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Quarter 5 > Pulmonary Exam I > Flashcards

Pulmonary Exam I Flashcards

1
Q

Plateau Pressure (Pp)

[also known as….]

A

alveolar pressure

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2
Q

Plateau Pressure (Pp)

[equal to]

A

static pressure

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3
Q

Peak Inspiratory Flow

A

highest flow that is used to deliver tidal volume during inspiration

VT / inspiratory time

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4
Q

(4) phases of ventilator cycle

A

trigger, delivery, cycle, and expiration

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5
Q

trigger, delivery, and cycle are all part of the _____ phase

A

inspiratory

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6
Q

Variables set in Assist/Control mode

A
  • tidal volume
  • flow waveform
  • backup rate
  • inspiratory flow rate or time
  • inspiratory trigger sensitivity
  • FiO2
  • PEEP
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7
Q

Type of Ventilation

A

volume-targeted Assist-Control ventilation

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8
Q

Cons of Assist-Control

A

must be weaned off

not very comfortable while awake due to preset tidal volume

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9
Q

Pros of Assist-Control

A

eases work of breathing

(good for respiratory distress)

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10
Q

Volume Control

[variables set]

A
  • respiratory rate
  • tidal volume
  • I:E
  • FiO2
  • PEEP
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11
Q

Pousille’s Law

A

(8 * l * n) / Π *r4

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12
Q

dynamic resistance

A

pressure needed to overcome airway resistance

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13
Q

Pressure Control

[variables set[

A
  • respiratory rate
  • inspiratory pressure
  • inspiratory time or I:E
  • PEEP
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14
Q

tidal volume delivered during pressure control depends on _____

A

compliance and resistance

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15
Q

What kind of cycling is used in Pressure Control?

A

time cycling

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16
Q

Type of Ventilation

A

pressure control

  • all mandatory breaths
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17
Q

Pressure Control Ventilation

[cons]

A

variable tidal volumes due to chances in compliance and resistance

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18
Q

Pressure Control Ventilation

[pros]

A

better tidal volumes and even time constants

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19
Q

Which ventilation has a decelerating flow pattern?

[pressure or volume control]

A

pressure

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20
Q

Which ventilation has a constant peak flow?

[pressure or volume control]

A

voiume control

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21
Q

Which ventilation has a constant peak airway and alveolar pressure?

[pressure or volume control]

A

pressure control

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22
Q

SIMV

A

synchronized intermittent mandatory ventilation

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23
Q

Type of Ventilation

A

SIMV

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24
Q

SIMV

[pros]

A

improved comfort in awake patient

prevents “breath stacking”

allows patient to breath spontaneously without concern for hypoventilation or atelectasis

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25
Q

SIMV mode

[applications]

A

when patient makes respiratort effort which is not sufficient for adequate ventilation

emergence from anesthesia

weaning mode from full ventilation

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26
Q

type of ventilation

A

Pressure Support

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27
Q

PSV

[pros]

A

allows patient to breath spontaneously

decreases work of breathing

weaning tool

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28
Q

PSV

[cons]

A

must set low and high VE alarms

must alter prset apnea time
(especially in pediatrics)

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29
Q

Dynamic compliance

A

change in pressure / change in volume

or

PIP / tidal volume

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30
Q

Physiologic deadspace

A

VD/VT

  • (paco - peco) / paco
  • should be less than 33%
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31
Q

Normal inspiratory time for an Adult

A

1 - 2 sec

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32
Q

Normal inspiratory time for newborn

A

0.4 - 0.5 sec

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33
Q

the value of inspriatory pause provides diagonistic informaiton about _____

A

peak airway pressure, airway resistance, and static lung compliance

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34
Q

Types of PEEP valves

A

water, spring, weight, diaphragm

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35
Q

Disadvantages of PEEP

[respiratory effects]

A

increased deadspace and PVR

increased alveolar and capillary permeability

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36
Q

Advantages of PEEP

A
  • improved oxygenation
  • improved compliance
  • prevention of alveolar collapse
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37
Q

Disadvantages of PEEP

[cardiovascular]

A
  • positive pressure in alveolus
  • reduced CO
  • elevated PVR
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38
Q

Auto PEEP

(intrinsic)

A

new inspiration begins before exhalation is complete

  • may occur in COPD, ARDS, or high Vf
  • may result in
    • hyperinflation
    • pneumothorax
    • decreased venous return
39
Q

How can you reduce the effects of Auto PEEP?

A

reduce RR and increase expiratory time

40
Q

VALI

A

Ventilator-Assisted Lung Injury

41
Q

Ideal tidal volumes

A

6 - 8 mL/kg

(definitely less than 9)

42
Q

“best PEEP”

A

less than 8 cm H2O

  • esepcially in patients with increased risk of postoperative pulmonary outcomes
    • ex: CLD, neonates, obese, throacic or abdominal surgery, laproscopic
43
Q

HFOV

A

high frequency oscillator ventilation

44
Q

high frequency ventilation

(fun facts)

A
  • aboout 900 breaths per minute
  • mean airway pressure
  • ventilation is active on inspiration and expiration
45
Q

High frequency jet ventilation

(fun facts)

A
  • can be used with conventional ventilation
  • active inspiration and passive exhalation
46
Q

Objectives in Volume-Controlled ventilation in a health patient

A
  • tidal volumes and PEEP between 6-8
  • recruitment maneuvers every 30-45 min
  • RR between 12 - 25
  • FiO2 between 30-50%
47
Q

Objectives in Volume-Controlled ventilation in Injured Lungs

A
  • tidal volume between 4-6
  • PEEP between 8-15
  • RR 15 - 35
  • FiO2 between 50-80%
48
Q

Target values in a healthy patient using Volume Control

A
  • plateau pressure lower than 25 cmH2O
  • EtCO2 between 35-45
  • SpO2 greater than 95%
49
Q

Target values in Injured lungs using Volume Control

A
  • plateau pressure below 30 cmH2O
  • PaCO2 between 40-60 mmHg
  • pH between 7.30 - 7.40
  • SpO2 92%
50
Q

3 mechanisms of airway obstruction

A

lumen is blocked (secretions, edema)

increased wall thickness

loss of radial traction (destruction of parenchyma)

51
Q

Terminal bronchioles start at which airway generation?

A

about 15

52
Q

Asthma

A

chronic inflammatory disorder of airways due to an increase in inflammatory cells

(mast, lymphocytes, neutrophils, eosinophils)

reversible

53
Q

Pathogenesis of Asthma

A

inhalation and sensitization of allergen

  • IgE are produced by Beta cells
  • bind to IgE receptors on mast cells
    • release of histamine, leukotrienes, and cytokines
    • perpetuate inflammation
54
Q

early response of asthma

A

bronchospasm

hypersensitivity reaction due to mast cell degranulation

55
Q

pulsus paradoxus

A

large decrease in systolic blood prsesure on inspiration

  • less than 10 mmHg
  • due to an increase in negative intrathoracic pressure
56
Q

signs and symptoms of Hyper-Responsiveness

A
  • wheezing (noticeable on exhalation
  • dyspnea
  • chest tightness
  • cough
  • increase in RR
  • accessory muscle use
  • tachycardia and pulsus paradoxus
57
Q

RSV

A

respiratory syncytial virus

58
Q

Nissen Fundoplication

A

fixes GERD

takes part of stomach and wraps around lower esophageal sphincter

59
Q

Sampter’s Triad

A

Nasal polyps, asthma, and ASA hypersensitivity

60
Q

NSAIDS and Asthma

A

inhibits COX pathway and shifts toward lipo-oxygenase pathway

  • produces leukotrienes which cause bronchoconstriction

avoid aspirin and toradol in Asthmatics

61
Q

Forced exhalation should see a ____% improvement after bronchodilation

A

20%

62
Q

Treatment for Intermittent asthma

A

short-acting beta agonist

63
Q

Step 6 Asthma - Treatment

A

high-dose inhaled corticosteroid

long-acting inhaled beta agonist

oral corticosteroid

consider omalizumab for patients with allergies

64
Q

spirometric changes in asthma

A

low FEV1/FVC ratio

65
Q

Diagnosis of Asthma

A

Methacholine

histamine challenege measures AHR by dose required to produce 20% decrease in FEV1

66
Q

Chronic Obstructive Pulmonary Disease

A

progressive chronic airflow limitation

  • hyperinflation, mucus secretion, and increased work of breathing
  • NOT reversible
67
Q

2 subtypes of COPD

A

emphysema and chronic bronchitis

68
Q

Emphysema

A

enlargement of air spaces distal to terminal bronchiole

69
Q

Chronic Bronchitis

A

cough w/sputum for 3 consecutive months and greater than 2 years

  • goblet cell hyperplasia
  • small airway obstruction
70
Q

What genetic disease may contribute to COPD?

A

alpha-1 antitrypsin deficiency

71
Q

Which lung capacities/volumes increase in COPD?

A

RV and ERV

72
Q

(4) clinical features of COPD

A
  • producive chronic cough
  • hypoxemia
  • purulent sputum
  • dyspnea
73
Q

(4) long term effects of COPD

A
  • hypercapnia
  • Cor pulmonale
  • lower extremity edema
  • weight loss secondary to increase WOB
74
Q

auscultation of emphysema

A

distant breath sounds w/ expiratory wheeze

75
Q

Emphysema patients have _____ TLC, FRC, and RV

A

increase

(also have an increased lung compliance)

76
Q

rales vs. rhonchi

A

rales - fluid in airway

rhonchi - secretions in airway

77
Q

ausculation in chronic bronchitis

A

rales and rhonchi

78
Q
A

COPD

flattened diaphragm

narrow heart size due to negative pressure

large lung volumes

increase AP diameter

loss of vascular markings

79
Q

lab values in COPD

A

increase RBC and WBC

high bicarb due to metabolic acidosis

80
Q

surgical treatment of COPD

A

excision of bulla

81
Q

Anesthesia management in Obstructive Disorders

A
  • humidify gases
  • regional anesthesia
  • use of ABG to guide ventilation
  • consider use of steroids
  • deep extubation in asthmatics
82
Q

Phosphodiesterase Inhibitors

A

increase cAMP

Theophylline and Aminophylline

prolongs smooth muscle relaxation

83
Q

Anti-cholinergics are used in which disease?

A

COPD

(not used in asthma)

84
Q

Anti-cholinergics mechanism of action

A

blocks M2 and M3 receptors

prevents parasympathetic nervous system bronchoconstriciton

85
Q

Leukotrines

A

bronchoconstricotrs

part of IP3 pathway

montelukast and zafirlukast

86
Q

True or False

Leukotrines are effective for acute bronchospasm

A

false

87
Q

long-acting Beta-2 agonist

[examples]

A

salmeterol and formoterol

terbutaline

88
Q

Inhaled corticosteroid

[examples]

A

flunisolide, fluticasone, mometasone

89
Q

systemic corticosteroid

[examples]

A

methylprednisone, prednisone

90
Q

Advair

A

fluticasone and salmeterol

91
Q

symbicort

A

budesonide and formoterol

92
Q

Omalizumab

A

immune modulator

recombinant antibody binds IgE without activating mast cells

93
Q

pressures given on CPAP

A

5 - 10 cmH2O

same pressure on inhalation and exhalation

94
Q

BiPAP pressures

A

12/5-6

two separate pressures set for inspiration and expiration

Bi-level positive airway pressure

difference between these numbers is the pressure support

Quarter 5 (8 decks)

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