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Respiratory Physiology > Pulmonary Function Tests > Flashcards

Pulmonary Function Tests Flashcards

1
Q

What is an FEV1?

A

Forced expiratory volume. How much volume can be forcefully exhaled in 1 second

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2
Q

What are examples of “high risk PFT results”?

A

FEV1 < 2L
FEV1/FVC < 0.5
VC < 15cc/kg and < 10cc/kg
VC < 40-50% than predicted

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3
Q

What drugs should be avoided in patients reactive airway?

A

Avoid histamine releasing drugs like:

Pentothal, morphine, atracurium, mivacurium, neostigmine.

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4
Q

What is the drug of choice for bronchospasm?

A

Epinephrine

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5
Q

What are extubation criteria?

A

VSS, awake+alert, rr<30.
MIF is more negative than -20cm H2O.
VC >15cc/kg

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6
Q

What should PaO2 and PaCO2 be on ABG at 40%FiO2 prior to extubation?

A

PaO2 >70
and
PaCO2 <55

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7
Q

What are the 4 intubation criteria?

A

Mechanic, Oxygenation, Ventilation, Clinical

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8
Q

What are clinical reasons for intubation?

A

Epiglotitis, airway burn, chemical burn, mental status

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9
Q

What are mechanics reasons for intubation?

A

RR>35, VC <15cc/kg, MIF more negative than -20cm H2O

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10
Q

What are oxygenation reasons for intubation?

A

PaO2 < 70 on 40% FiO2.

A-a gradient > 350mmHg on 100% O2.

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11
Q

What are ventilation reasons to intubate?

A

PaCO2 >55, Vd/Vt >0.6 (normal deadspace is 30%)

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12
Q

Are you more likely to discover a pneumothorax with an inspiratory or expiratory film?

A

Expiratory Film

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13
Q

Normal pH, PCO2, PO2, HCO3, Base

A 
pH 7.35-7.45
PCO2 35-45
PO2 75-105
HCO3 20-26
Base -3 -- +3
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14
Q

What is a buffer and what are examples?

A

Substance that can absorb or donate H+:

HCO3, Hb, serum proteins, Phosphate

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15
Q

An Increase in PCO2 by 10mmHg will change the pH by how much?

A

10mmHg increase will be a 0.08 decrease in pH.

10mmHg decrease will be a 0.08 increase in pH

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16
Q

What should the pH be if the PCO2 is 70?

A

7.16

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17
Q

How do you calculate the expected PaO2 for a given FiO2?```

A

PaO2= (Pb - PH2O) x (FiO2) - (PaCO2/0.8)

Where Pb=760 and PH2O=47

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18
Q

A decrease in Bicarb by 10mmoles will change the pH how much?

A

A decrease in Bicarb by 10mmoles will decrease pH by 0.15. And an increase in Bicarb by 10mmoles will increase pH by 0.15

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19
Q

What should the pH be if the bicarb is 33?

A

7.55

20
Q

What is a good formula for calculating how much HCO3 to give a patient?

A

(Base deficit x wt in kg x 0.4) in mEq/l, usually replace half of deficit.

21
Q

What is a normal A-a gradient?

A

Age/3

22
Q

How do you treat a larger than normal A-a gradient?

A

Supplemental O2, adjust ventilation, tx atelectasis, add PEEP, tx underlying cause.

23
Q

What is an A-a gradient measure?

A

Measures the efficiency of the lung

24
Q

What causes an A-a gradient to widen?

A

Anesthesia and intrinsic lung disease (PTX, PE, Shunt, V/Q mismatch, diffusion problems),

25
Q

Respiratory acidosis is defined as what?

A

Low pH and high PaCO2

26
Q

After 1-2 days of respiratory acidosis, what happens?

A

Renal compensation occurs

27
Q

What happens during renal compensation for respiratory acidosis?

A

H+ excreted by kidneys and HCO2 reabsorbed into blood to partially correct pH

28
Q

Respiratory alkalosis is defined by what?

A

High pH and low PaCO2

29
Q

What happens during renal compensation for respiratory alkalosis?

A

Increase secretion of HCO3 and decrease secretion of H+ which partially corrects pH

30
Q

What are two reasons that respiratory alkalosis may occur?

A

Pregnancy and artificial ventilation

31
Q

Metabolic acidosis is defined by what?

A

pH low and HCO3 Low

32
Q

What are some causes of metabolic acidosis?

A

Lactic acidosis from hypoperfusion, DKA, renal disease with bicarb loss, HCO3 loss in diarrhea, ASA ingestion

33
Q

How does the body try to correct metabolic acidosis?

A

Respiratory compensation through ventilation and kidneys may increase H+ excretion

34
Q

Metabolic alkalosis is defined by what?

A

High pH and high HCO3

35
Q

What are some causes of metabolic alkalosis?

A

Loss of H+ from vomitting or excessive NGT suctioning, bicarb infusion, metabolism of lactate or citrate

36
Q

What does the body do to try to correct metabolic alkalosis?

A

Respiratory compensation through limited hypoventilation.

Kidneys may excrete HCO3 in urine

37
Q

What is the most important clinical tool in assessing the severity of airway obstructive disease?

A

FEV1-second

38
Q

What is a normal FEV1?

A

3-5L

39
Q

Does an intrathoracic obstruction decrease inspiratory or expiratory flow?

A

Expiratory flow

40
Q

Does an extrathoracic obstruction decrease inspiratory or expiratory flow?

A

Inspiratory flow

41
Q

What is test is sometimes called the “will to live” test?

A

Maximal voluntary ventilation (MVV) or Maximal breathing capacity (MBC)

42
Q

How is MVV or MBC measured?

A

Maximum amount of air one can exhale in one minute and maximal effort

43
Q

What does an FEF 25-75 measure?

A

Forced expiratory flow at 25% to 75% of FVC

44
Q

Is FEF effort dependent or independent?

A

Effort independent

45
Q

What is FEF a good indicator for?

A

Sensitive indicator of early airway obstruction

46
Q

When assessing degree of risk in obstructive lung disease, what percentage is considered normal?

A

FEV1/FVC >75

47
Q

When assessing degree of risk in obstructive lung disease, what percentage is considered moderate risk or greater?

A

FEV1/FVC <60

Respiratory Physiology (7 decks)

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