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GNURS627 > Resp Final > Flashcards

Resp Final Flashcards

1
Q

Larynx: Anatomic Location

A

Adult: located anterior to 3rd-6th cervical vertebre

At birth: level at C3-4

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2
Q

A-O extension

A

normally 35 degrees

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3
Q

MP Class. 1 & 2

A

full view of uvula and tonsillar pillars, soft palate

partial view of uvula or uvular base, partial view of tonsils, soft palate

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4
Q

MP Class. 3

A

soft palate only

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5
Q

MP Class. 4

A

hard palate only

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6
Q

Recurrent Laryngeal nerve (CNX)

A

trachea below VC’s

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7
Q

Internal branch Superior Laryngeal nerve (CNX)

A

mucus membrane above the VC’s, glottis

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8
Q

Glossopharyngeal nerve (CN IX)

A

lingual back 1/3, pharyngeal, tonsillar nerves) – oral pharynx, supraglottic region

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9
Q

Sphenopalatine ganglion

A

middle division of CN V) – nasal mucosa, superior pharnx, uvula, tonsils

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10
Q

Internal SLN

A

provides sensation to supraglottic & ventricle compartment, STIMULATION CAUSES LARYNGOSPASM

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11
Q

External SLN

A

provides motor innervation of cricothyroid muscle

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12
Q

Left RLN

A

passes @ Aortic Arch

Provides Sensory innervation to infraglottis

Motor innervation to all larynx except cricothyroid muscle
Stimulation causes abduction of VC
Damage to RLN cause VC adduction

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13
Q

Trachea

A

Extends from C6 to T5

At carina (level T5-7) divides into 2 bronchi @ 25cm from teeth

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14
Q

Airway structures that participate in gas exchange

A

Respiratory Bronchiole

Alveolar Duct

Alveoli

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15
Q

Lung segment with thick smooth muscle (Contraction)

A

Bronchiole

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16
Q

Phrenic nerve

A

(C 3,4,5) transmits motor stimulation to diaphragm

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17
Q

Intercostal nerves

A

(T 1-11) send signals to the external intercostal muscles

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18
Q

The act of inhaling is?

A

negative-pressure ventilation

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19
Q

FRC =

A

ERV + RV

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20
Q

Spirometry cannot measure

A

Residual Volume (RV) thus Functional Residual Capacity (FRC) and Total Lung Capacity (TLC) cannot be determined using spirometry alone

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21
Q

FRC and TLC can be determined by

A

1) Helium dilution, 2) Nitrogen washout, or 3) body plethysmography

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22
Q

Look at Flow Volume Loop and Obstructions

A

Slide 19 & 20

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23
Q

Functions of Surfactant (3)

A

Lowers surface tension of alveoli & lung

Promotes stability of alveoli

Prevents transudation of fluid into alveoli

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24
Q

Poiseuille’s Law

A

r is radius of tube (to 4th power)

***reducing r by 16% will double the R

***reducing r by 50% will increase R 16-fold

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25
Q

Two mechanisms employed to decrease PVR when PVP rises

A

Recruitment & Distention (Slide 25)

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26
Q

Pulmonary Hemodynamics

A

Slide 23 & 24

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27
Q

Pulmonary Cap. characteristics

A

70-80% of alveolar surface area covered by capillary bed

Functional capillary volume

Capillary volume increases by opening closed segments (recruitment)

70 ml (1 ml/kg body weight) normal volume at rest
200 ml at maximal anatomical volume
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28
Q

Lung Zones

A

Slide 28

Zone 3 best in upright lung: Pa>Pv>PA

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29
Q

PVR Vasoconstrictors

A 
Reduced PAO2
Increased PCO2
Thromboxane A2
α-adrenergic catecholamines
Histamine
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30
Q

PVR Vasodilators

A

Increased PAO2
Prostacyclin
Nitric oxide

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31
Q

Alveolar hypoxia produces

A

hypoxic pulmonary vasoconstriction (HPV)

  • Localized response of pulmonary arterioles
  • Contraction of smooth muscle in small arterioles in hypoxic region
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32
Q

How does HPV improve V/Q

A

Shift of flow to better ventilated pulmonary regions

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33
Q

Normal alveolar PO2

Minimum ml O2/min

A

100mmhg

250ml O2/min

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34
Q

Normal alveolar Pco2

Normal CO2 production

A

40

200ml/min

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35
Q

Alveolar air is expired at

A

end of exhalation

36
Q

Fick’s Law

A

Diff. = (A * Dpp * D) / T
Diff. is diffusion of gas through a tissue membrane
A is cross sectional area of membrane
Dpp is the driving pressure (partial pressure difference)
D is gas coefficient
T is tissue thickness or length through membrane

37
Q

Physiologic Shunt =

A

perfusion but no ventilation

V/Q is below normal

Slide 37

38
Q

Physiologic Dead Space =

A

ventilation but no perfusion

V/Q greater than normal

Slide 38

39
Q

Saturation & Corresponding PAO2 Values

A

100 100+

95 75

90 60

75 40 (mixed venous blood in pulm. artery)

60 30

50 27 (Hb P50 point)

40
Q

HGB 02 Curve Slide 42

Curve affected in two ways, what are they and which is worse?

A

Shift in position

Change in shape

A change in shape indicates a greater interference with O2 transport than curve shift

41
Q

What happens with a right shift

A

Hb has less affinity for O2, releases O2, saturation will be less for a given PO2

Increased CO2/Temp/H+/2,3 DPG

42
Q

What happens with a left shift

A

Hb has higher affinity for O2, binds O2, saturation will be higher for a given PO2

CO2/Temp/H+/2,3 DPG

43
Q

CaO2 Equation

CaO2 = O2 content in blood (ml/dL)

A

CaO2 =

SO2 * [Hb] * 1.31) + (PO2 * 0.003

44
Q

Most C02 is transported as?

A

Bicarb (70%)
Carbonic Acid (23%)
C02 (7%)

45
Q

The DRG controls

A

inspiration & respiratory rhythm

46
Q

DRG receives signals from three sources

A

Peripheral chemoreceptors

Baroreceptors

Lung receptors

47
Q

Chemo sensitive area responds to what?

A

C02 & H+

CO2 has potent direct effect, via [H], on the chemosensitive area

48
Q

C02 is what to the blood brain barrier?

A

highly permeable to blood-brain barrier so blood & brain concentrations are equal

49
Q

Carotid Bodies are where and respond to what?

A

stimulated by hypoxemia

Bifurcations in common carotid

Afferent nerve fibers pass via CN IX to act on DRG

50
Q

Aortic Bodies where and stimulated by what?

A

hypoxemia

Aortic arch

CN X to DRG

51
Q

Chemoreceptor Impulse Rate is sensitive to drops in PaO2 from a range?

A

60 mmHg to 30 mmHg (hypoxia)

52
Q

High Risk PFT results

A

FEV1 < 2L

FEV1/FVC < 0.5

VC < 15cc/Kg in adult & < 10cc/Kg in child

VC < 40 to 50% than predicted

53
Q

Intubation Criteria

A

Slide 54

54
Q

Extubation Criteria

A

VSS, awake & alert,

resp. rate < 30

ABG on FiO2 of 40%  PaO2 >70 and PaCO2 <55

MIF is more negative than -20cm H2O

Vital capacity (VC) > 15cc/Kg

55
Q

ABG Values

A

pH: 7.35 – 7.45

PCO2: 35 – 45 mmHg

PO2: 75 – 105 mmHg

Bicarbonate: 20 – 26 mmoles/L

Base excess: -3 to +3 mmoles/L

56
Q

an increase of PCO2 by 10 mmHg causes a?

A

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

57
Q

A-a gradient is a measure of what?

A

efficiency of lung

Normal A-a = approximately (Age / 3)

Look at slide 58

58
Q

a decrease in bicarb. by 10 mmoles does what?

A

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

59
Q

Total body bicarb. deficit equation?

A

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

usually replace ½ of deficit

60
Q

Puzzle slide for acid base (Slide 60)

A

Slide 60

61
Q

Pulse ox wavelengths

A

940nm = infrared light, oxyhemoglobin absorbs more of this light, corresponds to 100% saturation

660nm = red light, deoxyhemoglobin absorbs more of this light, corresponds to 50% saturation

62
Q

Carboxyhemoglobin (COHb)

A

a SpO2 of 100%, this is an overestimation of the true oxygenation, co-oximeter used to distinguish between the two

63
Q

Methemoglobin (MetHb)

A

Fe2 changed to Fe3

absorbs equally at both wavelengths, 1:1, shows a SpO2 of 85%,

Tx’d with low dose methylene blue or ascorbic acid

64
Q

Fetal _______ and ___________ do not effect pulse Ox

A

hemoglobin and bilirubin

65
Q

Capnography rapidly and reliably indicates _______ _______ but does not reliably detect _______ ________

A

esophageal intubation, endobronchial intubation

66
Q

What is the gold standard for tracheal intubation

A

EtCO2

67
Q

Capnogram

A

AB segment = beginning exhalation, dead space gas

BC segment = exhalation, mixing of gases

CD segment = alveolar plateau, alveolar rich gas

D point = highest [CO2]

DE = start inspiration

68
Q

Difficult Airway Algo. (Slide 65)

A

Slide 65

69
Q

In the ________ & _______ the _______ lung is better perfused (gravity) & ventilated

A

Awake, Lateral

dependent

70
Q

Factors that inhibit HPV

A

Very high or very low pulmonary artery pressures

Hypocapnia

High or very low mixed venous PO2

Vasodilators: nitroglycerin (NTG), nitroprusside (SNP), b-adrenegic agonists (dobutamine), calcium channel blockers

Inhalation agents

71
Q

Hypoxia during one lung ventilation*** Slide 68

A

Slide 68

72
Q

MH Triggers

A

by inhaled agents (not N2O) and/or succinylcholine

73
Q

MH First sign, most sensitive

A

unexplained tachycardia

74
Q

MH Most Specific

A

increasing EtCO2 = hypercapnia, 2-3X

75
Q

MH S/s

A

decrease in SaO2 & SpO2, rigidity despite muscle relaxant onboard, dysrhythmias, tachypnea, cyanosis, sweating, unstable BP, mottling of skin, trismus (masseter spasm) after succinylcholine, darkening of blood in surgical field, decreased mixed venous saturation, cola-colored urine, heating and exhaustion of CO2 absorber, hyperthermia

76
Q

MH Labs

A

Labs: initial metabolic acidosis then a combined metabolic & respiratory acidosis, hyperkalemia, hypercalcemia, hyperphosphatemia, creatinine kinase (CK) > 1000 IU, myoglobinuria, hypoxemia

77
Q

Factors that increase MAC

A

Age: term infant to 6 months of age has the highest MAC requirement

Hyperthermia

Chronic EtOH abuse

Hypernatremia

Drugs that increase CNS catecholamines

78
Q

Factors that decrease MAC

A

Hypothermia: for every 1 deg. C drop in body temp – MAC decreases 2 to 5%

Elderly

Pregnancy

Acute EtOH ingestion

Hyponatremia

Severe hypoxemia – PaO2 < 38 mmHg

79
Q

No effect on MAC

A 
Thyroid gland dysfunction
Duration of anesthesia
Gender
Hyperkalemia
Hypokalemia
Hypocarbia
Hypercarbia
80
Q

Second Gas effect

A

The ability of a large volume uptake of a first gas (N2O) to accelerate the rate of rise of the alveolar partial pressure of a concurrently administered companion gas (agent) thus speeding induction

81
Q

Second gas effect example

A

Example: (alveolar space): 70% N2O, 30% O2 and ISO 1%____rapid uptake of ½ of the N2O _____35% N2O, 30% O2, and ISO now 1.53%

82
Q

Diffusion Hypoxia

A

Avoided by administering 100% O2 following N2O use

83
Q

Nicotine ________ sympathetic ganglia – catecholamines

A

stimulates.

catecholamines released from adrenal medulla – increasing HR, BP, and SVR – persists 30 minutes after last cigarette

84
Q

What to do with bad COPD

A

Pre-O2 well and avoid instrumentation of airway until deep level of anesthesia

85
Q

Preop smoking cessation education

A

Advise stopping at least 12 hours prior to surgery

Cessation of > 8 weeks will reduce post-op pulmonary complications

86
Q

Bronchospasm & what drugs to avoid

A

avoid *histamine releasing drugs
Pentothal (STP), Morphine (MSO4), Atracurium, Mivacurium, Neostigmine

Tx with nebulized albuterol especially before extubation

GNURS627 (5 decks)

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