Pulmonary

Question 1

Normal pH levels

Answer 1

A: 7.35-7.45
V: 7.32-7.42

Question 2

Normal PaO2

Answer 2

A: 80-100
V: 28-48

Question 3

Normal PaCO2

Answer 3

A: 35-45
V: 38-52

Question 4

Normal HCO3

Answer 4

A: 22-26
V: 19-25

Question 5

Normal SaO2

Answer 5

A: 90-100
V: 50-70

Question 6

Acidosis

Answer 6

Low pH
High CO2
Low Bicarb

Question 7

Alkalosis

Answer 7

High pH
Low CO2
High Bicarb

Question 8

Respiratory Alkalosis

Answer 8

-Hyperventilating, blowing off CO2
-caused by pain, ARDS, Excessive ventilator rate

Question 9

Respiratory Alkalosis

Answer 9

• Hypoventilating, retaining CO2
  -late respiratory failure
  -caused by oversedation, COPD, severe obesity

Question 10

Metabolic Acidosis

Answer 10

Caused by:
-DKA
-AKI
-Sepsis
-Lactic acidosis
-Low electrolytes

Calculate anion gap: 11-12

Question 11

Metabolic Alkalosis

Answer 11

Caused by:
-loss of acid
-vomiting/emesis
-NG suctioning
-loss of stomach acid

Question 12

Measuring ventilation/perfusion CO2 levels

Answer 12

-Ventilation: End tidal of 35-45
-Perfusion: PaCO2: 35-45

Question 13

When is capnography used?

Answer 13

-Ventilation (during sedation or continuous)
-Perfusion (during CPR to measure quality of CPR, low CO = low etCO2)
-Head injuries
-PCA/sedation agents

Question 14

Hypoventilation

Answer 14

Increased end tidal CO2

Too low of RR or tidal volume

Question 15

Hyperventilation

Answer 15

Decreased end tidal CO2

Too high of RR or tidal volume

Question 16

V/Q Ratio

Answer 16

-Ventilation/Perfusion
-PaCO2 - etCO2
-Should be less than 5

Question 17

V/Q Mismatch

Answer 17

-Low etCO2 but high PaCO2
-Causes: pulmonary embolism, pneumonia, ARDS, high PEEP, ETT in main stem, mucus plug, low CO

Question 18

Oxygen causes pulmonary _____ and vasco____

Answer 18

dilation, vasoconstriction

Question 19

Adventitious Breath Sounds

Answer 19

• Crackles: fluid
  -Wheezes: narrowed airways
  -Rhonchi: secretions in large airways, PNA
  -Stridor: harsh sounds, obstructed larynx or trachea, give nebulized epi

Question 20

Signs of Acute Respiratory Failure

Answer 20

-Acute: increased WOB, use of accessory muscles, increased RR, respiratory alkalosis
-Late: Hypercapnia/high PaCO2, respiratory acidosis

Question 21

3 main reasons for hypoxemia

Answer 21

-Hypoventilation: OSA, low Mg
-V/Q mismatch: PE, PNA, ARDS
-Poor perfusion: decreased CO, severe anemia

Question 22

Causes of asthma

Answer 22

-Bronchial constriction
-Airway hyperreactivity
-Inflammation

Question 23

Treatment for asthma

Answer 23

• Beta agonist: bronchodilators
  -Corticosteroids
  -Hydration is key!
  -Treat hypercapnia with mechanical ventilation or BiPAP
  -Give mg to produce bronchodilation
  -consider heliox
  -No O2
  -No CXR unless suspected PNA
  -No ABG
  -No abx

Question 24

Bronchodilators

Onset:
Duration:
Side effects

Answer 24

Onset: <5min
Duration: 2-5hrs
Side effects: tachycardia, tremors, hyperglycemia, low K,Mg, Phos

Question 25

Corticosteroid use for asthma

Answer 25

-reduces airway inflammation
-prevents relapse
-give for less than 7 days
-give IV or PO

Question 26

Status Asthmaticus

Answer 26

-Medical emergency
-exposure to allergy or trigger
-continuous bronchospasm and restriction
-Results in hypoxia, hypercapnia, respiratory failure

Question 27

Phases of Status Asthmaticus

Answer 27

Early bronchospasm
-inflammation
-bronchospasm
-increased capillary permeability
-increased mucus secretion

Late inflammatory
-mucus plugging
-increased airway resistance
-airway obstruction
-lung hyperinflation
-V/Q mismatch
-increased RR

Question 28

Rescue Treatment for Status Asthmaticus

Answer 28

Try CPAP or BiPAP
-Continuous PEEP
-CPAP: PEEP only
-BiPAP: PIP and PEEP

Intubate for:
-cardiac arrest
-decreased LOC
-respiratory fatigue/gasping