Pulmonary Assessment (ABG/CXR) Flashcards
Most O2 in the blood is bound to Hgb ~ ___%
97%
Mild hypoxemia = PaO2 ___-___ mmHg
60-79 mmHg
Moderate hypoxemia = PaO2 ___-___ mmHg
40-59 mmHg
Severe hypoxemia = PaO2 < ___ mmHg
40 mmHg
pH can be calculated by the _________ __________ equation
Henderson Hassleback equation
Kidneys reabsorb ______ and eliminate ___
HCO3
H+
PaCO2 < 35 mmHg = respiratory ________
alkalosis
PaCO2 > 45 mmHg = respiratory ________
acidosis
Rapidly change PaCO2 by adjusting _______ _________
minute ventilation
Most frequent cause of airway obstruction?
Tongue
HCO3 > 26 mmHg = metabolic _________
alkalosis
HCO3 < 22 mmHg = metabolic _________
acidosis
Causes of ________ HCO3: vomiting, diuretic administration
Increased
Causes of ________ HCO3: hypoperfusion, ketoacidosis, renal failure
Decreased
_________ __________ is characterized by hyperbicarbonatemia (>27 mEq/L) and usually by an alkalemic pH (>7.45)
Metabolic alkalosis
Factors that generate metabolic alkalosis include vomiting and ________ administration
diuretic
Metabolic alkalosis is associated with ____-kalemia, ionized ____-calcemia, secondary ventricular arrhythmias, increased ______ toxicity, and compensatory _____-ventilation (hypercarbia), although compensation rarely results in PaCO2 above ___ mmHg
hypokalemia
hypocalcemia
digoxin
hypoventilation
55 mmHg
Etiologic therapy for metabolic alkalosis consists of measures such as expansion of ________ ________ and/or the slow administration of __________
intravascular volume
potassium
Nonetiologic therapy for metabolic alkalosis includes administration of __________ (a carbonic anhydrase inhibitor that causes renal bicarbonate wasting), and _______
acetazolamide
dialysis
Sufficient reductions in pH may reduce myocardial _________, increase ________ vascular resistance, and decrease _______ vascular resistance
contractility
pulmonary
systemic
________ should rarely be used to treat acidemia induced by metabolic acidosis
NaHCO3
In contrast to NaHCO3, _______ effectively reduces [H+], does not increase plasma [Na+], does not generate CO2 as a byproduct of buffering, and does not decrease plasma [K+]16; however, there is no generally accepted indication for ______
THAM (buffer tris-hydroxymethyl aminomethane)
THAM
Results from an increase in minute alveolar ventilation (VA) that is greater than that required to excrete metabolic CO2 production
Respiratory alkalosis
_________ ________ ________ is tightly regulated and responds rapidly to changes in PaCO2
Cerebral blood flow (CBF)
List 3 acute conditions that respiratory alkalosis can produce
-hypokalemia
-hypocalcemia
-cardiac dysrhythmias
-bronchoconstriction
-hypotension
-digoxin toxicity
How do we typically tx respiratory alkalosis?
Treat underlying cause
Occurs because of a decrease in alveolar ventilation and an increase in production of carbon dioxide.
Respiratory acidosis
With acute respiratory acidosis, do we have HCO3- retention?
No
With chronic respiratory acidosis, do we have HCO3- retention?
Yes
Tx of severe acute respiratory acidosis
Mechanical ventilation
low pH, high PaCO2, high HCO3
Partially compensated Respiratory Acidosis
normal pH, high PaCO2, high HCO3
Fully compensated Respiratory Acidosis
low pH, low PaCO2, low HCO3
Partially compensated Metabolic Acidosis
normal pH, low PaCo2, low HCO3
Fully compensated Metabolic Acidosis
high pH, low PaCO2, low HCO3
Partially compensated Respiratory Alkalosis
Acute respiratory acidosis: for 10mmHg increase in PaCO2, the HCO3 will increase ~ __-__ mEq/L
1-2 mEq/L
Chronic respiratory acidosis: for 10mmHg increase in PaCO2, the HCO3 will increase ~ __ mEq/L
5 mEq/L
Base excess is highly negative, usually ______ related
volume related
For every ___ units of CO2 above normal, the pH should inversely change by 0.1
10 units
What is the calculated pH with a PaCO2 of 65 mmHg? (use 7.4 as normal)
7.2
If the measured pH is lower than expected, we can assume there are other acids bring the pH down, e.g. _____ _______
lactic acids
If the measured pH is better than the calculated, _______ __________ is probably occurring
renal compensation
Normal base excess range?
-3 to 3
Normal anion gap range?
8 - 12
(high, low or normal AG albumin / globulin ratio?) affected by increases in unmeasured ions (acidosis) or affect of toxins
High AG
(high, low or normal AG?) HCO3- is lost externally
Low AG
Name 3 causes of high AG acid/base imbalance
Uremia
lactic acidosis
ketoacidosis
Name 3 causes of normal AG acid/base imbalance
Renal tubular acidosis
diarrhea
administration of carbonic acid inhibitors
HCL administration
ureteral diversions
(partially or fully compensated system) Opposing system will be outside the normal range in the direction opposite the problem
partially compensated system
(partially or fully compensated system) Metabolic and respiratory systems will both be outside of range
fully compensated system
A normal or slightly low HCO3- in the presence of hypercapnia suggests a ________ metabolic _______
concomitant
acidosis
A normal or slightly elevated HCO3- in the presence of hypocapnia suggests a ________ metabolic ________
concomitant
alkalosis
Lung markings more prominent in _______ ________ and decreased in ____________
chronic bronchitis
emphysema
Antero-posterior diameter increased in _______
COPD
Flattened diaphragm in ______
COPD
Know how to read CXRs (refer to slide 30 on PP to see what we need to be able to identify)
Know it bro
List the ABCDEF method of reading CXRs
A: airways: trachea, R & L main bronchus
B: bones and soft tissue: ribs, clavicles, sternum, spine/vertebral bodies
C: cardiac silhouette / mediastinum (cardiomegaly)
D: diaphragm: R & L hemidiaphragm (curved)
E: everything else or effusions and pleura and costophrenic angles, gastric bubble
F: lung fields: fissures, lobes (R x 3, L x 2)
Also,
Lines, tubes, devices, surgeries (sternal wires)
