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Basics in Anesthesia > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Air confined to conducting airways. Mouth & nose –> terminal bronchioles

A

Anatomic dead space

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2
Q

Alveoli that are ventilated but not perfused

A

alveolar dead space

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3
Q

Anatomic + Alveolar dead space

A

Physiologic dead space

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4
Q

Calculate physiologic dead space by comparing ratio of CO2 in arterial blood and exhaled gas

A

(Bohr equation)

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5
Q

Bohr equation

A

Vd/Vt = (PaCo2 - PeCo2) / PaCO2

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6
Q

alveoli that are ventilated but not perfused

A

alveolar dead space

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7
Q

What is lung compliance?

A

change in volume / change in pressure

how easy it is to stretch something.

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8
Q

Change in lung volume per unit of pressure change within lung when air is not moving

A

static compliance

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9
Q

Change in lung volume per unit of pressure change within lung during air movement

A

Dynamic Compliance

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10
Q

disease that causes increase in pulmonary complicance (Greater change in volume for a given pressure)

A

emphysema

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11
Q

Disease that cause Decrease in pulmonary compliance (hard to inflate)

A

Fibrosis
Obesity
Vascular engorgement
Edema
ARDS
External compression

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12
Q

increase in airway resistance (Factors that oppose inflation to lungs)

A

Static elastic recoil of lungs
Frictional resistance of lung tissues
Resistance to airflow

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13
Q

volume of air remaining in the lungs after max expiration?

A

Residual volume

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14
Q

max volume of air expired from the resting end expiratory volume

A

expiratory reserve volume

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15
Q

max volume of air inspired from the resting end-inspirated level

A

Inspiratory reserve volume

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16
Q

max volume of air inspired from end expiratory level

A

Inspiratory capacity

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17
Q

max volume of air expired from the max inspiratory level

A

vital capacity

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18
Q

volume of air remaining in lung after expiration

A

Functional residual capacity

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19
Q

volume above residual volume where small airway close

A

closing volume

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20
Q

absolute volume of gas in lung when small airways close.

A

closing capacity

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21
Q

positions that increase dead space

A

Sitting position
neck extension

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22
Q

increase volume of conducting zone
reduce pulmonary blood flow effect on dead space

A

increase dead space

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23
Q

anything that reduces volume of the conducting zone or increases pulmonary blood flow. effect on dead space

A

decreases dead space

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24
Q

if dead space increases, what changes to compensate?

A

TV, RR, minute ventilation to maintain constant PaCO2

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25
Q

positions that decrease dead space

A

Neck flexion
trendelenburg
supine

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26
Q

Blood gas values that cause pulmonary vasoconstriction to shunt blood to areas with more O2

A

Low PO2 & High CO2 (acidosis)

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27
Q

What causes Pulmonary vasodilation to pick up more O2

A

High PO2
Low CO2

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28
Q

Physiologic shunt

A

ARDS, pneumonia

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29
Q

Anatomic shunt

A

cardiac anatomy: TOF, CAVC, HLHS
Oxygen will not reverse this shunt.

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30
Q

what is the difference between PAO2 and PaO2 called?

A

A-a Gradient

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31
Q

3 Reasons A-a gradient isn’t zero

A

Thebesian veins
bronchiolar veins
pleural veins

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32
Q

High A-a gradient

A

Shunt
V/Q mismatch
Diffusion defect

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33
Q

typical liters of ventilation per min

A

4L/min

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34
Q

typical liters of perfusion per min

A

5L/min

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35
Q

Typical V/Q ratio

A

0.8

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36
Q
A
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37
Q

simple definition of shunt

A

perfused but not ventilated

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38
Q

simple definition of dead space

A

ventilated but not perfused

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39
Q

PA>Pa>Pv

A

Zone 1
apex
dead space
lowest blood flow
V > Q

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40
Q

Pa>PA>Pv

A

Zone 2
Middle lobe
waterfall
medium blood flow

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41
Q

Pa > Pv > PA

A

Zone 3
Highest blood flow
V < Q
shunt
Base of lung

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42
Q

conducting zone

A

no gas exchange

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43
Q

Respiratory Zone

A

Gas exchange with the blood
Pulmonary circulation, not bronchial circulation

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44
Q

Type I pneumocytes

A

structural cells

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45
Q

Type 2 pneumocytes

A

produce surfactant

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46
Q

Type 3 pneumocytes

A

macrophages

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47
Q

Many things that Increase Dead Space

A

Facemask
heat & moisture exchanger
PPV
Anticholinergics
old age
Neck extension
decreased cardiac output
COPD

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48
Q

Decreased Dead Space

A

ETT
LMA,
Tracheostomy
neck flexion

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49
Q

conducting zone

A

upper airway to terminal bronchioles

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50
Q

Inspiration spontaneous breathing pressure and volume:

A

pressure decreases
volume increases

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51
Q

Anatomy of spontaneous breathing

A

External intercostals & diaphragm contract
Parietal & visceral pleura get pulled outward

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52
Q

Expiration spontaneous breathing pressure and volume

A

1 volume decreases
2 intra pleural and intraalveolar pressure increases

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53
Q

What values cause pulmonary vasoconstriction

A

Low oxygen
high carbon dioxide
acidosis

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54
Q

pulmonary vasodilation

A

High oxygen
low carbon dioxide

55
Q

where does gas exchange occur?

A

across the flat epithelium of type 1 pneumocytes by diffusion

56
Q

High O2 concentration in lungs

A

Higher affinity for hemoglobin binding
Loading of O2

57
Q

PaO2 when hemoglobin is 50% saturated with oxygen

A

P50

Normal P50 = about 27 mmHg

58
Q

Low O2 concentration in tissues

A

Low affinity for hgb binding
Unloading of O2

59
Q

Oxyhem DIssociation Curcve Right Shift

A

release O2
MORE O2 TO THE TISSUES
LOWER P50

60
Q

Causes of Right shift
Oxyhemoglobin curve

A

hypercapnia
hyperthermia
acidosis
Increased 2,3 DPG

61
Q

Oxyhem DIssociation Curcve Left Shift

A

Love to hold O2
LESS O2 TO THE TISSUES
HIGHER P50

62
Q

Causes of Left shift 02 dissociation curve

A

Hypocapnia
hypothermia
Alkalosis
Decrease 2,3 DPG
Hemoglobinopathies
Hgb F

63
Q

The CO2 dissociation curve is much __________ and _____________
than is that for O2 dissociation curve

A

steeper and linear

64
Q

Describes the relationship between PCo2 and total CO2 concentration in the blood

A

CO2 Dissociation Curve

65
Q

CO2 curve right shift

A

releases co2

66
Q

CO2 curve Left Shift

A

picking up CO2

67
Q

Hypoxic

A
68
Q

Where is central control located?

A

Brainstem (medulla/pons)
Cortex
Limbic System
Hypothalamus

69
Q

Center of inspiration
Pacemaker of normal rhythmic breathing

A

Dorsal Respiratory Group

70
Q

Holds most neurons in nucleus of the tractus solitarius (NTS)

A

dorsal portion of the medulla

71
Q

Sensory termination of glossopharyngeal &
vagus nerve

A

NTS

72
Q

transmits information to NTS

A
  1. Peripheral chemoreceptors
  2. Baroreceptors
  3. Receptors in liver, pancreas, GI tract
  4. Receptors in lungs
73
Q

Contains neurons controlling chiefly expiration & activated
during forceful breathing

A

Ventral Respiratory Group

74
Q

Pneumotaxic Center location

A

Pons

75
Q

Apneustic Center Location

A

pons

76
Q

Inhibitits apneustic center for inspiration
Fine tunes respiratory pattern
Controls respiratory rate and depth of breathing

A

Pneumotaxic Center inhibits the dorsal group

77
Q

Stimulates inspiratory center (dorsal group)

A

apneustic center

78
Q

center inhibited by J receptors

A

Apneustic center

apneustic doesn’t love to jam

79
Q

where are central chemoreceptors located

A

The ventral respiratory center in the medulla

80
Q

central chemoreceptors respond to

A

changes in pH in CSF, which in turn are caused by diffusion of CO2 from brain capillaries

81
Q

peripheral chemoreceptors respond to

A

reduced PO2 and increases in PCO2 and H+ concentration

82
Q

where are peripheral chemoceptors located

A

carotid bodies
Transverse aortic arch

83
Q

what do the carotid bodies respoond to

A

mainly PaO2, but also CO2 & pH (H+)

84
Q

what does the peropheral chemoreceptors detect?

A

mainly O2, but also CO2, pH (H+) changes

85
Q

what does central chemoreceptors detect?

A

High H+
High CO2

86
Q

peripheral chemoreceptor whos Afferent nerve –> vagus nerve –> dorsal medullary respiratory area

A

Aortic bodies

87
Q

Afferent nerve fibers pass through Hering’s nerves –> glossopharyngeal nerve
–> dorsal respiratory area of the medulla

A

Carotid bodies

88
Q

Reflex where Sensory nerves within the lungs discharge in response to lung distension (stretch)

A

Hering-Breuer Reflex

89
Q

increase in expiratory time & slows respiratory rate, switches off inspiratory ramp

stops overinflation

A

Hering-Breuer inflation reflex

90
Q

increased ventilation when lungs deflated abnormally, such as in pneumothorax, or it may have a role in the periodic spontaneous deep breaths (sighs) that help to prevent atelectasis

prevents atelectesis by stimulating a deep breath

A

Hering-Breuer deflation reflex

91
Q

location of J receptors

A

alveolar walls close to capillaries

92
Q

what do J receptors look like

A

Endings of unmyelinated C fibers

93
Q

What causes Stimulation of J receptors

A

rapid, shallow breathing or complete apnea

94
Q

Associated with: pulmonary edema, pulmonary embolism, CHF, interstitial lung disease

“Jam” Traffic

A

J receptors

95
Q

where do irritant receptor impulses go

A

Impulses travel up the vagus in myelinated
fibers

96
Q

Reflex of irritant receptor

A

bronchoconstriction hyperpnea

97
Q

hypoxic ventilatory response

A

PaO2 less than 60 triggered in carotid body chemoreceptor to increase minute ventilation

98
Q

What impairs hypoxic ventilatory response

A

Anesthetics
Carotid endardarectomy

99
Q

In what way does carotid endarterectomy shift CO2 curve?

A

Left shift

100
Q

T or F ? Bilateral carotid endarterectomy would result in significant impairment of the hypoxic drive.

A

True

101
Q

Actional potential along Hering’s nerve stimulates central controller to increase minute ventilation

A

Hypoxic Ventilatory Response

102
Q

involuntary ventilation

A

medulla
pons

103
Q

voluntary breathing

A

cortex

104
Q

Values that inhibits respiration

A

low h+ (alkalosis)
low PaCO2

105
Q

What effect does PaO2 <60 have on the body?

A

overcomes respiratory inhibition
(low H and Low PaCO2) in peripheral chemo receptors (Glomus cells)

106
Q

the rate of diffusion of a gas through a tissue sheet is proportional to the area of the sheet and the partial pressure difference across it, and inversely proportional to the thickness of the sheet

A

Ficks Law

107
Q

How does Hypoxic Pulmonary Vasoconstriction effect blood flow

A

Reduces the blood flow to poorly ventilated regions of the lung

108
Q

The PO2 of the alveolar gas, not the pulmonary arterial blood, chiefly determines the response.
This response does NOT depend on central nervous connections.

A

HPV (HYPOXIC PULMONARY VASOCONSTRICTION)

109
Q

This protective mechanism causes vasoconstriction in poorly ventilated areas of the lung to stop shunting.

Often, during atelectasis or one-lung ventilation

A

hypoxic pulmonary vasoconstriction

110
Q

5 causes of hypoxemia

A

1 Atmosphere (high altitude)
2. Hypoventilation
3. Diffusion limitation
4. Ventilation-perfusion inequality
5. Shunt

111
Q

Impaired movement of oxygen from alveoli to pulmonary vasculature

A

Diffusion Limitation

INCREASED A-a gradient

112
Q

causes of diffusion limitation

A

Thickening of alveolar capillary
Pulmonary fibrosis
Emphysema
Interstitial lung disease

113
Q

two causes of hypercapnia

A

hypoventilation
Vq mismatch

114
Q

The maximum amount of hemoglobin that can be bound

A

O2 capacity

115
Q

Most CO2 in the blood is in the form of what?

A

Bicarbonate

116
Q

preset inspi pressure over predetemined time

A

Pressure Control Ventilation

117
Q

Mode on vent where Inspiratory pressure varies based on compliane

A

volume control ventilation

118
Q

Inspiratory flow starts high then decreased

A

pressure control

119
Q

inspiratory flow is held constant

A

Volume control

120
Q

7 vent modes that can be used on a spontanously breathign patient

A

AC
APRV
BIPAP
CPAP
Manual
PSV/PSV pro
SIMV

121
Q

Bicarbonate leaves RBC and chloride
enters to maintain neutrality

A

Hamburger shift

122
Q

what transports CO2

A

1 Bicarbonate ions (70-90%)
2 Dissolved in plasma (5-10%)
3 Carbamino compounds: combined
with amino acids (5-20%)

123
Q

CO2 combines with H2O to form

A

carbonic Acid H2CO3

124
Q

Carbonic Acid H2CO3 dissolved into

A

bicarbonate (HCO3) and hydrogen

125
Q

The effect that says that oxygen causes hemoglobin to RELEASE CO2

A

Haldane Effect

Describes CO2 carriage

126
Q

Effects that says CO2 and hydrogen ions cause conformational change in Hgb that favors release of oxygen

A

Bohr Effect

describes OXYGEN carriage

127
Q

calculates physiological dead space

A

Bohr Equation = Vd/Vt

128
Q

what does bohr equation compare to

A

PP of CO2 in blood vs PP of CO2 in exhaled gas

129
Q

what is the normal Vd/Vt ratio?

A

150mL/450mL= 33%

130
Q

In the presence of oxygenated hemoglobin, the CO2 curve shift to the ________.

A

right

131
Q

in the presence of deoxygenated hemoglobin, the CO2 curce shifts to the __________.

A

left

132
Q

Hypercapnia AKA Hypercarbia

A

PaCo2 >45
increase in SNS response –> Increase BP

133
Q

What happens during a laryngospasm?

A

iSLN is stimulated (vagus)
lateral cricoarytenoids adduct
thyroarytenoids lengthen

These muscles close the glottis by adducting the vocal cords.

Basics in Anesthesia (5 decks)

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