Pulmonology Flashcards
Acute respiratory distress syndrome
Non-cardiogenic pulmonary edema
Cor pulmonale
Right-heart failure
Hemoptysis
Coughing up blood
Orthopena
Difficulty breathing while lying down
Paroxysmal nocturnal dyspnea
Difficulty breathing at night
Positive end-expiratory pressure (PEEP)
Extrinsic PEEP uses an impedance valve to increase volume of air remaining in lungs at end of expiration to improve gas exchange
Subcutaneous emphysema
Crackling under the skin upon palpitation due to trapped air. Typically found in chest, neck, or face
Tidal volume
Volume of air inhaled or exhaled with each breath; normal adult tidal volume is about 500mL
Ventilation
Mechanical process that moves air in and out of lungs
Inspiration
Active process of ventilation (requires energy)
Exhalation
Passive process of ventilation
External respiration
Movement of oxygen from the alveoli into the bloodstream and movement of CO2 from the blood stream to the alveoli
Internal respiration
The exchange of gasses (O2 & CO2) between the bloodstream and the tissues in the body
Minute volume
Respiratory rate x tidal volume
CO2 drive
The primary system for monitoring breathing status
Monitors CO2 levels in blood and cerebral spinal fluid
Chemoreceptors in the brain detect increased CO2 and rapidly trigger increased respiratory rate
Hypoxic drive
Backup to CO2 drive
Monitors oxygen levels in plasma
Prolonged exposure to high concentration oxygen in hypoxia drive patients can cause respiratory depression
May be present in end-stage COPD patients
Acid-base disorders
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Low pH and elevated CO2
PaCO2 greater than 45mmHg
Respiratory alkalosis
Elevated pH and low CO2
PaCO2 less than 35mmHg
Metabolic acidosis
Low pH and low HCO3
HCO3 below 22mmHg
Metabolic alkalosis
Elevated pH and elevated HCO3
HCO3 greater than 26mmHg
Normal arterial blood gas values
- pH: 7.35-7.45
- PaO2: 80-100 mmHg
- PaCO2: 35-45 mmHg
- HCO3: 22-26 mEq/L
- SaO2: 95% or above
Without adequate respiration x
- heart and brain become irritable almost immediately
- brain damage within 4 min
- permanent brain damage within 6 minutes
- irrecoverable brain damage within 10 minutes
Ventilation-perfusion mismatch
V/Q mismatch or V/Q defect
*Occurs when lungs receive oxygen,but not adequate blood flow
-or-
when the lungs receive blood flow, but inadequate oxygen
*could be a ventilator problem or perfusion problem
Mallampati score (used for oral intubation)
Class I: entire tonsil clear
Class II: upper half of tonsil visible
Class III: soft and hard palate visible
Class IV: only hard palate visible
LEMONS (for difficult airway)
L- look externally E- evaluate 3-3-2 rule M- mallampati score O- obstruction N- neck mobility S- saturation’s
Oxygen cylinder sizes and contents
D cylinder: about 350-L ; 0.16
E cylinder: about 625-L ; 0.28
M cylinder: about 3,000-L ; 1.56