Respiratory Flashcards
The most important part of the system is the
alveoli. That’s where there’s gas exchange. Everything else is just a conduit to the alveoli.
alveoli: there are Type 1 and type 2
Type 2 cells are
especially important
Surfactant is to
decrease surface tension so that the alveoli can expand, otherwise they’d be stuck together.
Right side of heart has much lower pressure than left side, because
it just has to push blood to the lungs which shouldn’t have a lot of pressure (unless there’s disease).
Oxygen does not go into solution, that’s why we need
hemoglobin
CO2 however can go into
solution
Under normal conditions alveoli and capillaries are in
direct contact.
Cyanosis is a very very
late sign
Dyspnea is subjective,
patient tells you if it happens.
Orthopnea
dyspnea when they’re laying down.
Paroxysmal nocturnal dyspnea-
wake up at night short of breath.
Assessing for minor heart failure
You’re laying down and then all the blood comes up from your legs and can cause minor heart failure, so ask how many pillows do you need to sleep with and do you wake up short of breath.
Kussmaul-
sign of metabolic acidosis - blowing off CO2
Cheyne-stokes -
can see it in very old and all ____?
Hyperthermia ____ the bond between hemoglobins and O2
weakens
Larger the A-a gradient, the less likely it is the
O2 is gonna help them.
tension pneumothorax.
This is when not only is the one lung shrinking, but it keeps getting pushed because the amount of air keep building which squashes the good lung and the great vessels. Trachea also shifts over. BP drops. Can happen in COPD, ventilator patients. treatment is to release the air that’s causing the continued tension.
Friction rub is usually
inflammation of the pleura
Flail chest
broken ribs causes a section of the chest to move parodoxically
ARDS-
fluid accumulation to the lungs between alveolus and capillary, no surfactant production, so you have trouble ventilating, you can’t have O2 exchange.
ARDS- you initially have
resp alkalosis but later get resp acidosis. There’s also a bunch of other manifestations.
Absent BS on one side, shock, distended jugulars, tracheal deviation
Tension pneumothorax
Multiple causes including nasal or tonsillar hypertrophy, obesity, genetic predisposition
obstructive sleep apnea
Several contiguous ribs broken 2-3 or more places
flail chest
Indication of LV failure, CHF
rales
Due to decrease RR or decreased tidal volume, increased pCO2 (and hypoxia)
Hypoventilation
Can cause respiratory failure (MG, GB, ALS, SCI, etc)
Neuromuscular patho
Post-op atelectasis, aspiration pneumonia, Ventilator-associated pneumonia
Considered iatrogenic
Interstitial edema, shunting, decreased compliance, decreased surfactant, refractory hypoxemia
Patho of ARDS
Night sweats, cough, weight loss, hemoptysis, fever
Tuberculosis
Air, blood, exudate between pleural layers
“Collapsed” lung
heard first on expiration, worse if inspiration
Wheezing
PE, CHF, hypoventilation, pneumonia, shock
Examples of V/Q mismatch
Hypoxia, shock, fever, anxiety, pain, acidosis
Causes of hyperventilation
Bronchial responsiveness increased, inflammation
Asthma
Blood: right ventricle to left ventricle without adequate O2 uptake
Pulmonary shunting (physiologic)
Increased mucus formation, air trapping in alveoli
Emphysema
Bronchodilation, increased volume
SNS pulmonary effects
Pulmonary fibrosis, COPD, ARDS, pneumonia, age
Cause decreased lung compliance
Can be idiopathic or associated with lung diseases
Pulmonary hypertension
Check ET tube placement; check perfusion
EtCO2 (capnography)
200 times more affinity to Hbg than O2
Carbon monoxide (CO)
