quiz 7

Question 1

Avoid what in bronchospasms? and list drugs? Tx?

Answer 1

Histamine releasing drugs

ex: Pentothal, Morphine, Atracurium, Mivacurium, Neostigmine

Albuterol Neb

Question 2

PFT ext. Criteria?

Answer 2

RR <30
ABG on 40%fio2 - 02 >70, PCO2 <55
MIF < -20cm H2O (aka -30, -40) max inspiratory force
Vital Capacity (VC) >15cc/kg

Question 3

Intubation criteria categories

Answer 3

• Mechanics
• Ventilation
• Oxygenation
• Clinical

Question 4

Intubation criteria: Mechanics?

Answer 4

RR>35
VC <15cc/Kg in adult or <10cc/Kg in child
MIF more neg. than -20cmH2O

Question 5

Intubation criteria: Ventilation?

Answer 5

PaCO2 > 55 (except in chronic hypercarbia)

Vd/Vt > 0.6 (remember normal dead space is 30%)

Question 6

Intubation criteria: Oxygenation

Answer 6

PaO2 < 70mmHg on FiO2 of 40%

A-a gradient > 350mmHg on 100% O2

Question 7

Intubation criteria: Clinical

Answer 7

airway burn, chemical burn, epiglottitis, mental status change, rapidly deteriorating pulmonary status, fatigue

Question 8

PaCo2 Rule?

Answer 8

an increase of PCO2 by 10 mmHg causes a decrease in pH by 0.08, likewise, a decrease of PCO2 by 10 mmHg will increase pH by 0.08

Question 9

what is A-a gradient? Normal A-a gradient?

Answer 9

a measure of efficiency of lung

Approx Age/3

Question 10

Bicarb Rule

Answer 10

a decrease in bicarb. by 10 mmoles decreases the pH by 0.15, likewise, an increase in bicarb. By 10 mmoles increases pH by 0.15

Question 11

Total body bicarb equation? Replace how much?

Answer 11

(base deficit * wt in Kg * 0.4), in mEq/L,

usually replace ½ of deficit

Question 12

what type of PH upset does COPD have? symptoms? long term?

Answer 12

Respiratory acidosis

hypoventilation/hypercarbia

After 1-2 days renal compensation occurs
H+ excreted by kidney and HCO3- reabsorbed into blood to PARTIALLY correct pH

Question 13

Causes Respiratory Alkalosis

Answer 13

hypoxic respiration, CNS Dz, encephalitis, anxiety, narcotic withdrawl, pregnancy, early septic shock, hypermetabolic states, artificial ventilation

Pregnancy/artificial ventilation underlined

Question 14

Causes of metabolic acidosis

Answer 14

lactic acidosis from hypoperfusion, DKA, renal Dz with bicarb loss (anion gap and K+), HCO3- loss in diarrhea, ASA ingestion, high protein intake

Underlined: Lactic acidosis/Diarrhea

Question 15

Causes of metabolic Alkalosis

Answer 15

bicarb. infusion, metabolism of lactate or citrate, loss of H+ from vomiting or excessive NGT suctioning

Underlined: loss of H+ from vomiting or excessive NGT suctioning

Question 16

Most important clinical tool in assessing the severity of airway obstructive disease

Answer 16

FEV-1 Second

Question 17

What is independent of effort?

Answer 17

FEF 25-75

Question 18

High risk PFT results?

Answer 18

FEV1 < 2L
FEV1/FVC < 0.5
VC < 15cc/Kg in adult & < 10cc/Kg in child
VC < 40 to 50% than predicted

Question 19

Normal Base excess?

Answer 19

-3 to +3 mmols/L

Question 20

What can widen an A-a gradient?

Answer 20

• PE
• anesthesia
• PTX
• shunt
• V/Q mismatch
• diffusion problems