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ICM-pulmonary > Pulmonary lecture Diagnostics > Flashcards

Pulmonary lecture Diagnostics Flashcards

1
Q

ABG

A

pH, PaCO2, PaO2

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2
Q

Allen test

A

to see if the ulnar and radial artery are not occluded by a thrombus

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3
Q

normal pH

A

7.4

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4
Q

normal PaCO2

A

35-40

-represents ventilatory problems

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5
Q

normal PaO2

A

around 100

-represents oxygenated problems

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6
Q

acidemia pH

A

blood pH <7.35

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7
Q

acidosis

A

primary physiologic process that, occurring alone, tend to cause acidemia.

  • example: metabolic acidosis from decreased perfusion (lactic acidosis)
  • respiratory acidosis from hypoventilation
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8
Q

Alkalemia pH

A

blood pH >7.45

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9
Q

alkalosis

A

primary physiologic process that occurring alone tends to cause alkalemia.

  • examples: metabolic alkalosis from excessive diuretic therapy
  • respiratory alkalosis acute hyperventilation
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10
Q

primary acid base disorder

A

one of the four acid base disturbances that is manifested by initial change HCO3 or PaCO2.

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11
Q

compensation

A

change in HCO3 or PaCO2 that results from the primary event

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12
Q

respiratory alkalosis

A
  • first change is a lowering of PaCO2-> elevated pH

- compensation is secondary by kidneys of lowering bicarbonate-> reduction in bicarbonate results in metabolic acidosis

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13
Q

respiratory acidosis

A
  • first change is elevation of PaCO2-> decrease pH

- compensation: retention of bicarbonate from kidneys-> metabolic alkalosis

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14
Q

metabolic acidosis

A
  • first change is lowering HCO3-> decreased pH

- Compensation: hyperventilation (lower PaCO2)

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15
Q

metabolic alkalosis

A
  • first change is elevation of HCO3-> increased pH

- compensation: hypoventilation (increase PaCO2), want to bring pH back down

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16
Q

anion gap

A

Na-(CL+CO2)

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17
Q

metabolic acidosis: increased anion gap is from

A

lactic acidosis, ketoacidosis, drug poisoning,

“MULEPAKS”

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18
Q

metabolic acidosis: normal anion gap is from

A

diarrhea, some kidney problems

“HARDUP”

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19
Q

metabolic alkalosis anion gap

A

chloride responsiveness: contraction alkalosis, diuretics, corticosteroids, gastric suctioning, vomiting
chloride resistance

20
Q

respiratory acidosis

A

(increased PaCO2, decreased pH)

  • CNS depression
  • chest bellows dysfunction (MA, GB)
  • disease of lungs (obstructive), severe asthma, severe pulmonary edema
21
Q

respiratory alkalosis

A 
(decreased PaCO2, increased pH)
hypoxemia
anxiety
sepsis
acute pulmonary insult (PE, pneumonia, pulmonary edema)
22
Q

patient with pH>7.4, with PaCO2 >40

A

either Met. Alka with respiratory compensation or

met. Alka and a respiratory acidosis

23
Q

FiO2

A

fraction of inspired oxygen

24
Q

SpO2

A

pulse Ox or bound oxygen (dissolved)

25
Q

A-a gradient

A

alveolar oxygen-Arterial oxygen

26
Q

abnormal A-a gradient

A

elevated when gas diffusion is impaired (lung problem)

27
Q

expected normal A-a gradient

A

(patient age/4) +4

28
Q

PiO2

A

pressure inspired oxygen in trachea

29
Q

SaO2

A

bound oxygen %

30
Q

for most pulmonary disease, the A-a gradient number will get

A

bigger

-sensitive for PE

31
Q

oxygenation failure

A

to quantify the degree of diffusion impairment or hypoxemia (low oxygen []) it is important to know two addition relationships:

  • oxygen saturation to the dissolved oxygen []
  • dissolved oxygen concentration to the inspired oxygen c[]
32
Q

PaO2 of 60 mmHg

A

saturation of 90%

-want to be at 90% or above

33
Q

causes Hb to hold onto O2

A 
-leftward shift
alkalosis
hypothermia
low PCO2
Low 2,3-DPG
34
Q

causes Hb to release of O2

A 
-rightward shift
High PCO2
fever
acidosis
high 2,3-DPG
35
Q

normal PaO2:FiO2 on room air

A

100: 21%= 475 (ratio)

36
Q

severity of diffusion impairment increases, what happens to PaO2:FiO2

A

ratio decreases

37
Q

shortcut for calculating PaCO2:FiO2 ration

A

PaO2 is about 5X FiO2

38
Q

decreased V/Q

A

areas of lung that are better perfused than ventilated

-shunt

39
Q

increased V/Q

A

areas are better ventilated than perfused

-dead space

40
Q

highest pressure zone of lung

A

lowest part of lung

  • zone 3: Pa>Pv>PA (alveolar pressure, doesn’t interrupt flow)
  • shunt happens hear
41
Q

zone 2 of lung

A

Pa>PA>Pv

42
Q

zone 1 of lung

A

PA>Pa>Pv

  • not able to pump the blood all the way up to the lung
  • alveolar pressure collapses capillaries, not able to be perfused
43
Q

what can cause an increased V/Q (increased dead space)

A
  • PE

- emphysema

44
Q

decreased V/Q (shunt)

A
  • emphysema (non-function alveoli)
  • fibrosis (poor diffusion of air)
  • secretions (blocks diffusion of air)
45
Q

shunts occur when

A

-venous blood mixes with arterial blood bypassing oxygenation

46
Q

extra pulmonary, you see

A

right to left cardiac shunts

-example: T or F

47
Q

intra pulmonary, you see

A

blood is transported thru lungs without taking part in gas exchange
-example: atelectasis, pneumonia, hepatopulmonary syndrome, Anomolous venous return

ICM-pulmonary (12 decks)

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