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Respiratory Flashcards

1
Q

Label picture 27 (9)

A

See picture 28

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2
Q

Name 5 causes hypoxemia (low pa02)

A

• low fio2
• hypoventilation
•decreased DLCO (diffusing capacity of lungs for Carbon monoxide) - ability to assess lungs’ ability to transfer gas to blood. Damage to alveolar-capillary interface.
• shunt ( po2 (A -a) > 15)
. VQ mismatch ( part of lung receive oxygen but no blood flow or other way around) (deadspace ventilation and intrapulmonary shunting)

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3
Q

Normal Pa02?

A

80-100 mmHg
(The amount of O2 in blood available to bind with Hb)

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4
Q

Define mild hypoxia value

A

Pa02 60-80 mm Hg

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5
Q

Define moderate hypoxia value using paO2

A

Pa02 40-60 mmHg

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6
Q

Define severe hypoxaemia value

A

<40 mmHg PaO2

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7
Q

What is physiological peep?

A

2-3 cm H2O

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8
Q

Result of too much peep?

A

Dead space ventilation

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9
Q

Name 4 causes haemoglobin oxygen dissociation curve to left

A

Increased affinity for oxygen
• hypothermia
• decrease pco2
• decrease 2,3 DPG (facilitate oxygen release)
• decrease hydrogen (increase ph)

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10
Q

Name 4 causes haemoglobin oxygen dissociation curve to right

A

Decreased affinity
• hyperthermia
Increase pco2
• increase 2,3 DPG
• increase hydrogen (decrease PH)

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11
Q

How much fio2 given intra-op?

A

At least 30%

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12
Q

How does general anaesthesia affect shunt fraction?

A

Increase by 5%

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13
Q

Lung compliance formula?

A

Change in volume ( l) ÷ change in pressure (cm)

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14
Q

Minute ventilation (mv) formula?

A

TV X rr

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15
Q

Which 3 factors are important in considering pa02?

A

• Fi02
• Pbarometric
• age

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16
Q

Identify pathology picture 29

A

Obstructive lung disease atelectatic

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17
Q

Simple formula for pa02?

A

102 - age/3

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18
Q

Identify pathology picture 30

A

Obstructive lung disease

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19
Q

Identify pathology picture 31

A

Bronchiectatic obstructive lung disease

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20
Q

Differences in static lung volumes in obstructive lung disease? (3)

A

• Larger FRC functional residual capacity
• increase tlC total lung capacity
• increase rv residual volume significant!

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21
Q

Diagnosis obstructive lung disease? (2)

A

FEV1: FvC <70% predicted and not reversible with bronchodilators
FEF 25-75% (forced expiratory flow )

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22
Q

Identify pathology picture 32

A

Graph 1: normal
2: obstructive
3: restrictive

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23
Q

Identify pathology picture 33

A

Restrictive lung disease

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24
Q

Identify pathology picture 34

A

Restrictive lung disease

25
Q

Name changes of static lung volumes in restrictive lung disease (3)

A

• Decreased TLC (total lung capacity)
• decreased FRC
Also decrease FEV1 and FvC severely

26
Q

Tidal volume distribution formula in normal awake breathing?

A

2 4 6 rule
Vtidal (6 ml/kg) = Valveolar (4ml/kg) + Vdeadspace (2ml/kg)
33 % therefore don’t reach alveoli

27
Q

Tidal volume distribution formula in anaesthetised ventilated patient?

A

Rule of 3 3 6
Vt (6ml/kg) = Va (3) + Vd (3)
Therefore 50% doesn’t reach alveoli.

28
Q

How is problem of only 50% gases reaching alveoli in anaethetised intubated patient solved? (4)

A

Give initial Vt of 8-9ml/kg (instead of normal 6)
Cautiously adjust to need of patient according to
• underlying lung disease
• airway pressure
• EtCO2

29
Q

Describe the different degrees of postoperative lung restrictions in upper abdominal, lower abdominal and thoracic, and other anatomical sites

A

•Upper abdominal surgery non-laparascopic: most profound restrictive defect post-op, 40-50% decrease FRC
• lower abdominal or thoracic surgery: 30% decrease FRC
• other operative sites eg ENT, intracranial: 15-20% decrease FRC

30
Q

Name 4 complications of decrease in FRC post op (atelectasis)

A

• Shunt
• hypoxaemia
• pulmonary infection
• Respiratory failure

31
Q

Pre-op management and anaesthetic implications of recent URTI in obstructive lung disease?

A

• Attempt to reduce secretions pre-op
• limit manipulation of potentially hyperresponsive airway
-Regional preferred to general anaesthesia
- if general, use SGA rather than ETT

32
Q

Treatment of intra-op bronchospasm? (6)

A
  1. Call for help
  2. Stop offending agent/stimulus eg ET tube
  3. 100 % oxygen and deepen anaesthesia with volatiles (potent bronchodilators), sedation or combination
  4. Administer beta 2 (salbutamol inhalation/IV) (will decrease BP) or alpha 2 agonist
    5 IV epinephrine in doses of 10 mcg/kg
  5. IV corticosteroids for later when need to extubate
    Ketamine may also be considered, good bronchodilator. Also MgSO4
33
Q

Most effective treatment aspiration pneumonitis?

A

Supplemental oxygen and ventilator support including peep

34
Q

Tidal volume given to patients with obstructive lung disease?

A

10-12 ml/kg
(Normal 6-8)

35
Q

Tidal volume given to patients with restrictive lung disease?

A

6-8 ml/kg (normal)

36
Q

Ventilation rate given to patients with obstructive lung disease?

A

8-10 bpm
(Normal =12)

37
Q

Ventilation rate given to patients with restrictive lung disease?

A

16-20 bpm
(Normal 12)

38
Q

I:E given to patients with obstructive lung disease?

A

1:3
(Normal 1:2)

39
Q

I:E given to patients with restrictive lung disease?

A

1:1,5 to 1:1
(Normal 1:2)

40
Q

Peak inspiritory pressure given to patients with obstructive lung disease?

A

Low as possible <30 cm H2O (normal)

41
Q

Peak inspiritory pressure given to patients with restrictive lung disease?

A

Low as possible <35 cm H2O
Normal <30

42
Q

Plateau inspiritory pressure given to patients with obstructive lung disease?

A

Low as possible <25 cm H2O (normal)

43
Q

Plateau inspiritory pressure given to patients with restrictive lung disease?

A

Low as possible <30 cm H2O
(Normal < 25)

44
Q

Hbsa02 given to patients with obstructive lung disease?

A

> 80-90%
(Normal 92-98%)

45
Q

Hbsa02 given to patients with restrictive lung disease?

A

> 88-90 %
(Normal 92-98 %)

46
Q

PaCO2 given to patients with restrictive and obstructive lung disease?

A

> 39 mmHg
(Normal 31-39)

47
Q

Name 4 risk factors hypercarbia

A

• Co2 retention pre-op
• high dose opioids
• airway obstruction
• inadequate muscle relaxant reversal

48
Q

Name 5 signs bronchospasm

A

• increased peak airway pressures (normal plateau inspiratory pressure)
• wheezing
• increased expiratory time (causes shark fin appearance on capnogram , and may even cause pneumothorax due to auto-peep activation on machine)
• increased end tidal co2 with upsloping et c02 waveform (shark fin capno)
• decreased tidal volumes if pressure contro)

49
Q

How should an asthma patient be anaesthetised? (7)

A

• Regional anaesthesia best so can maintain own airway
. If Ga necessary, use supraglottic airway device if no risk aspiration
• if intubation required: deep plane anaesthesia.
• induction: propofol/etomidate (thiopentone contraindicated, release histamine)
• analgesia: synthetic opioids eg tramadol, fentanyl ; ketamine (morphine contraindicated)
• muscle relaxant: vecuronium/cis-atracurium (atracurium, mivacurium, roc release histamine in high doses)
• volatiles safe to maintain (bronchodilators)
• use drugs that promote bronchodilatation: inhalation, ketamine, mgs04

50
Q

Name 5 at risk groups for laryngospasm

A

•Children
• airway surgery
• thyroid surgery: recurrent laryngeal nerve injury
• parathyroid surgery: recurrent laryngeal nerve injury, hypocalcaemia ( cause stridor)
• patients not completely awake (MAC 0,7-03)

51
Q

How does laryngospasm present (2)

A

• Stridor
. See saw movement of chest and abdo - trying to breathe against closed vocal cords

52
Q

What is normal p/f ratio?

A

(Pa02/fi02)
>300

53
Q

What is acute lung injury p/f ratio?

A

200-299
Go to high care

54
Q

What is ARDS p/f ratio?

A

<200
Go to ICU and keep intubated and ventilated

55
Q

Name the ventilator settings used for COPD patients (6)

A

• Mode: volume control (more control for physiological parameters)
• tidal volume: 8 ml/kg (higher than normal 6 - hyperinflation, low compliance)
• Respiratory rate: 10 (lower than normal 12 - slow rate = increased expiration time)
• i:e: 1:3 (higher than normal 1:2- increased expiration time so lungs can empty)
• fi 02 : lower. sats 88-92%, pre-op blood gas (hypoxia drive needed to breathe, high oxygen =decreased spontaneous breaths)
• PEEP: 0. (Auto-peep due to air trapping)

56
Q

Name 4 types hypoxia according to delivery of oxygen formula

A

1 stagnation hypoxia (cardiac output deranged) - cardiac failure, valvular disease, pericarditis. Treat cause.
2. Anemic hypoxia (hb) - treatment is transfusion, if hb < 3 it’s inadequate to maintain supply to match vo2
3. Hypoxic hypoxia (Sats) - any path interfering with gas exchange (shunt / ventricular septal defect). treat by increase oxygen, cpap, intubate and ventilate
4 toxic hypoxia (1,34 binding capacity of hb) - Co poisoning eg, treat with exchange transfusion (depend on poison)

57
Q

Define functional residual capacity

A

Residual volume plus expiratory reserve volume

58
Q

Ventilator settings for restrictive lung disease? (4)

A

• Tidal volume 6-8 ml /kg
• Respiratory rate high. 16
• aim for saturations > 88-90%
• i:e low 1:1

59
Q

Nb name 10 causes increase peak inspiratory pressure

A

If high difference (>5cm h20) between peak and plateau pressures (high peak, low plateau): increased restrictive work
• bronchospasm
• anaphylaxis
• endotracheal tube obstruction
• ventilator circuit obstruction eg ventilator tubing kinked

If low difference (high peak and plateau): acute decrease lung compliance, increased elastic work
• pneumothorax
• tension pneumothorax
• evolving pneumonia
• pulmonary oedema
• ARDS
• auto-peep caused by “breath stacking”

Anaesthesiology (24 decks)

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