Pulmonary II

Question 1

When HCO3 is low due to loss you will see…

Answer 1

increase in chloride ions

Question 2

All the positive charges in your body and all the negative charges in your body have to..

Answer 2

remain equal

Question 3

Normal Anion gap is…

Answer 3

12

Question 4

Normal Bicarb is….

Answer 4

24

Question 5

Normal pH is…

Answer 5

7.4

Question 6

Normal pCO2 is

Answer 6

40

Question 7

What makes up the majority of the anion gap…

Answer 7

Albumin

Question 8

Albumin of 4 makes up the anion gap of…

Answer 8

12

Question 9

Predicted anion gap should be…

Answer 9

Albumin x 3

Question 10

Acute respiratory acidosis

Answer 10

Bicarb has not had a chance to increase

Question 11

Chronic respiratory acidosis

Answer 11

Bicarb has had a chance to increase

Question 12

Indications for intubation

Answer 12

Airway support (altered mental status, secretions, airway anatomy)
Pulmonary disease (ARDS, pulmonary edema, failed NIV)
Circulatory causes (cardiopulmonary arrest, shock)

Question 13

Two types of positive pressure ventilation

Answer 13

Volume controlled ventilation

Pressure controlled ventilation

Question 14

Trigger of MV

Answer 14

Trigger initiates inspiration
Pressure, flow, or time
Usually Flow

Question 15

Cycle of MV

Answer 15

Cycle terminates inspiration

Pressure, volume, flow or time

Question 16

Limit of MV

Answer 16

Maximum level that can be reached and sustained during inspiration
Can be pressure, volume or flow

Question 17

Ventilator breath phases

Answer 17

Trigger (when to deliver)
Control variables (how to deliver)
Cycle phase (how much to deliver-terminate)
Expiratory phase

Question 18

Conditions that affect compliance

Answer 18

ARDS, Pulmonary edema, pneumothorax, atelectasis

Question 19

Complications of Volume ventilation

Answer 19

Barotrauma
uneven gas distribution
may induce ARDs

Question 20

Pressure ventilation advantages

Answer 20

Improved gas distribution
improved alveolar filling
reduced barotrauma
improved comfort

Question 21

Winter’s formula ratios

Answer 21

Metabolic acidosis- 1 bicarb/1CO2
Metabolic alkalosis- 2 bicarb/ 1 pCO2
Acute respiratory acidosis- 1 bicarb/10pCO2
Chronic respiratory acidosis- 1BIcarb/3pCO2
Acute respiratory alkalosis- 1Bicarb/5pCO2
Chronic respiratory alkalosis- 1Bicarb/2pCO2

Question 22

Anion gap metabolic acidoses

Answer 22

Methanol
Uremia
DKA-all sorts of ketones
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol, ethanol
Salicylates

Question 23

Non anion gap metabolic acidosis

Answer 23

Diarrhea
Renal tubular acidosis
Carbonic anhydrase inhibitors- medications

Addisons disease- the only one of the three that causes hyperkalemia

Question 24

Metabolic alkalosis

Answer 24

Vomiting- chloride responsive

Cushings disease- nonchloride responsive

Question 25

Acute respiratory acidosis

Answer 25

COPD exacerbation | Drug overdose

Question 26

Chronic respiratory acidosis

Answer 26

COPD

Question 27

Acute respiratory alkalosis

Answer 27

Asthma exacerbation | hyperventilation anxiety

Question 28

Chronic respiratory alkalosis

Answer 28

Pregnancy

Question 29

High peak pressures with low plateau pressures

Answer 29

Mucus plug bronchospasm ET tube blockage Biting

Question 30

High peak pressures | High plateau pressures

Answer 30

``` ARDS Pulmonary edema Pneumothorax ET tube migration to a single bronchus Effusion ```

Question 31

CMV ventilation

Answer 31

Controlled mandatory ventilation delivers a preset number of breaths per minute of a predetermined tidal volume additional breaths cannot be initiated by the patient

Question 32

AC ventilation

Answer 32

Set RR and TV Every breath is supported by the ventilator A back up rate is sent and the patient may choose any rate above that rate

Question 33

AC advantages

Answer 33

Controlled ventilation with breath support Increased ventilatory support on demand May help critically ill patients who need constant TV or near full support

Question 34

AC disadvantages

Answer 34

Excessive patient work May be poorly tolerated May lead to respiratory alkalosis May worsen air trapping in COPD

Question 35

IMV ventilation

Answer 35

Intermittent mandatory ventilation Combines a present number of ventilator breaths of a preset tidal volume with the capability of intermittent patient initiated breaths Spontaneous breaths above the set rate will be whatever TV the patient can generate

Question 36

IMV advantages

Answer 36

Patient can perform a variable amount of work with a preset level of mandatory ventilation

Question 37

IMV disadvantages

Answer 37

Risk of dyssynchrony between patient effort and machine delivered volume

Question 38

SIMV ventilation

Answer 38

Synchronized mandatory intermittent ventilation Will sense if the patient is trying to initiate a breath and will deliver the mandatory breath in synchrony with the patients effort

Question 39

PSV ventilation

Answer 39

Pressure support ventilation | Amount of positive pressure is pre set, each breath must be initiated by the patient

Question 40

Applications for PSV

Answer 40

used to improve patient tolerance and decreased work in spontaneous breathing Used as sole ventilatory mode for patients under consideration for weaning or during the stabilization period

Question 41

PSV disadvantages

Answer 41

Tidal volume not controlled: may be poorly tolerated in patients with high airway resistance. requires very careful monitoring in unstable patients