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Critical Care Course > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Inspiration is:

A

Active part of ventilation- diaphragm contracts via autonomic nervous system

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2
Q

Respiratory rate and depth of breath is controlled by?

A
  • The Medulla Oblongata and Pons
  • Changes in carbon dioxide, hydrogen ion and oxygen levels in the blood
  • Autonomic nervous system
  • Chemo and stretch receptors
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3
Q

Oxygen dissociation is potentiated by:

A
  • Pyrexia
  • Acidosis
  • Hypercarbia
  • Hypercapnia
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4
Q

Adequate oxygenation requires:

A
  • Ventilation
  • Diffusion
  • Perfusion
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5
Q

Purpose of surfactant in alveoli

A
  • Reduces surface tension of water
  • Increases pulmonary compliance
  • Prevents atelectasis at end of expiration
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6
Q

Oxygen debt causes cells to do what?

A

Metabolise glucose into lactic acid

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7
Q

Aerobic Metabolism turns oxygen and glucose into:

A
  • Heat (Kcal)
  • Carbon Dioxide (Co2)
  • Water (H20)
  • Adenosine triphosphate (ATP)
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8
Q

Serous membrane lining the lungs

A

Visceral pleura

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9
Q

Ventilation is

A

Movement of gases between the atmosphere and alveoli

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10
Q

Respiration occurs at three levels :

A
  • Ventilation
  • External Respiration
  • Internal Respiration
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11
Q

Functions of the Larynx

A
  • Contains epiglottis which protects trachea from aspiration
  • Contain the vocal cords
  • Forms part of the anatomical deadspace
  • Contains cricoid and thyroid

It does NOT filter out particles

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12
Q

Expiration is:

A

Passive
Involves the relaxation of diaphragm
Involves the recoil of the lungs

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13
Q

Causes of respiratory failure

A
  • Atelectasis
  • Pneumonia/infection
  • COPD (asthma/chronic bronchitis/emphysema)
  • Pulmonary embolism
  • Haemothorax/pneumothorax
  • Secondary to cardiac failure
  • Drugs
  • Neurological
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14
Q

Symptoms of Respiratory Failure

A
  • Increases work of breathing=hypoxia=cyansis=silent chest
  • Hyperdynamics=shock=poor perfusion=circulatory collapse
  • Altered mental state=exhaustion=coma
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15
Q

Chemoreceptors:

A
  • Peripheral in aorta carotid body respond to Pa02

- Peripheral and central (medulla) respond to Co2

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16
Q

Stretch Receptors

A

In trachea and bronchial smooth muscle- detect over stretch and stimulate expiration (relaxation of diaphragm is active in this case) to reduce chance of overinflation/barotrauma to lungs

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17
Q

VQ ratio Mismatch

A

V=ventilation
Q= perfusion

  1. Deadspace- anatomical or disease, eg clot PE or extreme pneumothorax
  2. Shunt- areas of good perfusion but POOR ventilation eg. pneumonia
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18
Q

Deadspace is:

A

Areas within respiratory system that are ventilated but not perfused.
Ie. Trachea, bronchi and bronchioles

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19
Q

Respiration is:

A

Ventilation- active and passive

External Respiration- gas exchange within lungs

Internal Respiration- within tissues at cell level

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20
Q

Lines thoracic wall

A

Parietal Pleura

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21
Q

Fluid filled space surrounding lungs

A

Pleural Cavity

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22
Q

Daltons Law

A

Gases exert pressure against each other- this partial pressure = p

p02+pco2+pN2+pH20=. 101kPa

oxygen 21%
Nitrogen 79%

Gasses diffuse from areas of high to low pressure

23
Q

Henry’s Law

A

The amount of gas that will dissolve in liquid is proportional to the partial pressure of the gas and its solubility coefficient- when temperature is constant.

24
Q

Arterial Blood Gas Interpretation

A

pH- H+ ions

pCO2- partial pressure of arterial CO2

pO2- the partial pressure of arterial O2

HCO3 sodium bicarb- bicard in plasma

Base Excess- the amount of bicarb needed to return an equilibrium

25
Q

Control of pH- RESP

A

Normal pH 7.4

H2O + CO2 —-> H2CO3 (carbonic acid)

Resp= increases RR to blow off acidic CO2

26
Q

Control of pH- RENAL

A

In acidosis kidneys eliminate H+ and retain HCO3
In alkalosis kidneys eliminate HCO3 and retain H+

via urine

27
Q

Control of pH- Buffering systems

A

Bicarbonate
Haemolglobin/proteins
Inorganic phosphates and other buffers

28
Q

Buffering

A

Co2+H2o H2Co3H+ + HC03

Intermediate + natural =compensation

VS

Treatment + medically managed =correction

29
Q

Partial or Complete compensation

A

Partial= pH normal but other systems involved

Complete= pH normal and other systems corrected

30
Q

Type 1 Respiratory Failure

A

PaO2 <8 with normal or low CO2

Acute hypoxic event- asthma, pneumonia, ARDS

31
Q

Type 2 Respiratory Failure

A

PaO2<8 and CO2 >6.1

(ventilation failure)

chronic, chest wall deformities, Respiratory depression

32
Q

Chemoreceptors and CO2

A

Co2 diffuses into CSF —> Carbonic Acid

H2CO3

33
Q

Analysing Gases

A

HCO3 if low + pH low = metabolic acidosis
HCO3 in high and pH high= metabolic alkalosis
BE- metabolic
PaCO2 and PaCO2- respiratory or pH

34
Q

Breath Sounds

A

Vesicular Breath- normal
Bronchial Breath- higher pitch
Added breath sounds- crackles (fine/coarse) or wheeze (mono/polyphonic)

35
Q

Functional Residual Capacity

A

Volume left post expiration

36
Q

PEEP

A
  • Positive end expiratory pressure
  • Increases gas exchange (external respiration
  • increases functional residual capacity
  • Maintains open airways
37
Q

PRESSURE SUPPORT

A

-Increases tidal volume
-Increases Co2 removal
-Supports inspiration
start at 5 to 8 above peep

38
Q

Tidal Volume normal values

A

6-8ml/kg

39
Q

Rapid sequence induction

A

Sedation- Propofol/Medaz
Opiate- Fentanyl
Paralysis- Rocuronium
BP- Metaraminol

40
Q

Pressure Modes Ventilation

A

CPAP/PS
SIMV PS/PC
Automode PRVC

41
Q

Volume Modes Ventilation

A

SIMV VS/VC
Automode VS/VC
PRVC

42
Q

Ventilator induced lung injury

A

Barotrauma (high pressure)
Volutrauma (high volumes)
BOTH CAUSE Pneumothorax

Atelectatrauma (shear stress on alveoli)

Biotrauma (inflammation)- Similar to ARDS

43
Q

OXYGEN TOXICITY

A

Caused by free radicals

44
Q

Effects on CVS with Positive Pressure Ventilation

A

Increases intra-thoracic pressure
=reduces venous return

Increases pulmonary resistance
=decreases cardiac output

45
Q

Effects on Renal with Positive Pressure Ventilation

A

Reduced Cardiac output
=reduced renal perfusion

Increase in sympathetic activity= increased ADH production, Aldosterone and increased H20 and Na reabsorption

AND

Increase in thoracic pressure= reduced ANP production = increased Na reabsorption

46
Q

Effects on Liver with Positive Pressure Ventilation

A

Reduced cardiac output= reduced hepatic flow

Increased intra-thoracic pressure = increased hepatic congestion

47
Q

Effects on CNS with Positive Pressure Ventilation

A

Increased intra-thoracic pressure= Increased ICP and ICC

Reduced cardiac output= reduced blood flow to brain

48
Q

Nurses role in reduction of VAP

A
  • Subglottic aspirates
  • Oral hygiene
  • Tracheal cuff pressure +regulation
  • Positioning 30 degree
  • PPI/stress ulcer prophylaxis
  • Sedation level assessment
49
Q

Tracheostomy Indications

A
  • Upper airway obstruction
  • Surgical procedure
  • Respiratory insufficiency
  • Neuromuscular Disorders- MND
  • Long term ventilation
50
Q

Vital Capacity

A

Volume of air you can expel on expiration with max effort

51
Q

Inspiratory Capacity

A

Maximum volume that can be inspired

52
Q

Tidal volume

A

Amount of air that moves in or out per Respiratory cycle

53
Q

SPUTUM

A
  • Produced by goblet cells
  • Normally cleared by cilia and cough

Cleared using direct percussion/ViBS- not good for trauma patients, bleeds pneumothorax and hernias

Postural drainage- not good for ICP, post meds or cardio instability

54
Q

NORMAL ABG VALUES

A 
pH 7.35-7.45
PaO2 12-14kPa
PaCo2 4.6-5.9 kPA
HCO3 22-26mmols/L
Base Excess +2/-2

Critical Care Course (6 decks)

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