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Pharm Test 4 > Respiratory Complications > Flashcards

Respiratory Complications Flashcards

1
Q

LIST OF RESPIRATORY COMPLICATIONS

A
  1. Hypercapnia
  2. Hypocapnia
  3. Hypoxemia
  4. Airwayobstruction
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2
Q

minute ventilation =

A

VE=VTx RR
= tidal volume x RR

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3
Q

ETCO2 values; what do they mean

A

the amount of carbon dioxide (CO2) in exhaled air, which assesses ventilation. So a high ETCO2 is a good sign of good ventilation, while low ETCO2 is bad sign that represents hypoventilation.

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4
Q

if we have an INCREASE IN CO2; > 50 mmHg what is this called? how would this condition arise?

A

“Hypercapnia”
“Hypercarbia”
* From slow RR, to small VT, to APNEA > causes hypercapnia

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5
Q
  1. HYPERCAPNIA- CAUSES
A
  1. Hypoventilation
  2. Apnea
  3. Rebreathing
  4. Increased CO2 production
  5. Increased dead space
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6
Q

what is hypoventilation and how might it arise (and contribute to hypercapnia)

A
  • Less efficient VE
  • Any drug that depresses the CNS
  • Drug concentration in CNS
  • Short for induction drugs (e.g., propofol, alfaxalone)
  • Longer for sedatives (e.g., opioids) and inhalant anesthetics
  • Any disease that depresses the CNS
  • Iatrogenic
  • IPPV
    > Low VT; Slow RR; Combination of both
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7
Q

what is apnea and how might it arise (and contribute to hypercapnia)

A
  • > 1 minute without a breath
  • If, CO2 production continues
    > CO2 increases 2-3 mmHg/min
  • Induction overdose
  • Inhalant overdose
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8
Q

how might rebreathing contribute to hypercapnia

A
  • Low Fresh gas flow
  • Exhausted sodalime
  • Incompetent unidirectional valve
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9
Q

how might increased CO2 production in the body arise

A
  • Fever
    > Intrinsic (disease)
    > Iatrogenic (exercise)
  • Laparoscopic procedures with CO2 insufflation
  • Thyroid storm
  • Malignant hyperthermia (MH)
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10
Q

is PaCO2 = ETCO2? why?

A

no
* Because of alveolar dead space
* PaCO2 > ETCO2 (≈ 5-10 mmHg)

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11
Q

hypoventilation treatment

A
  • Increase TV
  • Increase RR
  • Combination
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12
Q

apnea treatment

A
  • Intubate and assist breathing
  • Wait for induction drug to wear off
  • Adjust inhalant %
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13
Q

rebreathing treatment

A
  • Increased FGF
  • Change sodalime
  • Fix the valve
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14
Q
  1. INCREASED CO2 PRODUCTION treatment
A
  • Increase TV and/or RR
  • Changes not always needed for laparoscopy
  • Control fever
  • MH- bad prognosis; Dantrolene
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15
Q

increased dead space treatment

A
  • Adjust the endotracheal tube
  • Improve perfusion to the lung
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16
Q

Alveolar Dead Space definition? what is hypoperfusion?

A
  • Ventilated but not perfused
  • Hypoperfusion (V/Q > 1)
17
Q

syndrome associated with hypercapnia?

A

respiratory acidosis (acute)

18
Q

syndrome associated with hypocapnia?

A

respiratory alkalosis

19
Q

what is hypocapnia? what causes this, in general terms?

A

DECREASE IN CO2; < 30 mmHg “Hypocapnia” “Hypocarbia”

  • From fast RR to large VT
20
Q
  1. HYPOCAPNIA- CAUSES
A
  1. Hyperventilation
  2. Decreased CO2 production
  3. Hypoxia
21
Q

how does hyperventilation arise?

A
  • Exercise/anxiety
  • Over ventilation from mechanical ventilation
    > RR, VT, or both
  • Pain
  • Drug-induced
    > Panting with opioids
22
Q

how does decreased CO2 production arise?

A
  • Hypothermia
  • Decreased cardiac output
  • Cardiovascular collapse/cardiac arrest
23
Q

how to treat hyperventilation

A
  • Anxiety-“Calmdown”
  • IPPV
    > Decrease VT and/or RR
  • Pain
    > Analgesics
    > Deeper plane of anesthesia
  • Opioids- no action required
24
Q

how do we treat decreased CO2 production

A
  • Hypothermia- Warming devices
  • Cardiovascular collapse
  • Sympathomimetics
  • CPR
    > Epinephrine
    > Cardiac massage
25
Q

how is hypoxemia defined and what types are there?

A

-PaO2 < 80 mmHg “Relative hypoxemia” (SpO2 <95%)

-PaO2 < 60 mmHg “Absolute hypoxemia” (SpO2 <90%)

26
Q

Normal arterial blood gas tensions (mmHg)
for CO2 and O2 at sea level in a dog or horse
or cow or sheep or goat or cat, breathing an
FiO2 of 0.2 are:

A

PaO2 = 95 (90-100)
PaCO2 = 40

26
Q

The hemoglobin saturation of arterial and
venous blood at room air is:

A

SO2 = 98% arterial, 75% venous

27
Q

normal PaO2 and PvO2 and corresponding SO2 values

A

PaO2 = 95, SO2 = 98

PvO2 = ~40, SO2 = 75

28
Q

what proportion of room air in O2 and how does PaO2 change on room air vs pure oxygen?

A

room air ~20% O2

Room PaO2 = 100 mm Hg
Oxygen PaO2 = 663 mm Hg

PaO2 stands for the partial pressure of oxygen, and it is a measurement of the pressure of the oxygen that is found in the blood.
PaO2 is a sensitive and non-specific indicator of the lungs’ ability to exchange gases with the. atmosphere.

29
Q
  1. HYPOXEMIA- Causes
A
  1. Low FiO2
  2. Hypercapnia (Hypoventilation)
  3. Venous admixture
30
Q
  • FiO2 of 0.2 results in PaO2 of 100 mmHg, if:
A
  • VT is adequate
31
Q

how does hypercapnia affect PaO2?

A

decreases, eg

PaO2 =0.21(760-47)-70/0.8 = 0.2 (713) – 88
= 150 – 88
= 62 mm Hg
=> should be 100 for room air

can be due to hypoventilation

32
Q

how does venous admixture occur?

A
  • R-L shunting (V/Q = 0)
  • Low V/Q mismatch (V/Q < 0.8)
  • Diffusion barrier
    > Edema, Neumonia
33
Q

what is dead space?

A

Ventilated but not perfused
* Hypoperfusion (V/Q > 1)

34
Q

what is a shunt?

A

Perfused but not ventilated
* Complete small airway closure
* Collapsed alveoli (atelectasis)
* Bronchoconstriction (V/Q < 1)

35
Q
  1. Low FiO2 treatment
A
  • Increase FiO2 (> 21%)
  • Normalize VT
36
Q
  1. Hypercapnia (Hypoventilation) treatment
A

if hypoventilation,
* Increase TV
* Increase RR
* Combination

could also be due to apnea, rebreathing, increased CO2 production, increased dead space… which we would treat accordingly

  • Note that increasing FiO2 would help with hypoxemia but the
    hypercapnia needs to be treated
37
Q
  1. R-Lshunting treatment
A
  • For complete R-L shunting (V/Q=0):
  • FiO2 helps but does not correct hypoxemia
  • Correct the reason for the shunt
  • Heart defect
    > Patent ductus arteriosus
    > Ventricular septal defect
38
Q

Low V/Q mismatch shunting treatment

A

For V/Q 0 to <1:
* FiO2 can significantly overcome hypoxemia

Pharm Test 4 (10 decks)

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