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Pathophysiology > Pulmonary (part 3) > Flashcards

Pulmonary (part 3) Flashcards

1
Q

____ ___ is inadequate gas exchange due to dysfunction of 1 or more components of the respiratory system

A

Respiratory failure

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2
Q

Respiratory failure can be ___, ___ or both

A

Acute, chronic

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3
Q

Type 1 respiratory failure is ____ respiratory failure

A

Hypoxemia

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4
Q

With type 1, lungs cannot ____ ___ because the alveoli are filled with fluid

A

Oxygenate blood

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5
Q

Examples of diseases that can cause type 1 respiratory failure:

A

-Pulmonary edema
-Pneumonia
-ARDS

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6
Q

Type 2 respiratory failure is ____ respiratory failure

A

Hypercapnic

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7
Q

With tye 2 respiratory failure, there is inadequate ____ due to a problem related to CO2 removal

A

Ventilation

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8
Q

What may cause type 2 respiratory failure?

A

-Chest wall deformities that don’t allow it to expand
-Insufficient quantities of air reach the alveoli

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9
Q

What signifies respiratory distress?

A

-Position
-Wheezing/stridor
-Speech
-Retraction
-Nasal flaring
-Level of consciousness
-Cyanosis

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10
Q

What is normal pH of the blood?

A

7.35-7.45

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11
Q

What is normal PaCO2 of the blood?

A

35-45 mm Hg

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12
Q

What is normal PaO2 of blood?

A

80-100 mm Hg

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13
Q

What is normal SaO2 of blood?

A

95-100%

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14
Q

What is normal oxygen saturation of the blood (SpO2)?

A

95-100%

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15
Q

What are advantages and disadvantages of using arterial blood for analysis of respiratory function?

A

-More data (O2 + acid-base, not influenced by hypoxemia, not influenced by pulsatile flow)
-Episodic
-Invasive (pain)
-Blood loss

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16
Q

What are advantages and disadvantages of using a pulse oximeter for analysis of respiratory function?

A

-Less data (O2 only; inaccurate < 70%, may require pulsatile flow)
-Continuous
-Noninvasive
-Home use

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17
Q

Types of pulse oximeters include…

A

-Light transmission through tissue (finger, toe, earlobe)
-Light reflected off Hgb (forehead, smartphone applications)
-Medical use vs non-medical use

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18
Q

Light transmission devices shine 2 wavelengths of light through the ___ ___ to a sensor on the other side

A

Vascular bed

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19
Q

Hemoglobin absorbs light at a different degree depending on the number of binding sites that are _____

A

Bound

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20
Q

An internal algorithm of the light transmission devices converts absorbance pattern to ____

A

SpO2

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21
Q

Light transmission devices require a ____ ____ and may not detect Hgb variants

A

Pulsatile flow

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22
Q

Light reflection devices can be ___ based (FDA certified or ____ based

A

Hospital; smartphone

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23
Q

Smartphone-based light reflection devices use a smartphone flash as a light source; the light is reflected off of ____ and detected by the camera

A

Hgb

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24
Q

An internal algorithm of he light reflection device converts the signal to estimate ____

A

SpO2

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25
Q

Both hospital and smartphone-based light reflection devices may have poor accuracy if SpO2 is under ___% if they are not for medical use

A

90

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26
Q

One problem with a 2-wavelength pulse oximeter is that while it detects Hgb that is bound, it doesn’t know what the Hgb is bound to; this is an issue for ___ ___ inhalation because PaO2 would come up normal (7-wavelength would show this)

A

Carbon monoxide

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27
Q

Possible sources of error with pulse oximetry:

A

-Device technology (not for medical use is unreliable with SpO2 under 90%; medical grade is unreliable under 70-75%
-Hgb variants
-Skin pigmentation (black pts are 3 times more likely to be hypoxemic)
-Decreased pulsatile flow

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28
Q

One concern as oxygen saturation decreases is that ____ diffuses out of plasma and into red blood cells

A

O2

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29
Q

What are acceptable levels for PaO2 and SaO2?

A

PaO2: 80 or more mm Hg
SaO2: 94% or higher

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30
Q

What levels of PaO2 and SaO2 indicate mild hypoxemia?

A

PaO2: 60 mm Hg
SaO2: 90% or higher

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31
Q

What levels of PaO2 and SaO2 indicate moderate hypoxemia?

A

PaO2: 55 mm Hg
SaO2: 88% or higher

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32
Q

What levels of PaO2 and SaO2 indicate severe hypoxemia?

A

PaO2: 40 mm Hg
SaO2: 75% or higher

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33
Q

What levels of PaO2 and SaO2 indicate tissue hypoxia and possible cardiac arrhythmias?

A

PaO2: <40 mm Hg
SaO2: <75% or higher

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34
Q

With the ___ ___ ___, multiple the FIO2 (in non-decimal form) by 5 to get the expected PaO2

A

Rule of 5’s

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35
Q

Room air has an FIO2 of ___

A

0.21 (this means that room air is 21% oxygen)

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36
Q

We can determine severity of respiratory failure by using the ____/____ ratio

A

PaO2/FIO2

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37
Q

A normal PaO2/FIO2 ration should be greater than ____

A

380

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38
Q

We can also assess severity of respiratory failure with the ___/___ ratio

A

SpO2/FIO2 ratio

39
Q

Alveolar gas equation:

A

PAO2 = (PB - PH20) FIO2 - (PaCO2/R)

PAO2: alveolar oxygen tension in mm HG
PB: barometric pressure (sea level= 760 mm Hg)
PH20: water vapor session (fully saturated = 47 mm Hg)
FIO2: oxygen concentration in air (room air=21%)
R: respiratory quotient (VCO2/VO2=200/250=0.8)

40
Q

To calculate the A-a gradient, subtract ____ from PAO2

A

PaO2

41
Q

Normal A-a gradient is less than or equal to ____

A

10

42
Q

The A-a gradient is the most sensitive indicator of diseases that interfere with ___ __

A

Gas exchange

43
Q

A-a gradient helps to differentiate pulmonary from non-pulmonary causes of ____ and ____

A

Hypoxemia and hypercapnia

44
Q

When on ____, A-a gradient is not precise, therefore it is only good to use A-a gradient on room air

A

O2

45
Q

Oxygen content is the total O2 carries by ____

A

Blood

46
Q

CaO2 is equal to…

A

(1.34 x Hgb x SaO2) + (0.0031 x PaO2)

-Bound hgb=19.49
-Dissolved plasma= 0.4

47
Q

Normal CaO2 is ___-___ mL O2/100 mL of blood

A

17-20

48
Q

What are 2 non-acute mechanisms of hypoxemia?

A

-Less inspired oxygen
-Diffusion defect

49
Q

What are 3 acute mechanisms of hypoxemia?

A

-Hypoventilation
-V/Q imbalance
-Shunt

50
Q

At higher ____, barometric pressure is lower

A

Higher

51
Q

Barometric pressure at sea level is ____mm Hg, while barometric pressure at Mt. Everest is ____ mm Hg

A

760; 253

52
Q

At higher altitudes/lower barometric pressure, there is a _____ PAO2 (blood oxygen)

A

Lower

53
Q

When is barometric pressure a concern?

A

-Flying
-Climbing to high altitudes

54
Q

What happens to pressure in a plane (even with it pressurized to less than 8000 ft)?

A

-Barometric pressure decreases
-PaO2 and SpO2 will decrease
-May require supplemental O2

55
Q

With Covid-19, a company starting running faster trips to Everest; this included sending participants a ____ ____ that is connected to a device that extracts O2 from the air to help climbers get acclimated with higher altitudes

A

Hypoxicator Tend

56
Q

Diffusion limitation results from…

A

-Loss of lung tissue
-Thicker A/C membrane

57
Q

What happens with diffusion limitation?

A

-Okay at rest
-Severely short of breath with exercise

58
Q

To help with diffusion limitation, you can give ___ ___ during exercise

A

Supplemental oxygen

59
Q

The hallmark of diffusion limitation is ____ ___ ____

A

Hypoxemia on exertion

60
Q

When someone with diffusion limitation exercises, they have insufficient ____ transfer

A

O2

61
Q

Diffusion limitation is measured by…

A

DLCO (diffusing capacity of the lungs for carbon monoxide)

62
Q

DLCO reflects ____ ____

A

Diffusion capacity

63
Q

Normal ventilation requires…

A

-Contraction of the diaphragm
-Expansion of the chest wall
-Adequate tidal volume to flush CO2 from alveoli

64
Q

If normal ventilation does not occur, what results?

A

-Increased CO2
-Decreased O2
-pH decreases (more acidic-> respiratory acidosis)

65
Q

Common causes of hypoventilation are anything that decreases ____ ____

A

Alveolar ventilation

66
Q

What are examples of things that would decrease alveolar ventilation and cause hypoventilation?

A

-CNS drive is depressed
-Rapid shallow breathing
-Decreased tidal volume
-Pain and splinting

67
Q

What are the three zones of the lungs?

A

-Conducting
-Transitional
-Respiratory

68
Q

___ ___ ____ is the last 1/3 of the inhale and is about 150 mL

A

Dead space ventilation

69
Q

_____ is a deformity of the rib cage that can impact respiration

A

Kyphoscoliosis

70
Q

With ___, a ventilator is commonly used to increase tidal volume

A

ALS

71
Q

Acute exacerbation of COPD causes…

A

-Rapid, shallow breathing
-Small tidal volume (increase PaCO2)
-Primarily ventilate dead space

72
Q

A _____ can increase dead space

A

Tracheostomy

73
Q

We worry about dead space ventilation with restrictive diseases secondary to ____ conditions like ALS, post polio, Duchennes’s Muscular Dystrophy

A

Neuromusclar

74
Q

When respiratory muscles lose function, ____ ____ falls, and CO2 is retained, causing acidosis

A

Tidal volume

75
Q

To manage hypoventilation/dead space ventilation, we can use ____ ____ ____ (mouthpiece, mask, tracheostomy)

A

Positive pressure ventilation

76
Q

An absolute shunt causes _____ without ____

A

Perfusion without ventilation

77
Q

An increase in absolute dead space causes increased ____ without _____

A

Ventilation without perfusion

78
Q

A relative ventilation/perfusion (V/Q) imbalance causes some decreased ____ and some decreased ____

A

Ventilation, perfusion

79
Q

What are examples of ventilation/perfusion (V/Q) imbalances?

A

-Pulmonary embolus (dead space ventilation/no perfusion)
-COPD exacerbation (no ventilation)
-Community onset pneumonia (no ventilation)

80
Q

A V/Q imbalance / Shunt is distinguished by the response to ____

A

O2

81
Q

With a V/Q imbalance/Shunt, increase FIO2 and evaluate if there is a brisk response; if yes the cause is ____ and if no, the cause is ____

A

V/Q mismatch (brisk response)
Shunt (no brisk response)

82
Q

With an absolute shunt or absolute dead space, increased ____ has little impact because O2 is not reaching the blood

A

FIO2

83
Q

With a V/Q mismatch, the hypoxemia does respond to ___

A

O2

84
Q

Covid can cause ___ ___ ___ by viral replication in nasal, bronchial, and epithelial cells and compromise of the epithelial-endothelial barrier

A

Acute respiratory failure

85
Q

Covid can cause an inflammatory response and cause interstitial thickening, increased vascular permeability, and lead to the development of pulmonary edema and a ____

A

Shunt

86
Q

In some patients with covid, they may have ____ hypoxemia

A

Silent hypoxemia

87
Q

With silent hypoxemia, someone has a very low ____ without dyspnea, loss of consciousness, or loss of alertness

A

SpO2 (70%) (also low PaO2 of 40)

88
Q

Long term outcomes of acute renal failure and covid:

A

-Restrictive disease
-Decreased diffusion capacity
-Fibrotic changes
-Dyspnea
-Decreased exercise capacity

89
Q

At risk populations for respiratory failure:

A

-Obstructive sleep apnea (90% undiagnosed)
-Morbid obesity
-Extremes of age
-No previous opioid use
-Escalating dose requirements/habituation
-Concomitant sedatives or CNS depressant

90
Q

Type I respiratory compromise is ___ ___ ___ ___

A

Hyperventilation Compensated Respiratory Disress

91
Q

Type I respiratory compromise can be caused by…

A

-Sepsis
-CHF
-PE

92
Q

Type II respiratory compromise is ____ ____ ____ (CO2 narcosis)

A

Progressive Unidirectional Hypoventilation

93
Q

Type III respiratory compromise is ____ ____ ____

A

Sentinal rapid airflow (SpO2 reduction to precipitous fall)

94
Q

Traditional monitoring of respiratory rate is with either…

A

-Impedance respiratory rate monitoring (ECG)
-Pulse oximetry

Pathophysiology (18 decks)

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