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Step 2 Critical Care Course > Ventilation + Respiratory > Flashcards

Ventilation + Respiratory Flashcards

1
Q

What is the function of the respiratory system?

A

Supplies oxygen to the metabolically active tissues and remove the carbon dioxide, the waste product of metabolism.

  • o2 + Fuel = Energy + Co2 + H2O
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2
Q

What are the 4 components of respiration?

A
  • Mechanical movement
  • Metabolic process
  • Gas exchange
  • Gas transportation
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3
Q

What is mechanical movement?

A

Mechanical movement is the movement of gases into and out of the lungs.

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4
Q

What is metabolic process?

A

Metabolic process within the cell to produce energy.

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5
Q

What is gas exchange?

A

Gas exchange across the membrane and occurs in the alveoli.

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6
Q

What is gas transportation?

A

Transportation of gases to and from the tissues by the circulatory system.

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7
Q

What is cellular respiration?

A

It is the membrane pathway that uses glucose to produce ATP (Adenosine TriPhosphate) which the body uses for energy.

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8
Q

What is Aerobic Respiration?

A
  • Requires oxygen
  • Main type of respiration that occurs in most situations in plants and animals.
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9
Q

What is Anaerobic Respiration?

A
  • Does not require oxygen.
  • During exercise, the oxygen in muscles is inadequate so aerobic respiration does not occur and builds up lactic acid.
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10
Q

What is respiratory failure?

A

Acute impairment in gas exchange between the lungs and the blood causing hypoxia with or without hypercapnia.

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11
Q

What is Type 1 Respiratory Failure?

A
  • Low PaO2 (below 8 on room air)
  • Hypoxic respiratory failure
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12
Q

What is Type 2 Respiratory Failure?

A
  • Low PaO2 (below 8 on room air)
  • High PaCo2 (above 6.5 on room air)
  • Hypercapnic respiratory failure
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13
Q

What does a Respiratory Assessment consist of?

A
  • Inspection
  • History taking
  • Hand inspection
  • Respiratory rate
  • Chest examination
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14
Q

What are you looking for during Inspection in Respiratory Assessment?

A
  • Cyanosis
  • Short of breath
  • Cough
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15
Q

What are you information are you seeking in History Taking in a Respiratory Assessment?

A
  • Past medical history
  • Family + social history
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16
Q

What are you looking out for in Hand Inspection in a Respiratory Assessment?

A
  • Cyanosis
  • Brusing
  • Tremors
  • Clubbing
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17
Q

What are you looking out for in Respiratory Rate in a Respiratory Assessment?

A
  • Look, Listen, Feel
  • Rate
  • Depth
  • SpO2, PaO2, PaCO2
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18
Q

What are you looking for in Chest Examination in a Respiratory Assessment?

A
  • Chest deformity or scarring
  • Tracheal position
  • Oedema
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19
Q

Give some examples of abnormal breathing sounds?

A
  • Crackles
  • Gurgles
  • Friction rub
  • Wheeze
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20
Q

Where does Stridor occur?

A
  • Upper airway
  • Over trachea
    Foreign airway obstruction
21
Q

Where does Wheezing occur?

A
  • Effects bronchi
  • Constriction
  • Air trying to pass through the bronchioles
  • E.g. asthma; bronchitis
22
Q

Where does Rales occur?

A
  • Crackles
  • Smaller airways
  • Fluids in the lungs (alveoli)
  • E.g. CHF and Pneumonia
23
Q

Where does Rhonchi occur?

A
  • Larger airways
  • Obstruction or fluid accumulation in the larger airways
  • E.g. COPD and Pneumonia
24
Q

What does VQ mismatch stand for?

A

Ventilation Perfusion Mismatch

25
Q

What is VQ mismatch?

A
  • Alveolar gas exchange depends not only on ventilation of the alveoli but also on circulation of blood through the alveolar capillaries.
  • It depends both on ventilation and perfusion.
  • When the proper balance of o2 and adequate blood flow is lost, ventilation perfusion mismatch exists.
  • There are 2 types of mismatch:
    Dead space
    Shunt
26
Q

What is Deadspace?

A
  • Deadspace is the portion of the respiratory system where the tidal volume doesn’t participate in gas exchange.
  • It is ventilated but not perfused.
  • There are 3 types of deadspace:
  • Anatomic
  • Physiological
  • Ventilation assisted
27
Q

What is Anatomic Deadspace?

A
  • Anatomic deadspace consists of the parts of the respiratory tract that are ventilated but not perfused.
  • It consists of conducting airways such as, the trachea, bronchi, and the bronchioles.
28
Q

What is Physiological Deadspace?

A

Physiological deadspace consists of alveoli that are ventilated but lack capillary blood flow to pick up oxygen and drop Co2.

29
Q

What is Pulmonary Shunt?

A

Pulmonary shunt is the opposite of deadspace and consists of alveoli that are perfused, but not ventilated.

30
Q

What are some common causes of Shunts?

A
  • Pneumonia or pulmonary oedema (alveoli filling with fluid)
  • Tissue trauma (alveolar wall swelling)
  • Atelectasis (collapsing alveolar absorption of air without replacement)
  • Mucous plugging (air cannot get into the alveoli)
31
Q

Why are chest drains inserted and what do they do?

A
  • Inserted to allow draining of the pleural spaces of air, blood or fluid.
  • Allows expansion of the lungs and restores negative pressure in the chest.
  • The underwater seal prevents backflow of air and fluid into the pleural cavity.
32
Q

What is Positive End Expiratory Pressure (PEEP)?

A
  • PEEP is the application of a constant positive pressure to the airways so that at end-expiration the pressure remains above atmospheric pressure.
  • PEEP prevents the alveoli and small airways from collapsing, increases the functional residual cavity; rest-distributes lung water and improves oxygenation.
33
Q

What is Tidal Volume (VT)?

A
  • Tidal Volume is the amount of air in millimetres delivered per breath.
  • The tidal volume can be set in volume control modes (SIMV VC).
34
Q

What is Peak Flow?

A
  • Peak Flow is the speed at which the tidal volume is delivered in volume control.
  • The peak flow is one of the determinants of inspiratory time (I:E ratio).
35
Q

What is Pressure Support (PS)?

A

Pressure support is a level of support set above PEEP to assist spontaneous breathing patient’s overcome circuitry and augment spontaneous breathing.

36
Q

What is Inspiration to Expiration Ratio (I:E)?

A
  • I:E refers to the ratio between inspiratory time and expiratory time.
  • The I:E ratio is usually 1:2.
37
Q

What is Peak Inspiratory Pressure (PIP)?

A
  • PIP is the maximum amount of pressure reached during inspiration.
  • The set pressure support (PS) will determine the PIP.
  • PS + PEEP = PIP
38
Q

What are the 4 phases of a breath?

A
  • Expiration to inspiration
  • Inspiration
  • Inspiration to expiration (cycling)
  • Expiration (baseline)
39
Q

What is Pressure Control Ventilation?

A

The ventilator delivers a pre-set pressure when delivering a breath, the inspiratory pressure is the control variable; is maintained during the inspiratory phase.

40
Q

What is BIPAP?

A
  • Provides a set inspiratory pressure (a pressure controlled time triggered, time cycled breath).
  • Patient can breathe in between mandatory ventilation (often small breaths).
  • Spontaneous breaths are supported with pressure support.
41
Q

What is Controlled Mandatory Ventilation (CMV) and Assist Control (A/C)?

A
  • Ventilator initiates all breaths at a pre-set rate and volume.
  • Used mainly in theatre for paralysed and sedated patients.
42
Q

What are some Pros of Controlled Mandatory Ventilation (CMV) and Assist Control (A/C)?

A
  • Guaranteed minute volume
  • Precise control of VT to limit barotrauma.
43
Q

What are some Cons of Controlled Mandatory Ventilation (CMV) and Assist Control (A/C)?

A
  • Will overcome high resistance to deliver set VT.
  • Breath stacking.
44
Q

What is Pressure Support/ASB?

A
  • The patient triggers the ventilator and receives a supported breath at a pre-set pressure.
  • This can be used as a weaning mode.
45
Q

What is Airway Pressure Release Ventilation (APRV)?

A
  • This is a pressure controlled mode of ventilation that delivers an almost continuous positive pressure, with intermittent time cycled short breaths at a lower pressure.
  • This is generally used on patients with the following:
  • Severe Acute Respiratory Failure (SARF)
  • Acute Respiratory Distress Syndrome (ARDS)
46
Q

What are the benefits of APRV?

A
  • APRV maximises the recruitment of available lung tissue and therefore improves oxygenation.
  • The sustained high mean airway pressure of APRV aims to promote alveolar recruitment.
  • Uses P High and P Low.
47
Q

What is CPAP (Non-Invasive Ventilation)?

A
  • Provides one form of positive airway pressure therapy.
  • CPAP is a method of NIV where the patient breaths against a continuous positive pressure throughout the ventilatory cycle.
  • Provides an improvement surface area for gas exchange.
  • For patients with hypoxia.
48
Q

What is BIPAP (Non-Invasive Ventilation)?

A
  • Has 2 pressure settings:
    Inhibition Positive Airway Pressure (IPAP)
    Exhalation Positive Airway Pressure (EPAP)
  • EPAP provides the physiological advantages of CPAP/PEEP.
  • IPAP is the pressure support on inspiration which actively assists spontaneous ventilation.

Step 2 Critical Care Course (7 decks)

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