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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
Both hospital and smartphone-based light reflection devices may have poor accuracy if SpO2 is under ___% if they are not for medical use
90
26
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)
Carbon monoxide
27
Possible sources of error with pulse oximetry:
-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
28
One concern as oxygen saturation decreases is that ____ diffuses out of plasma and into red blood cells
O2
29
What are acceptable levels for PaO2 and SaO2?
PaO2: 80 or more mm Hg SaO2: 94% or higher
30
What levels of PaO2 and SaO2 indicate mild hypoxemia?
PaO2: 60 mm Hg SaO2: 90% or higher
31
What levels of PaO2 and SaO2 indicate moderate hypoxemia?
PaO2: 55 mm Hg SaO2: 88% or higher
32
What levels of PaO2 and SaO2 indicate severe hypoxemia?
PaO2: 40 mm Hg SaO2: 75% or higher
33
What levels of PaO2 and SaO2 indicate tissue hypoxia and possible cardiac arrhythmias?
PaO2: <40 mm Hg SaO2: <75% or higher
34
With the ___ ___ ___, multiple the FIO2 (in non-decimal form) by 5 to get the expected PaO2
Rule of 5's
35
Room air has an FIO2 of ___
0.21 (this means that room air is 21% oxygen)
36
We can determine severity of respiratory failure by using the ____/____ ratio
PaO2/FIO2
37
A normal PaO2/FIO2 ration should be greater than ____
380
38
We can also assess severity of respiratory failure with the ___/___ ratio
SpO2/FIO2 ratio
39
Alveolar gas equation:
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
To calculate the A-a gradient, subtract ____ from PAO2
PaO2
41
Normal A-a gradient is less than or equal to ____
10
42
The A-a gradient is the most sensitive indicator of diseases that interfere with ___ __
Gas exchange
43
A-a gradient helps to differentiate pulmonary from non-pulmonary causes of ____ and ____
Hypoxemia and hypercapnia
44
When on ____, A-a gradient is not precise, therefore it is only good to use A-a gradient on room air
O2
45
Oxygen content is the total O2 carries by ____
Blood
46
CaO2 is equal to...
(1.34 x Hgb x SaO2) + (0.0031 x PaO2) -Bound hgb=19.49 -Dissolved plasma= 0.4
47
Normal CaO2 is ___-___ mL O2/100 mL of blood
17-20
48
What are 2 non-acute mechanisms of hypoxemia?
-Less inspired oxygen -Diffusion defect
49
What are 3 acute mechanisms of hypoxemia?
-Hypoventilation -V/Q imbalance -Shunt
50
At higher ____, barometric pressure is lower
Higher
51
Barometric pressure at sea level is ____mm Hg, while barometric pressure at Mt. Everest is ____ mm Hg
760; 253
52
At higher altitudes/lower barometric pressure, there is a _____ PAO2 (blood oxygen)
Lower
53
When is barometric pressure a concern?
-Flying -Climbing to high altitudes
54
What happens to pressure in a plane (even with it pressurized to less than 8000 ft)?
-Barometric pressure decreases -PaO2 and SpO2 will decrease -May require supplemental O2
55
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
Hypoxicator Tend
56
Diffusion limitation results from...
-Loss of lung tissue -Thicker A/C membrane
57
What happens with diffusion limitation?
-Okay at rest -Severely short of breath with exercise
58
To help with diffusion limitation, you can give ___ ___ during exercise
Supplemental oxygen
59
The hallmark of diffusion limitation is ____ ___ ____
Hypoxemia on exertion
60
When someone with diffusion limitation exercises, they have insufficient ____ transfer
O2
61
Diffusion limitation is measured by...
DLCO (diffusing capacity of the lungs for carbon monoxide)
62
DLCO reflects ____ ____
Diffusion capacity
63
Normal ventilation requires...
-Contraction of the diaphragm -Expansion of the chest wall -Adequate tidal volume to flush CO2 from alveoli
64
If normal ventilation does not occur, what results?
-Increased CO2 -Decreased O2 -pH decreases (more acidic-> respiratory acidosis)
65
Common causes of hypoventilation are anything that decreases ____ ____
Alveolar ventilation
66
What are examples of things that would decrease alveolar ventilation and cause hypoventilation?
-CNS drive is depressed -Rapid shallow breathing -Decreased tidal volume -Pain and splinting
67
What are the three zones of the lungs?
-Conducting -Transitional -Respiratory
68
___ ___ ____ is the last 1/3 of the inhale and is about 150 mL
Dead space ventilation
69
_____ is a deformity of the rib cage that can impact respiration
Kyphoscoliosis
70
With ___, a ventilator is commonly used to increase tidal volume
ALS
71
Acute exacerbation of COPD causes...
-Rapid, shallow breathing -Small tidal volume (increase PaCO2) -Primarily ventilate dead space
72
A _____ can increase dead space
Tracheostomy
73
We worry about dead space ventilation with restrictive diseases secondary to ____ conditions like ALS, post polio, Duchennes's Muscular Dystrophy
Neuromusclar
74
When respiratory muscles lose function, ____ ____ falls, and CO2 is retained, causing acidosis
Tidal volume
75
To manage hypoventilation/dead space ventilation, we can use ____ ____ ____ (mouthpiece, mask, tracheostomy)
Positive pressure ventilation
76
An absolute shunt causes _____ without ____
Perfusion without ventilation
77
An increase in absolute dead space causes increased ____ without _____
Ventilation without perfusion
78
A relative ventilation/perfusion (V/Q) imbalance causes some decreased ____ and some decreased ____
Ventilation, perfusion
79
What are examples of ventilation/perfusion (V/Q) imbalances?
-Pulmonary embolus (dead space ventilation/no perfusion) -COPD exacerbation (no ventilation) -Community onset pneumonia (no ventilation)
80
A V/Q imbalance / Shunt is distinguished by the response to ____
O2
81
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 ____
V/Q mismatch (brisk response) Shunt (no brisk response)
82
With an absolute shunt or absolute dead space, increased ____ has little impact because O2 is not reaching the blood
FIO2
83
With a V/Q mismatch, the hypoxemia does respond to ___
O2
84
Covid can cause ___ ___ ___ by viral replication in nasal, bronchial, and epithelial cells and compromise of the epithelial-endothelial barrier
Acute respiratory failure
85
Covid can cause an inflammatory response and cause interstitial thickening, increased vascular permeability, and lead to the development of pulmonary edema and a ____
Shunt
86
In some patients with covid, they may have ____ hypoxemia
Silent hypoxemia
87
With silent hypoxemia, someone has a very low ____ without dyspnea, loss of consciousness, or loss of alertness
SpO2 (70%) (also low PaO2 of 40)
88
Long term outcomes of acute renal failure and covid:
-Restrictive disease -Decreased diffusion capacity -Fibrotic changes -Dyspnea -Decreased exercise capacity
89
At risk populations for respiratory failure:
-Obstructive sleep apnea (90% undiagnosed) -Morbid obesity -Extremes of age -No previous opioid use -Escalating dose requirements/habituation -Concomitant sedatives or CNS depressant
90
Type I respiratory compromise is ___ ___ ___ ___
Hyperventilation Compensated Respiratory Disress
91
Type I respiratory compromise can be caused by...
-Sepsis -CHF -PE
92
Type II respiratory compromise is ____ ____ ____ (CO2 narcosis)
Progressive Unidirectional Hypoventilation
93
Type III respiratory compromise is ____ ____ ____
Sentinal rapid airflow (SpO2 reduction to precipitous fall)
94
Traditional monitoring of respiratory rate is with either...
-Impedance respiratory rate monitoring (ECG) -Pulse oximetry

Pathophysiology (18 decks)

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