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A1 > PFT > Flashcards

PFT Flashcards

1
Q

What pts are at risk for PPC?

A

Hx of significant pulmonary disease
Obesity
Aortic, thoracic, abdominal surgery
Long term smokers
Elderly (>70)

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2
Q

High risk PFT results: FEV1, FEV1/FVC, VC

A

<2L
<.5
< 40-50% predicted (15cc/kg in adults, 10cc/kg in children)

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3
Q

What % improvement in PFT is good?

A

15

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4
Q

How to treat bronchospasm and infections preoperatively

A

Bronchodilators
ABX, culture and senstivity

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5
Q

IE ratio for COPD pt

A

BIGGER
1:2 to 1:3!

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6
Q

What level to keep etco2 in co2 retainers? What if you dont?

A

Baseline, if not, you will cause metabolic alkalosis

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7
Q

What drugs to avoid in bronchospasm?

A

Histamine releasing drugs
STP (penthotal, barbituate for induction),
ABX,
neostigmine,
morphine/meperdine,
atracurium/succ/mivacurium,
Possibly aspirin, and if so then ketoralac

Only use albuterol, ketamine

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8
Q

If FEV1 is less than ___% of predicted, extubation will not be effected

A

50

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9
Q

If FEV1 is __% - __% of predicted, with some hypoxemia and hypercarbia, prolonged extubation is probably

A

25-50

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10
Q

If FEV1 is less than 25% what procedures should be done?

A

only life saving procedures
use regional if possible
Risk: inability to wean ventilator, trachestomy

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11
Q

Extubation criteria; RR, PaO2, PaCO2, MIF, VC

A

<30
>70 (on fio2 .4)
<55
less than -20cmH2o
>15cc/kg

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12
Q

Intubation criteria for acute respiratory failure; rr, vc, MIF, pao2, paco2, vd/vt, aa gradient, and clinical diagnosis’

A

> 35
<15cc/kg or 10cc/kg
-20cm h20
<70 on fio2 .4
55 (unless chronic)
.6
350mmHg on fio2 1.0
burns, AMS, rapid deterioration, fatigue

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13
Q

ABCs if CXR

A

airway
bone
cardiac
diaphragm
equal fields of lungs
gastric
hilum
invasive lines

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14
Q

How soon does an ABG need to be measured? What will happen if not?

A

15 minutes, glycolysis with lactic acid production, decreased ph, increased pco2

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15
Q

How long can i store abg on ice?

A

2h

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16
Q

What will heparin do to abg

A

lower PCO2 by dilution, especially in children with small samples

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17
Q

ABG normal values, ph, pco2, po2, hco2, base excess

A

7.35-7.45
35-45
70-105
22-27
-3 - 3

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18
Q

How does PCO2 effect ph

A

pco2 increase by 10, ph drop by .08
vice verse

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19
Q

Alveolar gas equation/ AA gradient equation

A

PAO2=(Pb-Ph2o)x(fio2)-(paco2/rq)
PaO2= from abg

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20
Q

What increases AA gradient?

A

GA
PTX
PE
shunt
VQ MM

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21
Q

When is AA gradient normal? in disease processes

A

hypoventilation, low fio2

22
Q

How to treat high Aa?

A

fio2
PEEP

23
Q

How does bicarb effect ph?

A

Increase in bicarb by 10mmoles increases ph by .15 (stronger than pco2)

24
Q

When (how soon) does renal compensation occur after respiratory acidosis

A

1-2 days after

24
Q

What causes respiratory acidosis?

A

CNS depression from trauma or drugs
Obesity PF
COPD asthma

25
Q

Causes of respiratory alkalosis

A

hypoxic respiration
encephalitis
anxiety
pregnancy
mech ventilation

26
Q

Metabolic acidosis causes

A

Lactic acidosis
DKA
ASA
high protein intake
Bicarb loss from diarrhea

26
Q

Metabolic alkalosis causes

A

bicarb infusion
excessive vomiting
NGT suctioning

27
Q

FRC in ml

A

2300

28
Q

IC in ml

A

3500

29
Q

vc in ml

A

4600

30
Q

TLC in ml

A

5800

31
Q

what % of TLC is FRC?

A

40%

32
Q

FEV1 normal range

A

4L or 75% (if fev1 frc ratio)

33
Q

What is the most important tool in assessing the severity of obstructive airway disease?

A

FEV1 will decrease to below 20% with acute asthma

34
Q

Most sensitive marker of small airway disease?

A

FEF 25 75

35
Q

Degree of risk in OLD, FEV1FRC

A

Normal- >75
Mild- 60-75
moderate- 45-60
severe- 35-40
extreme- <35

36
Q

What is the use of flow volume loops?

A

Helps distinguish extrathoric/ intrathoracic diseases
ALSO
Helps distinguis from OLD vs RLD

37
Q

FV loop normal

A

Semi circle on bottom (inspiration right to left)
Line up and angled right, and start line back to starting point (expiration)

38
Q

What PFT has been shown to predict increased mortality in pts undergiong thoracic surgery?

A

MMV/ MBC
Maximum voluntary ventilation

39
Q

What % fef 25 75 is considered confirmation of airway obstruction?

A

60
WITH
FEV1 FVC low or normal

40
Q

FV loops intrat vs extra thoracic

A

Extra thoracic- top heavy
Intrathoracic- bottom heavy
(extra- you can see, it, intra, underground, cant see)

41
Q

FV loops L or R shift

A

L shift- OLD
R shift- RLD

42
Q

PFTs that indicate airway obstructions

A

FEF 25 75- less then 60% predicted
AND
FEV1:FVC- low (or normal)

43
Q

What PFT, when decreased, has a high correlation with mortality and morbidity?

A

MMV max minute ventilation
MBC mac breathing capacity

44
Q

Patho of extra vs intrathoracic disease? what do each mean?

A

Extra- obstruction
Intra- lung disease

45
Q

Most important PFT for assessment of severity of OLD?

A

FEV1

46
Q

How to differentiate OLD from RLD (PFT)

A

FEV1 FVC ratio

47
Q

What conditions (bad) dont stimulate HPV?

A

Anemia/ CO poison
PaO2 stays normal

48
Q

Extrathoracic vs intrathoracic obstruction effect on inspiratory vs expiratory flow

A

Extra- inspra
Intra-extra
Extra blocks inspiration
Intra block expiration

49
Q

Fixed FV loop shape and cause

A

Its a small rectangle around the line
Tracheal stenosis

A1 (125 decks)

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