Respiratory 1 Flashcards
Capillaries occupy 70-80% of ______ surface area
alveolar
normal respiratory rate for newborn?
30-60
normal respiratory rate for early childhood?
20-40
normal respiratory rate for late childhood?
15-25
normal respiratory rate for adults
10-15
how many alveoli in the normal human lung?
300 million
what is an average tidal volume?
500 ccs
how much do we breathe per minutes?
6 Liters (similar to cardiac output)
what is the normal saturation?
100%
when do hear rales and crackles?
Will hear on inspiration
when do you hear rhonchi and wheezing?
Hear on expiration
if you hear wheezing on inspiration what type issue is it?
Upper airway
what is the I:E ratio?
1:2
do you breathe quicker in or out?
In
what does cobblestoning of pharynx indicate?
Allergies
why do people turn cyanotic
vasoconstriction; want to shunt all the blood to the brain
when percussion is dull, what can it be?
Flesh of the lung (full of crap, not air) consolidation
lots of fluid (pleural effusion)
If percussion is hyperessonance?
Lots of air (pneumothorax or emphysema)
when will you feel fremitus?
Consolidation
what are normal breath sounds?
Vesicular
when will you hear bronchial breath sounds?
Sounds like blowing through a hose
consolidation (pneumonia)
what does clubbing look like
convex nail (spoon)
what is clubbing a sign of?
chronic hypoxia
do you normally use other muscles besides the diaphragm to breath?
No
is hypoxia usually a late or early finding of respiratory failure?
Late sign
what is low pO2 in tissues?
Hypoxia
what is low oxygen in the blood?
Hypoxemia (see on ABGs)
what is normal p)2
70-80 mm Hg
what does the last number of the pH usually correlate with?
Carbon dioxide level
how much percentage of the air is oxygen?
21%
5 causes of hypoxia?
V/Q mismatch
altitude (rare unless lungs not working well)
alveolar hypoventilation (end stage process)
decreased diffusion (problem w/ alveoli and vessel)
Shunt (anatomic)
3 main parts of the lungs?
Bronchus
Alveoli
Capillaries
things that cause decreased diffusion
pulmonary fibrosis
emphysema
what is V/Q mismatch
too much blood, not enough air
too much air, not enough blood
what does 90 hemoglobin saturation correspond to a PO2 of?
60
is there a lot of difference b/w 90-100 hemoglobin saturation?
No, corresponds to about 60 and above O2
No problem with lung parenchyma
Not moving air in and out
Elevated pCO2, decreased pO2
Alveolar hypoventilation
when do you mostly see alveolar hypoventilation?
Drugs
obesity
CNS injury
neuromuscular weakness
blood flow goes through without having a chance at being oxygenated?
Shunt
does increased FIO2 help with shunts?
No
2 diseases causing shunts
Intracardiac defects
Dense consolidated pneumonia
when can you see V/Q mismatch
PE
COPD
pneumonia
asthma
The relative ventilation and perfusion of all alveoli determines the PO2 of the blood.
V/Q mismatch
does delivering oxygen help with V/Q mismatch
yes
what is FVC?
forced vital capacity
Amount of air able to expire
what is FEV1?
Amount of air able to expire in 1 sec
what is RV?
residual volume
Amount of air left in lung after exhalation
What is TLC?
Total lung volume
what fall under the category of restrictive lung disease? flesh of the lung problem
Pulmonary fibrosis
Obesity
What fall under the category of obstructive lung dz?airway problem
Asthma
COPD
how much of the air should come out in expiration in the first second?
75% of the air
what is (forced) vital capacity?
as much of the air you can possibly empty out
forced- where you push the air out
Caused by a variety of lung diseases
Interstitial Lung Diseases, silicosis
Restrictive Defect
what diseases do you see in New Mexico a lot scarring lung disease?
mining
If you have a normal lung volume, can you have a restrictive lung disease?
No
If obstructive lung disease FEV1 decreases more than….
FVC
In an restrictive lung dz what are low?
FEV1
FVC
why do you look at/ count the posterior ribs?
fixed to the spine
where does the film go on the x-ray?
on the anterior aspect and beam goes from the back
Air in pleural space; visceral pleural line
Pneumothorax
who is at greatest risk of a pneumothorax?
tall thin males
smokers
what can also mimic a pnuemothorax?
COPD (hyper-lucent) air within lung
tx for a pneumothorax?
chest tube placement
after a tension pneumothorax what are patients placed on?
vents
don’t see diaphragm on x-ray, structures being pushed away from the slide.
pleural effusion
local problems, usually only found on one side of the chest
pus, cancer, blood
the higher the LDH the more what?
cell dying; if this is high in a fluid it is probably from cell dying in that system
1 of what categories must you have for exudates?
LDH fl/s ratio 0.6
protein fl/s ratio >0.5
pleural fluid LDH >2/3 upper limit normal LDH
what is empyema?
pus in pleural
what must you have to qualify a hemothorax?
Hct of fluid (in pleura) >50% serum Hct value
what can cause pulmonary fibrosis?
scarring of lung due to injury chronic aspiration inhalation injury ARDS Infection occupational exposures collagen-vascular related (lupus, RA, vasculitis)
Person presents with dyspnea and desaturation w/ exercise. Have nonproductive cough, clubbing
“Velcro rales” at bases on inspiration
Pulmonary fibrosis
what is a VQ scan good for?
rule out pulmonary embolism
what does a VQ scan show?
inhale nuclear stuff
put nuclear stuff in IV
see if they match or not
what must you compare the VQ scan to?
chest x-ray (look for mass)
what can provide false positives of VQ scans?
asthma
obstructie airway
obstructing tumors
when should you not do a V/Q scan?
severe obstructive lung dz
what is the best test for patients w/ abnormal CXR?
Spiral CT
what is a good way to look for clots of the lower extremities (where 75% of PEs come from)?
doppler
are pulmonary arteriograms used?
No, spiral CTs are used; however this is the gold standard
how long does tx for a PE last?
at least 6 months
drugs used to treat PE?
Heparin/ lovenox followed by Coumadin
to evaluate persistent infiltrates on CXR or mass.
Bronchoscopy (only in the bronchi)
to evaluate upper airway, vocal cord problems
laryngoscopy
to biopsy mediastinal nodes in CA work up. Cut and go behind the sternum
Mediastinoscopy
to evaluate type of pleural effusion
Thoracentesis
Used primarily in evaluating nodules, masses for malignancy.
PET scan; if it lights up then it may be malignant
what type lung dz will there be with obesity
restrictive lung disease
if something very sudden happen what problem is it usually?
Vascular
causes of acute dyspnea (cardiac)?
Acute MI
CHF
Cardiac tamponade
High pressure on the right side of the heart
Pulmonary HTN
when will you hear wheezing?
Any narrowing of the airway
PE
wheeze heard on one side of the chest, heard on inspiration and expiration.
endobronchial obstruction
How do you make a diagnosis of vocal cord dysfunction
Diagnosis of VCD is from indirect or direct vocal cord visualization during an episode, during which abnormal adduction can be documented
what is the number one reason to see a doctor in U.S.?
Cough
what are the 4 most common reasons for chronic cough?
Asthma
GERD
allergic rhinitis
Lisinopril
most common reason on hemoptysis?
Bronchitis
bronchogenic carcinoma
bronchiectasis
red, frothy, mixed with sputum.
Alkaline
Hemoptysis
