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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
Two mechanisms employed to decrease PVR when PVP rises
Recruitment & Distention (Slide 25)
26
Pulmonary Hemodynamics
Slide 23 & 24
27
Pulmonary Cap. characteristics
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 ```
28
Lung Zones
Slide 28 Zone 3 best in upright lung: Pa>Pv>PA
29
PVR Vasoconstrictors
``` Reduced PAO2 Increased PCO2 Thromboxane A2 α-adrenergic catecholamines Histamine ```
30
PVR Vasodilators
Increased PAO2 Prostacyclin Nitric oxide
31
Alveolar hypoxia produces
hypoxic pulmonary vasoconstriction (HPV) - Localized response of pulmonary arterioles - Contraction of smooth muscle in small arterioles in hypoxic region
32
How does HPV improve V/Q
Shift of flow to better ventilated pulmonary regions
33
Normal alveolar PO2 Minimum ml O2/min
100mmhg 250ml O2/min
34
Normal alveolar Pco2 Normal CO2 production
40 200ml/min
35
Alveolar air is expired at
end of exhalation
36
Fick’s Law
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
Physiologic Shunt =
perfusion but no ventilation V/Q is below normal Slide 37
38
Physiologic Dead Space =
ventilation but no perfusion V/Q greater than normal Slide 38
39
Saturation & Corresponding PAO2 Values
100 100+ 95 75 90 60 75 40 (mixed venous blood in pulm. artery) 60 30 50 27 (Hb P50 point)
40
HGB 02 Curve Slide 42 Curve affected in two ways, what are they and which is worse?
Shift in position Change in shape A change in shape indicates a greater interference with O2 transport than curve shift
41
What happens with a right shift
Hb has less affinity for O2, releases O2, saturation will be less for a given PO2 Increased CO2/Temp/H+/2,3 DPG
42
What happens with a left shift
Hb has higher affinity for O2, binds O2, saturation will be higher for a given PO2 CO2/Temp/H+/2,3 DPG
43
CaO2 Equation CaO2 = O2 content in blood (ml/dL)
CaO2 = | SO2 * [Hb] * 1.31) + (PO2 * 0.003
44
Most C02 is transported as?
Bicarb (70%) Carbonic Acid (23%) C02 (7%)
45
The DRG controls
inspiration & respiratory rhythm
46
DRG receives signals from three sources
Peripheral chemoreceptors Baroreceptors Lung receptors
47
Chemo sensitive area responds to what?
C02 & H+ CO2 has potent direct effect, via [H], on the chemosensitive area
48
C02 is what to the blood brain barrier?
highly permeable to blood-brain barrier so blood & brain concentrations are equal
49
Carotid Bodies are where and respond to what?
stimulated by hypoxemia Bifurcations in common carotid Afferent nerve fibers pass via CN IX to act on DRG
50
Aortic Bodies where and stimulated by what?
hypoxemia Aortic arch CN X to DRG
51
Chemoreceptor Impulse Rate is sensitive to drops in PaO2 from a range?
60 mmHg to 30 mmHg (hypoxia)
52
High Risk PFT results
FEV1 < 2L FEV1/FVC < 0.5 VC < 15cc/Kg in adult & < 10cc/Kg in child VC < 40 to 50% than predicted
53
Intubation Criteria
Slide 54
54
Extubation Criteria
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
ABG Values
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
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
57
A-a gradient is a measure of what?
efficiency of lung Normal A-a = approximately (Age / 3) Look at slide 58
58
a decrease in bicarb. by 10 mmoles does what?
decreases the pH by 0.15, likewise, an increase in bicarb. By 10 mmoles increases pH by 0.15
59
Total body bicarb. deficit equation?
(base deficit * wt in Kg * 0.4), in mEq/L, usually replace ½ of deficit
60
Puzzle slide for acid base (Slide 60)
Slide 60
61
Pulse ox wavelengths
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
Carboxyhemoglobin (COHb)
a SpO2 of 100%, this is an overestimation of the true oxygenation, co-oximeter used to distinguish between the two
63
Methemoglobin (MetHb)
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
Fetal _______ and ___________ do not effect pulse Ox
hemoglobin and bilirubin
65
Capnography rapidly and reliably indicates _______ _______ but does not reliably detect _______ ________
esophageal intubation, endobronchial intubation
66
What is the gold standard for tracheal intubation
EtCO2
67
Capnogram
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
Difficult Airway Algo. (Slide 65)
Slide 65
69
In the ________ & _______ the _______ lung is better perfused (gravity) & ventilated
Awake, Lateral dependent
70
Factors that inhibit HPV
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
Hypoxia during one lung ventilation*** Slide 68
Slide 68
72
MH Triggers
by inhaled agents (not N2O) and/or succinylcholine
73
MH First sign, most sensitive
unexplained tachycardia
74
MH Most Specific
increasing EtCO2 = hypercapnia, 2-3X
75
MH S/s
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
MH Labs
Labs: initial metabolic acidosis then a combined metabolic & respiratory acidosis, hyperkalemia, hypercalcemia, hyperphosphatemia, creatinine kinase (CK) > 1000 IU, myoglobinuria, hypoxemia
77
Factors that increase MAC
Age: term infant to 6 months of age has the highest MAC requirement Hyperthermia Chronic EtOH abuse Hypernatremia Drugs that increase CNS catecholamines
78
Factors that decrease MAC
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
No effect on MAC
``` Thyroid gland dysfunction Duration of anesthesia Gender Hyperkalemia Hypokalemia Hypocarbia Hypercarbia ```
80
Second Gas effect
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
Second gas effect example
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
Diffusion Hypoxia
Avoided by administering 100% O2 following N2O use
83
Nicotine ________ sympathetic ganglia – catecholamines
stimulates. catecholamines released from adrenal medulla – increasing HR, BP, and SVR – persists 30 minutes after last cigarette
84
What to do with bad COPD
Pre-O2 well and avoid instrumentation of airway until deep level of anesthesia
85
Preop smoking cessation education
Advise stopping at least 12 hours prior to surgery Cessation of > 8 weeks will reduce post-op pulmonary complications
86
Bronchospasm & what drugs to avoid
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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