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Starred Summer 2015 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Respiratory physiology is related to what law?

A

Boyle’s (p1v1=p2v2) - explains intrapulmonary pressure changes during respiratory cycle

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2
Q

Intrapulmonary pressure is the pressure within the ____

A

alveoli

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3
Q

Intrapulmonary pressure is ____ with inspiration and ____ with expiration

A

negative, positive - oscillates around atmospheric pressure

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4
Q

Intrapleural pressure is the pressure in the _____

A

potential space between inside of chest wall and lungs

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5
Q

Lungs recoil ____ and chest recoils ____

A

inward, outward

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6
Q

Intrapleural pressure is ___ with inspiration and ___ with expiration

A

more negative, less negative (may become positive with forced expiration) - always negative pressure

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7
Q

Lowest intrapulmonary pressure is reached halfway into ____ after that, air ____ lungs raises pressure

A

inspiration, entering

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8
Q

Highest intrapulmonary pressure is reached halfway into ____ after that, air ____ the lungs reduces the pressure

A

exhalation, leaving

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9
Q

Intrapleural pressure is more negative in the (dependent/non-dependent?) lung, less negative in the (dependent/non-dependent?) lung

A

non-dependent, dependent

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10
Q

Normal V/Q

A

0.8 - alveolar ventilation is

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11
Q

Absolute shunt (V/Q) number, defined and examples

A

zero- there is no ventilation- desaturated blood from the right heart returns to left without being oxygenated. Babies, atelectesis, pneumo

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12
Q

Absolute dead space (V/Q) number, defined, example

A

Infinitiy, no perfusion, PE

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13
Q

Causes of low PaO2

A

Low inspired oxygen, hypoventilation or V:Q mismatch

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14
Q

Equation for PAO2

A

PAO2 = FiO2 (Patm - PH2O =~713) - PaCO2/0.8

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15
Q

Equation for A-a gradient

A

PAO2 - PaO2 (can estimate PaO2 by FiO2 x5)

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16
Q

When will increasing oxygen help increase PaO2

A

If problem is hypoventilation or increasing dead space such as PE

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17
Q

When will increasing oxygen not help increase PaO2

A

Right to left shunts - atelectasis, PDA - use recruitment breaths, add PEEP, suction, dilators

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18
Q

FEV1 defined

A

Forced expiratory volume in one second

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19
Q

FVC defined

A

volume of gas that can be exhaled during forced expiratory maneuver

20
Q

FEV1/FVC usefulness*

A

ratio useful in distinguishing between obstructive & restrictive disease

21
Q

FEF 25-75% defined*

A

midmaximal expiratory flow, *best test for assessing small airway disease independent of respiratory effort

22
Q

*FEV 1 normal value

A

4L/sec

23
Q

*FVC normal value

A

5L/sec

24
Q

*FEV1/FVC normal value

A

0.8 (80%)

25
Q

Variable extrathoracic obstruction defined and examples

A

Inspiration is impaired - negative pressure causes closure of something - vocal cord paralysis, residual paralysis, etc

26
Q

Variable intrathoracic obstruction defined and examples

A

Exhalation is impaired - usually tumors of trachea or bronchi- positive pressure very difficult if OET not past obstruction

27
Q

Fixed large airway obstruction

A

Outside of the system - plugged or kinked OET

28
Q

Restrictive lung disease

A

Decreased lung compliance -> decreased lung volumes -> impaired alveolar ventilation, will have normal looking flow volume loops but will be smaller

29
Q

Obstructive lung disease

A

Increased airway resistance results in decreased maximum rate of exhalation

30
Q

Restrictive lung disease and PFT changes

A

FEV1 and FVC decreased, FEV1/FVC will be normal to increased, compliance may be as low as 0.02 L/cmH2O where normal is 0.10

31
Q

Examples of restrictive lung disease

A

pulmonary edema, aspiration, ARDS, POPE

32
Q

Chronic intrinsic vs extrinsic restrictive lung disease examples

A

Intrinsic- Sarcoidosis, drug-induced (amio, bleomycin). Extrinsic- Obesity, pregnancy, kyphosis, spinal cord transection, MD

33
Q

Anesthesia causes of restrictive lung

A

pain, NMBA, surgery of thorax, positioning - lithotomy/trend

34
Q

What causes increased risk of PPC with restrictive lung disease?

A

Dyspnea limiting activity, vital capacity

35
Q

Intraoperative lung mgmt of restrictive disease

A

Larger OET, smaller TV with higher rate and sigh breaths, PIPs 35-45 cmH2O, prolonged inspiratory time, pressure control, consider PEEP, above T10 regional can compromise, utilize peripheral blocks, maintain NMBA to help compliance

36
Q

What causes post obstructive pulmonary edema (POPE)

A

Type I follows episode of upper airway obstruction, Type II develops after surgical relief of chronic upper airway obstruction. High NIF causes increased venous return to right ventricle which elevates pulmonary capillary hydrostatic pressure and decreases pulmonary interstitial pressure (increased afterload, decreased EF and CO)

37
Q

Treatment of POPE

A

Self limiting usually, sometimes reestablish airway, provide oxygen and or CPAP, PEEP

38
Q

Emphysema defined

A

Destructive process involving lung parenchyma that results in loss of elastic recoil of lungs- airway collapse during exhalation, usually preserve PaO2 and CO2

39
Q

Emphysema PFTs

A

Decreased FEV1, FEV1/FVC, FEF25/75, Increased RV and possibly FRC and TLC

40
Q

Chronic bronchitis defined

A

Hypersecretion of mucus and inflammatory changes in bronchi, copious secretions, tendency for hypoxemia and hypercapnia, respiratory acidosis and pulmonary hypertension leading to RV failure and cor pulmonale

41
Q

Chronic bronchitis PFTs

A

FEV1/FVC decreased, FEF 25/75 decreased, increased RV and possibly FRC and TLC

42
Q

Asthma defined

A

Chronic airway narrowing due to bronchial hyperactivity with exacerbations, know it is IGE mediated

43
Q

Cromolyn Sodium use in asthma

A

Preventative measure for bronchospasm, stabilizes mast cells and prevents release of mediators

44
Q

COPD regional anesthesia

A

Above level of T6 not recommended

45
Q

COPD intraoperative management

A

Use of volatiles, propofol and/or ketamine for bronchodilation, avoid N2O in emphysematous patients (pulmonary bullae), sensitive to opioids, large tidal volumes with slower RR, increased expiratory time, avoid high PIP, likely avoid PEEP

Starred Summer 2015 (12 decks)

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