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Schmidtty Final > (Special Scenarios/Pulmonary Physiology/Miscellaneous) > Flashcards

(Special Scenarios/Pulmonary Physiology/Miscellaneous) Flashcards

1
Q

At higher elevations, why is it so much more difficult to absorb oxygen?

A

There is not as much pressure to push oxygen into our pulmonary capillaries

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2
Q

Roughly, what is the barometric pressure and PIO2 at the top of Mt. Everest?

A

PB: 253 mmHg
PIO2: 43.1 mmHg

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3
Q

Prior to climbing Mt. Everest, what would be a beneficial tactic to lessen your chances of having issues?
Why?

A

You should climatize your body in a place in high altitudes.

If the body sees a lower than normal amount of oxygen, the kidney will release epoetin to expand your RBC count.

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4
Q

What would happen if we were suddenly exposed to a very high altitude/low pressure environment?

A

The pressures in the blood could get so high that they want to move out of solution and reform as a gas = basically boiling

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5
Q

Gas diffusion works by using a:

A. Concentration gradient
B. Diffusion gradient
C. Pressure gradient
D. Passive gradient

A

C. Pressure gradient

This is why if we were suddenly exposed to really low pressures = our blood PO2 of 100 mmHg will be much higher than the environment and the blood starts to boil to reform as a gas and move into the lower pressure area (environment of 40 mmHg)

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6
Q

How many feet below sea level would we have to be at to experience an Atmospheric pressure of 4 ATM’s?

A

Roughly 90-100 ft

1 ATM = Sea level
2 ATM = 30-33 Feet below and every 30-ish feet after that = 1 more ATM

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7
Q

What kind of gas/air is put into most scuba tanks?

A

Plain ole air
(79% Nitrogen, 21% O2)

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8
Q

What happens if a scuba diver suddenly ascended back to sea level after being at very low altitudes?

A

The high concentration of N2 will want to get out of solution and reform as a gas = bubbles/emboli in the blood form.

Sudden change doesn’t allow the scuba diver to exhale the Nitrogen slowly over time.

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9
Q

What are a couple of ways that we can avoid such high concentrations of N2 in scuba tanks?

A

Increase the O2 concentration a little bit
Swap the N2 for Helium (inert gas)

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10
Q

What is the benefit of having more Nitrogen in our lungs over Nitrous per lecture?

A

Nitrogen will act to keep alveoli and airways open, whereas Nitrous outs you at a higher risk of airway collapse.

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11
Q

In our anesthesia machines, once the nitrogen is swapped with something like a Nitrous and Oxygen mixture, what is our patient at risk of developing?
What is seen with this issue?

A

Absorption atelectasis

Alveoli start to collapse due to no filler gas in the lungs

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12
Q

What is one reason per lecture, as to why a person may have a raspy, soft tone?
What would the cords look like?

A

Sectioned/damaged inferior laryngeal nerve

The affected side would stay open a little at all times

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13
Q

Treatment for a diver having to suddenly ascend to sea level after a deep dive?

A

Hyperbaric Chamber Therapy

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14
Q

Normal Hospital Hyperbaric chamber pressure setting?
What about military/oil rigs?

A

Hospital: 3 ATMs
Military/oil rig: >3 ATMs

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15
Q

Examples of patients that may benefit from Hyperbaric Chamber therapy? (Other than divers)

A

DM Patients
Circulatory problems
Poor wound healing

(Basically anything where they can’t get a sufficient amount of oxygen to their extremities)

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16
Q

True or False: The oxygent content is equal to the amount bound to Hemoglobin?

A

FALSE
The content incorporates the bound AND the dissolved

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17
Q

At > ___ ATM’s we start to see a high risk of oxygen poisoning.

A

Roughly > 2 ATMs
(1520 mmHg)

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18
Q

Per Dr. Schmidt, how long could we theoretically stay at 2 ATMs of pressure before running into oxygen poisoning?

A

30 minutes

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19
Q

4 Dangerous oxygen molecules:

A
  1. Hydrogen peroxide (H2O2)
  2. Superoxide (O2-)
  3. Nitric Oxide (NO)
  4. Peroxynitrite (OONO-)
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20
Q

What is the difference in normal O2 and superoxide?

A

Extra negative charge on superoxide = highly reactive

21
Q

What is produced if Superoxide binds to Nitric Oxide?
Why might this be a bad thing?

A

Peroxynitrite

OONO- can destroy DNA = can cause long term problems such as cancer.

22
Q

What may be affected if we give an NO donor to a very unhealthy patient?

A

Hemoglobin’s ability to carry O2 may be affected

23
Q

What is the normal scavenging enzyme that destroys superoxide?

A

Superoxide Dismutase

24
Q

True or False: Peroxidase enzymes can both destroy and make peroxide?

A

TRUE

25
Q

This is an OTC medication that can help with scavenging some of the free radical oxygen molecules.
Also useful for patients with ___?

A

N. Acetylcysteine

Acute Liver Disease

26
Q

In regard to the Iron lung, when would the plunger that is connected to the diaphragm be pulled out?

A

During inspiration

(moves back in during expiration)

27
Q

Why is the iron lung thought to be a better long-term treatment compared to positive pressure ventilation?

A

The iron lung preserves the normal mechanics of breathing

28
Q

Polio destroyed ____

A

Motor Neurons

29
Q

Main nerve affected with polio

A

Phrenic Nerve

30
Q

Did the iron lung work by pulling the outer or inner lung tissue open?

A

Outer lung tissue = even pressure spread

31
Q

True or False: A completely healthy 100 year old patient will still have PaO2 of 100 mmHg?
Why or Why not?

A

FALSE:
Age related discrepancy due to the A-a gas difference.

32
Q

Formula to quantify the A-a gas difference caused by normal aging?

A

(Age + 10) / 4

33
Q

2 reasons, per lecture, as to why there is a greater A-a difference with aging?

A

More dead space
Increased shunting

34
Q

What does the “R” stand for in the arterial gas equation?
What does it tell us?
Normal number?

A

Respiratory Quotient

Tells us the amount of CO2 produced divided by the amount of O2 used

0.8 (mls??)

35
Q

What is the respiratory quotient influenced by?

A

The compound that we are burning for energy (ATP).

36
Q

Normal Respiratory quotient for:
Just Carbs:
Just Fats:
Just Proteins:

A

Carbs: 1
Fats: 0.7
Proteins: 0.8

37
Q

Why is the RQ lowest when just burning fats?

A

Less CO2 is being produced because more water is formed.

38
Q

Of the 3 things we can burn for energy, which is the one we use last? Such as if we were starving?

A

Proteins

39
Q

If you were to actually measure/physically quantify the CO2 going out or the O2 going in, it would be described as the

A

(RER) Respiratory Exchange Ratio
(Same as RQ basically)

40
Q

Variables needed to actually perform the RER formula:

A

Arterial Blood draw
Barometric Pressure
FIO2
“R” (CO2 produced and O2 used)

41
Q

PACO2 can be estimated by looking at ___.

A

ETCO2

42
Q

How does ETCO2 and PaCO2 change with increasing age?

A

Widens out, with the ETCO2 getting progressively lower than the PaCO2

43
Q

What is the “normal” arterial and Alveolar difference for CO2?

A

<3 mmHg (PaCO2 higher)

44
Q

Examples that would widen out the A-a gas difference?

A

Age
V/Q Mismatches
Abnormal diffusion barriers
(Increased diameter)

45
Q

Which 2 nerves do our irritant receptors use?

A

Vagus and Trigeminal (nose)

46
Q

What do our J receptors look at?
What are 2 disease processes that may cause these receptors to be set off?

A

Blood volume in the lungs

HF, Pneumonia

47
Q

When are our basic pulmonary stretch receptors set off?

A

With a very deep tidal volume
(VT of about 2L’s)

48
Q

What are 2 ways/methods in which we could lengthen our breath holding time per lecture?

A
  1. Supplemental oxygen
  2. Hyperventilation for a few minutes prior to the breath hold
49
Q

Hiccups and the sensation of getting the wind knocked out of you are caused by:

A

Phrenic nerve spasm or injury

Schmidtty Final (3 decks)

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