Pulmonary Exam I Flashcards
1
Q
Plateau Pressure (Pp)
[also known as….]
A
alveolar pressure
2
Q
Plateau Pressure (Pp)
[equal to]
A
static pressure
3
Q
Peak Inspiratory Flow
A
highest flow that is used to deliver tidal volume during inspiration
VT / inspiratory time
4
Q
(4) phases of ventilator cycle
A
trigger, delivery, cycle, and expiration
5
Q
trigger, delivery, and cycle are all part of the _____ phase
A
inspiratory
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
7
Q
Type of Ventilation
A
volume-targeted Assist-Control ventilation
8
Q
Cons of Assist-Control
A
must be weaned off
not very comfortable while awake due to preset tidal volume
9
Q
Pros of Assist-Control
A
eases work of breathing
(good for respiratory distress)
10
Q
Volume Control
[variables set]
A
- respiratory rate
- tidal volume
- I:E
- FiO2
- PEEP
11
Q
Pousille’s Law
A
(8 * l * n) / Π *r4
12
Q
dynamic resistance
A
pressure needed to overcome airway resistance
13
Q
Pressure Control
[variables set[
A
- respiratory rate
- inspiratory pressure
- inspiratory time or I:E
- PEEP
14
Q
tidal volume delivered during pressure control depends on _____
A
compliance and resistance
15
Q
What kind of cycling is used in Pressure Control?
A
time cycling
16
Q
Type of Ventilation
A
pressure control
- all mandatory breaths
17
Q
Pressure Control Ventilation
[cons]
A
variable tidal volumes due to chances in compliance and resistance
18
Q
Pressure Control Ventilation
[pros]
A
better tidal volumes and even time constants
19
Q
Which ventilation has a decelerating flow pattern?
[pressure or volume control]
A
pressure
20
Q
Which ventilation has a constant peak flow?
[pressure or volume control]
A
voiume control
21
Q
Which ventilation has a constant peak airway and alveolar pressure?
[pressure or volume control]
A
pressure control
22
Q
SIMV
A
synchronized intermittent mandatory ventilation
23
Q
Type of Ventilation
A
SIMV
24
Q
SIMV
[pros]
A
improved comfort in awake patient
prevents “breath stacking”
allows patient to breath spontaneously without concern for hypoventilation or atelectasis
25
SIMV mode
[applications]
when patient makes respiratort effort which is not sufficient for adequate ventilation
emergence from anesthesia
weaning mode from full ventilation
26
type of ventilation
Pressure Support
27
PSV
[pros]
allows patient to breath spontaneously
decreases work of breathing
weaning tool
28
PSV
[cons]
must set low and high VE alarms
must alter prset apnea time
(especially in pediatrics)
29
Dynamic compliance
change in pressure / change in volume
or
PIP / tidal volume
30
Physiologic deadspace
VD/VT
* (paco - peco) / paco
* should be less than 33%
31
Normal inspiratory time for an Adult
1 - 2 sec
32
Normal inspiratory time for newborn
0.4 - 0.5 sec
33
the value of inspriatory pause provides diagonistic informaiton about \_\_\_\_\_
peak airway pressure, airway resistance, and static lung compliance
34
Types of PEEP valves
water, spring, weight, diaphragm
35
Disadvantages of PEEP
[respiratory effects]
increased deadspace and PVR
increased alveolar and capillary permeability
36
Advantages of PEEP
* improved oxygenation
* improved compliance
* prevention of alveolar collapse
37
Disadvantages of PEEP
[cardiovascular]
* positive pressure in alveolus
* reduced CO
* elevated PVR
38
Auto PEEP
| (intrinsic)
new inspiration begins before exhalation is complete
* may occur in COPD, ARDS, or high Vf
* may result in
* hyperinflation
* pneumothorax
* decreased venous return
39
How can you reduce the effects of Auto PEEP?
reduce RR and increase expiratory time
40
VALI
Ventilator-Assisted Lung Injury
41
Ideal tidal volumes
6 - 8 mL/kg
| (definitely less than 9)
42
"best PEEP"
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
HFOV
high frequency oscillator ventilation
44
high frequency ventilation
| (fun facts)
* aboout 900 breaths per minute
* mean airway pressure
* ventilation is active on inspiration and expiration
45
High frequency jet ventilation
| (fun facts)
* can be used with conventional ventilation
* active inspiration and passive exhalation
46
Objectives in Volume-Controlled ventilation in a health patient
* tidal volumes and PEEP between 6-8
* recruitment maneuvers every 30-45 min
* RR between 12 - 25
* FiO2 between 30-50%
47
Objectives in Volume-Controlled ventilation in Injured Lungs
* tidal volume between 4-6
* PEEP between 8-15
* RR 15 - 35
* FiO2 between 50-80%
48
Target values in a healthy patient using Volume Control
* plateau pressure lower than 25 cmH2O
* EtCO2 between 35-45
* SpO2 greater than 95%
49
Target values in Injured lungs using Volume Control
* plateau pressure below 30 cmH2O
* PaCO2 between 40-60 mmHg
* pH between 7.30 - 7.40
* SpO2 92%
50
3 mechanisms of airway obstruction
lumen is blocked (secretions, edema)
increased wall thickness
loss of radial traction (destruction of parenchyma)
51
Terminal bronchioles start at which airway generation?
about 15
52
Asthma
chronic inflammatory disorder of airways due to an increase in inflammatory cells
(mast, lymphocytes, neutrophils, eosinophils)
**reversible**
53
Pathogenesis of Asthma
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
early response of asthma
bronchospasm
hypersensitivity reaction due to mast cell degranulation
55
pulsus paradoxus
large decrease in systolic blood prsesure on inspiration
* less than 10 mmHg
* due to an increase in negative intrathoracic pressure
56
signs and symptoms of Hyper-Responsiveness
* wheezing (noticeable on exhalation
* dyspnea
* chest tightness
* cough
* increase in RR
* accessory muscle use
* tachycardia and pulsus paradoxus
57
RSV
respiratory syncytial virus
58
Nissen Fundoplication
fixes GERD
takes part of stomach and wraps around lower esophageal sphincter
59
Sampter's Triad
Nasal polyps, asthma, and ASA hypersensitivity
60
NSAIDS and Asthma
inhibits COX pathway and shifts toward lipo-oxygenase pathway
* produces leukotrienes which cause bronchoconstriction
avoid aspirin and toradol in Asthmatics
61
Forced exhalation should see a \_\_\_\_% improvement after bronchodilation
20%
62
Treatment for Intermittent asthma
short-acting beta agonist
63
Step 6 Asthma - Treatment
high-dose inhaled corticosteroid
long-acting inhaled beta agonist
oral corticosteroid
*consider omalizumab for patients with allergies*
64
spirometric changes in asthma
low FEV1/FVC ratio
65
Diagnosis of Asthma
Methacholine
histamine challenege measures AHR by dose required to produce 20% decrease in FEV1
66
Chronic Obstructive Pulmonary Disease
progressive chronic airflow limitation
* hyperinflation, mucus secretion, and increased work of breathing
* NOT reversible
67
2 subtypes of COPD
emphysema and chronic bronchitis
68
Emphysema
enlargement of air spaces distal to terminal bronchiole
69
Chronic Bronchitis
cough w/sputum for 3 consecutive months and greater than 2 years
* goblet cell hyperplasia
* small airway obstruction
70
What genetic disease may contribute to COPD?
alpha-1 antitrypsin deficiency
71
Which lung capacities/volumes increase in COPD?
RV and ERV
72
(4) clinical features of COPD
* producive chronic cough
* hypoxemia
* purulent sputum
* dyspnea
73
(4) long term effects of COPD
* hypercapnia
* Cor pulmonale
* lower extremity edema
* weight loss secondary to increase WOB
74
auscultation of emphysema
distant breath sounds w/ expiratory wheeze
75
Emphysema patients have _____ TLC, FRC, and RV
increase
(also have an increased lung compliance)
76
rales vs. rhonchi
rales - fluid in airway
rhonchi - secretions in airway
77
ausculation in chronic bronchitis
rales and rhonchi
78
**COPD**
flattened diaphragm
narrow heart size due to negative pressure
large lung volumes
increase AP diameter
loss of vascular markings
79
lab values in COPD
increase RBC and WBC
high bicarb due to metabolic acidosis
80
surgical treatment of COPD
excision of bulla
81
Anesthesia management in Obstructive Disorders
* humidify gases
* regional anesthesia
* use of ABG to guide ventilation
* consider use of steroids
* deep extubation in asthmatics
82
Phosphodiesterase Inhibitors
increase cAMP
**Theophylline and Aminophylline**
prolongs smooth muscle relaxation
83
Anti-cholinergics are used in which disease?
COPD
| (not used in asthma)
84
Anti-cholinergics mechanism of action
blocks M2 and M3 receptors
prevents parasympathetic nervous system bronchoconstriciton
85
Leukotrines
bronchoconstricotrs
part of IP3 pathway
**montelukast and zafirlukast**
86
True or False
Leukotrines are effective for acute bronchospasm
false
87
long-acting Beta-2 agonist
[examples]
salmeterol and formoterol
terbutaline
88
Inhaled corticosteroid
[examples]
flunisolide, fluticasone, mometasone
89
systemic corticosteroid
[examples]
methylprednisone, prednisone
90
Advair
fluticasone and salmeterol
91
symbicort
budesonide and formoterol
92
Omalizumab
immune modulator
recombinant antibody binds IgE without activating mast cells
93
pressures given on CPAP
5 - 10 cmH2O
same pressure on inhalation and exhalation
94
BiPAP pressures
12/5-6
two separate pressures set for inspiration and expiration
Bi-level positive airway pressure
difference between these numbers is the pressure support
