-saturated hemoglobin in arterial blood

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26
Q

How is Sa02 measured?

A

ABG

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27
Q

Normal SaO2

A

> 95%

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28
Q

What is Sp02?

A

Percentage of oxygen-saturated hemoglobin in the capillary bed

29
Q

How is Sp02 measured?

A

with pulse oximeter

30
Q

What is PaO2?

A

Partial pressure of oxygen dissolved in arterial blood
* Amount of oxygen dissolved in plasma

31
Q

Normal PaO2

A

80-100mmHg

32
Q

How is PaO2 measured?

A

ABG

33
Q

Hypoxemia

A

low blood PaO2 level (<50mmHg)

34
Q

Hypoxia

A

inadequate cellular O2 = anaerobic metabolism

35
Q

What is tissue oxygen delivery through dissociation from hemoglobin based on?

A

Tissues need for oxygen

36
Q

The rate of oxygen unloading changes depending on:

A

How much oxygen is already in the tissues

37
Q

Describe the top portion of the oxygen dissociation curve

A

This portion is representative of oxygen leaving the alveoli and saturating the hemoglobin (high SaO2)

Because the hemoglobin is saturated in oxygen, the PaO2 is also high

When blood perfuses tissues in which oxygen levels are high, hemoglobin remains tightly binded/no unloading

38
Q

Describe the bottom portion of the oxygen dissociation curve

A

At the tissue level, there is low amounts of oxygen so hemoglobin more readily desaturates itself to transfer the oxygen to the tissue

Hemoglobin is releasing oxygen to the tissue

Low saturation (SaO2) and thus low amounts of oxygen in arterial blood (PaO2)

39
Q

What is P50

A

The partial pressure of oxygen at which hemoglobin is 50% saturated. Normally, when Hgb is 50% saturated with oxygen, the PaO2 will be 27mmHg

40
Q

What occurs at the tissue level when the oxygen saturation curve shifts to the left?

A

Tissues need less oxygen due to a lower metabolic demand

Hemoglobin affinity increases

Oxygen being given to the tissues less easily

41
Q

What is the haldane effect?

A

A shift of the oxygen dissociation curve to the left due to lower metabolic demand, increasing hemoglobins affinity and saturation

42
Q

What occurs at the tissue level when the oxygen dissociation curve shifts to the right?

A

When the need for oxygen is greater in the tissues, hemoglobin will dissociate faster

Hemoglobin affinity decreases

Oxygen being given to tissues more easily

43
Q

What 6 Physiologic Factors cause a left shift of the hemoglobin dissociation curve?

A

Left think LESS metabolic demand

  • decrease altitude
  • increase pH/alkalosis
  • decrease pCO2
  • decrease temperature
  • decrease 2-3 DPG
44
Q

What 5 Physiologic Factors cause a right shift of the hemoglobin dissociation curve?

A

Right think READILY released

  • increase altitude
  • decrease pH/acidosis
  • increase pCO2
  • increase temperature
  • increase 2-3 DPG
45
Q

Perfusion

A

Movement/flow of blood through the circulatory system that results in oxygenation of tissues

Arterial Blood Flow

46
Q

What is perfusion dependent on?

A

Outside of other components (ventilation and diffusion)

  1. Pump
  2. Pipes
  3. Plasma
47
Q

Describe how damage to the heart effects perfusion

A

Decreases ability of heart to properly function as a pump, therefore is cannot move enough blood through the body to support perfusion

48
Q

Describe how damage to the vessels effects perfusion

A

If all the blood vessels dilate rapidly, the normal amount of blood volume is not enough to fill the system and provide adequate perfusion to the body

49
Q

Describe how damage to the blood/plasma effects perfusion

A

If there is enough blood/plasma last, the volume of fluid in the vessels is not enough to support the perfusion needs of the body

50
Q

What can inhibit perfusion?

A

VQ mismatch

Ventilation must match perfusion

51
Q

What 2 things cause a VQ mismatch?

A
  1. When part of the lung receives oxygen (without blood flow)
  2. When part of the lung receives blood flow (without oxygen)
52
Q

5 VQ Relationships at Alveoli

A
  1. absolute shunt: no ventilation die to fluid filling alveoli
  2. mismatch: ventilation partially compromised by secretions in airway
  3. normal lung unit
  4. mismatch: perfusion partially compromised by emboli obstructing blood flow
  5. dead space: no perfusion due to obstruction of pulmonary capillary
53
Q

Oxygenation occurs as a result of what 3 processes?

A
  1. oxygen intake (ventilation)
  2. oxygen delivery (diffusion and perfusion)
54
Q

What is FiO2 and normal value?

A

Fraction of oxygen in the air that is delivered to the patient

Room Air - 21%

55
Q

How do nasal prongs effect FiO2?

A

Each additional liter of flow adds about 3% FiO2 to the inspired air (up to 6L)

56
Q

How does a simple mask effect FiO2?

A

40-60% FiO2 @ 5-8L/min

57
Q

How does a non-rebreather mask effect FiO2?

A

80-95% FiO2 @ 10-15L

58
Q

How does an ETT w/BVM effect FiO2?

A

21-100% FiO2

59
Q

Why do we care about oxygenation?

A

Oxygen is consumed to produce energy (aerobic metabolism)!

Oxygen is used for cellular processes; converting nutrients into ATP

60
Q

What occurs during aerobic metabolism?

A

Energy using oxygen

Carbohydrates, fats, proteins broken down into substrates

61
Q

What is the product of aerobic metabolism

A

= 36 ATP molecules, CO2, H20

62
Q

What occurs during anaerobic metabolism?

A

Energy not using oxygen

Carbohydrates only into substrates

63
Q

What is the product of anaerobic metabolism?

A

= 2 ATP, lactate

Small amounts of energy

64
Q

What is lactate/lactic acid?

A

Acid metabolites (i.e. lactic acid) result from cellular breakdown and anaerobic metabolism

65
Q

What is the normal lactate/lactic acid range?

A

0.3-2mmol/L

66
Q

What drives serum lactate up rapidly>

A

Cellular hypoxia

67
Q

Rapid rise in serum lactate usually precedes:

and can be an indicator of:

A

decompensatory signs

impending shock

68
Q

What 7 conditions increase oxygen consumption?

A
  • Hyperventilation
  • Hyperthermia
  • Trauma
  • Sepsis
  • Stress/anxiety
  • Hyperthyroid
  • Increased muscle activity
69
Q

What 6 conditions decrease oxygen consumption?

A
  • Hypoventilation
  • Hypothermia
  • Sedation
  • Anesthesia/neuromuscular blocking agents
  • Decreased activity
  • Hypothyroid

High Acuity (20 decks)

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