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Semester 1 Quizzes > Ventilation (from resources) > Flashcards

Ventilation (from resources) Flashcards

1
Q

Define the following terms:

PaO2
PAO2
PA/Palv
Pao
Vd
Vt

A

PaO2: arterial partial pressure of O2
PAO2: alveolar partial pressure of O2
PA/Palv: alveolar pressure
Pao: pressure at mouth opening
Vd: dead space
Vt: tidal volume

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2
Q

Define the following terms:

PaCO2
PACO2
CaO2
DO2
PAP

A

PaCO2: arterial partial pressure of CO2
PACO2: alveolar partial pressure of CO2
CaO2: content of oxygen in arterial blood
DO2: oxygen delivery
PAP: pulmonary artery pressure

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3
Q

Define diffusion and state by which law it’s dictated.

A

The process of a liquid or gas moving from an area of higher concentration to an area of lower concentration to create equilibrium. Graham’s law.

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4
Q

How many mL of Vt should be given for every mL of dead space

A

3mL. 3:1 ratio of Vt:Vd is important so we don’t just move dead space air back and forth.

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5
Q

What is PIP and where is it measured

A

Peak Inspiratory Pressure is a combination of PEEP, airway resistance (coughing, asynchrony, ETT size) and target pressure setting
It is measured at the flow sensor (pressure at the mouth) during inspiration

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6
Q

What is Pplat an indication of and where is it measured

A

Plateau pressure is an indication of lung compliance, where if it is high then pt’s lung compliance is an issue
It is measured at the end of an inspiration (with hold) and should be < 30cmH2O

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7
Q

What is Driving Pressure (ΔP on Hamilton)

A

The difference between Pplat and PEEP and should be < 15 cmH2O
It’s the pressure required to keep alveoli open

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8
Q

List controls for ventilation

A

Vt
Pressure control
Pressure support
I:E ratio

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9
Q

List controls for Oxygenation

A

Oxygen (FiO2)
PEEP

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10
Q

A shift in the oxygen-hemoglobin dissociation curve to the _____ will = an increase in hemoglobin’s affinity for oxygen, a shift to the ____ will decrease affinity and release oxygen to the tissues more readily.

A

Left, Right

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11
Q

What is the V/Q ratio in the 3 different zones of the upright lung?

a) Upright zone 1 (apex)
b) Upright zone 2 (mid)
c) Upright zone 3 (base)

A

a) V>Q (more alveoli, narrower blood vessels)
b) V/Q 1:1 (blood vessels & alveoli at maximal size)
c) V

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12
Q

Describe tidal volume (Vt) and state it’s average value

A

Volume of air entering or leaving lungs during a single breath, ~300-500mL (6-8 mL/Kg)

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13
Q

Describe inspiratory reserve volume (IRV) and state it’s average value

A

Extra volume of air that can be maximally inspired over and above the typical tidal volume, ~1900-3300mL

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14
Q

Describe inspiratory capacity (IC) and state it’s average value

A

Maximum volume of air that can be inspired at the end of a normal expiration, ~2400-3800mL (IC = IRV + Vt)

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15
Q

Describe expiratory reserve volume (ERV) and state it’s average value

A

Extra volume of air that can be actively expired by maximal contraction beyond normal volume of air after a resting tidal volume, ~700-1200mL

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16
Q

Describe residual volume (RV) and state it’s measurement

A

Volume of air remaining in the lungs after maximal expiration, indirectly measured by FRC-ERV

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17
Q

Describe total lung capacity (TLC) and state it’s average value

A

The sum of all volumes, it’s the maximum volume of air the lungs can accommodate after maximum inspiration (Vt+IRV+ERV+RV), ~4-6L

18
Q

Describe vital capacity (VC) and state it’s average value

A

The total amount of air exhaled after maximal inhalation (VC=Vt+IRV+ERV), ~4800mL. VC should be ~3x greater than Vt for effective cough.

19
Q

Describe functional residual capacity (FRC) and state it’s average value

A

The amount of air remaining int he lungs at the end of a normal exhalation (FRC = RV + ERV), ~1800-2200mL. In COPD FRC is increased, can be up to 80% of TLC

20
Q

What is the difference between intrapulmonary and extrapulmonary shunts?

A

Intrapulmonary is usually alveoli filled with pus or fluids unable to participate in gas exchange, while extrapulmonary shunts (aka right-to-left shunt) bypasses lungs due to a cardiac defect (eg. ventricular septal) or a fistula

21
Q

What are the three types of dead space?

A

Anatomical: conducting airways, ~150mL in adults
Mechanical: anything added to the vent circuit (extender, ETCO2 adapter, HME, suction, etc.)
Physiologic: functional alveoli that are inadequately perfused

22
Q

What is the normal percentage of dead space (Vd) to tidal volume (Vt)?

A

30%. The % increases as Vt decreases, that’s why we can’t ventilate at <4mL/Kg - we would then only be moving dead space air back and forth

23
Q

What are the two factors determining lung compliance?

A
  1. Stretchability of the lung’s elastic fibres
  2. Surface tension within alveoli (no surfactant = high surface tension = collapse, collapsed alveoli resist expansion resulting in low compliance)
24
Q

Describe the 3 sections of the lung pressure-volume curve.

A
  1. The lower portion indicates the increased pressure required to open the alveoli (recruitment), big pressure = small changes in volume
  2. Middle portion = optimal compliance (alveoli are open, small changes in pressure = big changes in vol)
  3. Upper portion = low compliance due to overstretch, wasted pressure as it doesn’t change volume
25
Q

What are the 8 steps in dealing with respiratory distress in a patient with a tracheostomy?

A

Proceed through steps if problem not resolved with each one

  1. Call for help
  2. Apply oxygen (to face & site)
  3. Remove inner cannula
  4. Suction (passage = patency)
  5. Remove trach (if suction doesn’t pass)
  6. Intubate (skip if laryngectomy)
  7. Ventilate stoma (with ped mask)
  8. Intubate stoma (bougie + #6 cuffed ETT)
26
Q

What are the 3 indications for intubation & mechanical ventilation?

A
  1. Respiratory failure
    - Type 1: reduction in rate of diffusion
    - Type 2: reduction in minute vent
  2. Airway protection
  3. Decrease metabolic demand (sepsis)
27
Q

EtCO2 reflects _____ while SpO2 reflects _______.

A

Ventilation (immediate detection of apnea, hypo/hyperventilation)
Oxygenation (30 sec - 3 min. lag in detecting apnea or hypoventilation)

28
Q

What is mainstream vs sidestream EtCO2 sampling?

A

Mainstream samples CO2 in a stream of gas, sidestream uses a pump to pull a sample into the monitor for testing (considered more robust as they’re harder to break, but have to account for condensation in the line)

29
Q

What are the suction pressures on our mechanical suction and on the drainage unit for current chest drainage system?

A

New system: set suction from -80 to -100mmHg on suction unit, drainage unit (box) can be adjusted from -10mmHg to -40mmHg (stick with -20, may need higher pressures for viscous fluids, etc.)

30
Q

What does Phase 1 represent

A

Air coming from conducting pathways so CO2 is low or 0

31
Q

What does Phase 2 represent

A

CO2 rises quickly as CO2 from anatomical dead space is replaced by CO2-rich alveolar gas

32
Q

Describe Phase 3

A

Late expiration (plateau) → all the CO2 that passes through sensor is alveolar gas

33
Q

Describe Phase 4

A

The point where CO2 levels are measured - this will have the highest level of CO2, again, due to CO2-rich alveolar gas passing the sensor but at the end of expiration (END tidal → EtCO2)

34
Q

What does Phase 5 represent

A

Respiratory baseline, where CO2 value is normally 0 (during inspiration)

35
Q

What is the calculation for ideal body weight (IBW) for men & women?

A

Men: 50 + 2.3 x (height in inches - 60)
Women: 45.5 + 2.3 x (height in inches - 60)

36
Q

What is the calculation for PaCO2 using minute ventilation & CO2 production?

A

PaCO2 ∝ VCO2/MV (1 - Vd/Vt)

Partial pressure of arterial CO2 (PaCO2) is proportional to the metabolic production of CO2 (VCO2) divided by minute volume (MV) times (1 minus dead space divided by tidal volume)

37
Q

How do you calculate minute volume (MV)?

A

MV = RR x Vt

Eg. RR of 12 x Vt of 500mL = 6,000 mL or 6 L

38
Q

How do you calculate dead space percentage?

A

Vd/Vt

Divide dead space (average is 150mL) by tidal volume (average 500mL)

Eg. 150/500 = 0.3, or 30%

39
Q

What’s the difference between high pressure oxygen (HPO) and low pressure oxygen (LPO) source gas on FiO2?

A

HPO:The FiO2 remains constant and can be adjusted on the ventilator, and requires less O2

LPO: You have to change your flow at the regulator to adjust FiO2 as it entrains room air (and actually uses more O2), and oxygen alarms need to be set manually.

Note: can’t leave LPO nipple in T1 as it will register a leak on test and sound alarm

40
Q

How long do the batteries last on the Hamilton T1?

A

4.5 hrs each

Semester 1 Quizzes (42 decks)

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