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PAR2012 - Respiratory > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What are the 5 things you need to read on ETCO2 (PQRST)

A
  • Proper
  • Quantity
  • Rate
  • SHape
  • Trend
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2
Q

What does capnography allow you to meaure?

A
  • C02 metabolism
  • C02 transport
  • Perfusion
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3
Q

What is the target ETCo2 for normal adult?

A

35-34 mmHg

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4
Q

What is the rate of ventilation for an adult breathing on their own?

A

12-20 breaths per min

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5
Q

What is the rate of ventilation for an adult if you’re ventilating for them?

A

10 - 12 bpm

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6
Q

What is the rate that children should be ventilated at?

A

15 - 30 bpm

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7
Q

What is the rate that infants should be ventilated at?

A

25 - 50 bpm

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8
Q

What happens if you ventilate too slowly?

A

Allows CO2 to build up in alveoli resulting in high ETCO2 readings

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9
Q

What happens if you ventilate too quickly?

A

Not enough Co2 builds up in alveoli resulting in low ETC)@ readings

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10
Q

What happens during phase 1 of capnography?

A

Inhalation

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11
Q

WHat occurs during phase 2 of capnography?

A

beginning of exhalation - co2 travels from alveoli through anatomical dead space causing rapid rise in co2

  • measures co2 from alveoli plus gas in dead space - more concentrated
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12
Q

What occurs during phase 3 of capnography?

A

when sensor receives the co2 that was in alveoli. As this is fairly stable the graph levels off

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13
Q

What is the partial pressure of oxygen (PaO2) in the alveoli?

A

100mmHG

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14
Q

What is the partial pressure of oxygen (PaO2) in the capillaries?

A

95mmHg

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15
Q

What is the partial pressure of CO2 (PaCO2) as it leaves the organs?

A

46mmHg

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16
Q

What is the partial pressure of CO2 (PaCO2) in capillaries?

A

45mmHg

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17
Q

What is the partial pressure of CO2 (PaCO2) as it leaves the alveoli?

A

35-45 mmHg

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18
Q

What is the partial pressure of oxygen (PaO2) in the organs?

A

40mmHg

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19
Q

What is the effect of High and low Co2 on hemoglobin for oxygen?

A

High co2 reduces affinity for o2 on hemoglobin
Lown co2 increases affinity

Reduction in affinity makes haemoglobin release oxygen molecules where needed, but can lead to acidosis

Increased affinuty means haemoglobin may not release o2, meaning sats may show normal but organs are not getting the oxygen as it’s not released by haemoglobin - happens during HYPERVENTILATION

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20
Q

what is the ETCo2 goal during cardiac arrest resus?

A

> 10mmHg

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21
Q

What happens to ETC02 during shock

A

Less co2 is produced and delivered to lungs so ETCo2 decreases

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22
Q

What does etco2 <35mmHg mean in relation to shock?

A

indicates significant cardiopulmonary distress and required aggressive treatment

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23
Q

If someone has normal resp rate and normal pulese and BP but has ETCO2 <35mmHg, whagt is it a sign of?

A

Pulmonary embolism.

Mismatch between ventilation and perfusion

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24
Q

WHat is a sharks fin shape on ETCO2 representitive of?

A

Asthma

  • due to slow uneven emptying of alveoli… gradual curve up
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25
Q

WHat if the shape is a sharks fin at the ow-expiratory phase, but then bent?

A

indicates mechanical obstruction

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26
Q

If the top of the capnogram slopes down from left to right rather than gradually slopping up, what does this indicated?

A

Emphysema & pneumothroax… indicates poor surface area or leaky alveoli

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27
Q

What signs would be shown on ETCO2 by obese and pregnanet people?

A

a sharp increase at the end of pahse 3 due to poor compliant lungs tissue or extra weight pushing out co2

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28
Q

what is the main function of the respiratory system?

A

exchange gases with the environment

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29
Q

What are the processes that allow gas exchange to occur

A

ventilation
internal resp
external resp

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30
Q

difference between ventilation and respiration?

A 
Ventilation = movement of air in and out of lungs
rspiration = exchange of oxygen and CO2 in the lungs
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31
Q

What are the two phases to respiration?

A

Internal - transfer o2 and co2 between capillary RBC and tissue cells

External - transfer of o2 and co2 between the inspired air and pulmonary capillaries

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32
Q

what is ventilation?

A

mechanical process of moving air in and out of lungs

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33
Q

what performs 80% of the work of breathing?

A

diaphragm

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34
Q

What controls the diaphragm?

A

Medulla oblongata

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35
Q

what do the phases of ventilation depend on?

A

changes in volume of thoracic cavity

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36
Q

what happens during inspiration in the chest?

A
  • thoracic volume changes with contraction of diaphragm
  • contraction flattens diaphragm
  • intercostals contract pulling chest outwards
  • increases volume of chest, which produces a decrease in the air pressure inside chest cavity
  • this draws air into the lungs
  • It is an ACTIVE Process
37
Q

What is inspiration dependent on?

A

intact chest wall and intact pleural cavity

  • pleural space has a pressure of 4-8mmHG below atmospheric pressure
  • difference between lungs and pleural space, and surface tension of pleural fluid means lungs will move with the chest wall
38
Q

What happens to bronchioles when the lungs expand?

A

they expand too

39
Q

What does an opening to the pleural cavity do?

A

eliminates negative pressure in the pleural space so lungs do not expand with the chest wall

40
Q

What happends during expiration?

A
  • chest wall and diaphragm recoil to normal resting state
  • increaing the pressure inside chest (1-2mmHg above atmospheric pressure)
  • drives air out of lungs
  • PASSIVE Process
41
Q

Which of inpriation and expiration is active and passive process?

A

Inspiration - active

Expiration - passive

42
Q

What are the pressure gradients in the lungs during inspiration?

A

Atmospheric pressure = 760mmHh
Alveolar pressure = 758mmHg
Intrapleural pressure = 754mmHg

43
Q

What are the pressure gradients in the lungs during expiration?

A

Atmospheric pressure = 760mmHh
Alveolar pressure = 762mmHg
Intrapleural pressure = 756mmHg

44
Q

What are the pressure gradients in the lungs at rest?

A

Atmospheric pressure = 760mmHh
Alveolar pressure = 758mmHg
Intrapleural pressure = 756mmHg

45
Q

how much of inhaled air fills the anatomical dead space?

A

1/5

150mls

46
Q

What is the physiological dead space?

A

anatomical dead space + the volume of any non-functioning alveoli

47
Q

What is the average tidal vol?

A

vol of gas inhaled or exhaled during a normal breath

500-600ml

48
Q

What is the inspiratory reserve vol?

A

The lungs can hold 8x TV, this is called the inspiratory reserve volume
= 2000-3100 mls

49
Q

What is the expiratory reserve vol?

A

amount of air that can be forcibly exhaled

= 1200mls

50
Q

what is the residual voilume?

A

remaining air left in alveoli after forcibly exhaling

= 1000-1200mls

51
Q

that is the minute volume?

A

amount of gas inhaled or exhaled in one minute

= TV X RR

52
Q

What is inspiratory capacity?

A

TV + inspiratory reserve vol

Reflects amount of gas a person can inspire maximally after normal expiration

3600mls

53
Q

what is functional residual capacity (FRC)?

A

expiratory reserve vol + residual vol

Reflects amount of gas remaining in the lung at the end of a normal expiration
2400mls

54
Q

What is vital capacity?

A

inspiratory reserve + tidal vol + expiratory reserve vol

reflects the vol of gas that can move on the deepest inspiration and expiration

4800mls

55
Q

what is total lung capacity (TLC)

A

sum of all volumes

6000mls

56
Q

How much energy does ventilation use?

A

3% of total body energy

57
Q

How can loss of pulmonary surfactant, increased airway resistance or decrease pulmonary compliance effect energy consumption of ventilation?

A

may increase to 33% of total body energy

58
Q

What is dalton’s law?

A

law of partial pressures

states that the pressure of a mixture of gasses is the sum of the partial pressures of each individual gas

The air you breath is a mixture of gases, composed primarily f Nitrogen, o2, co2, and water vapour

59
Q

what are the partial pressures of o2 and co2 in the venous return system?

A 
PO2 = 40
PCO2 = 45
60
Q

what are the partial pressures of o2 and co2 in the arterial system?

A 
PO2 = 100
PCO2 = 40
61
Q

what are the partial pressures of o2 and co2 in the alveoli?

A 
PO2 = 100
PCO2 = 40
62
Q

what is ficks law?

A

ficks law of diffusion

the diffusion of gases through blood is determined by the pressure of the gas and its solubility

diffusion stops when alveolar and capillary partial pressure equalise

63
Q

What is boyls law?

A

describes relationship between pressure and volume of a gas

pressure increases, volume goes down

as volume descreases, pressure goes up

only applies when temp is constant

If you increase temp, vol of gas will increase.

64
Q

What is bohrs law?

A

\co2 is the main player in o2 transport due to VASOLDILATION and the BOHR LAW

bohr states that lower pH will bind haemoglobin and O2 with less affinity

Essentially more O2 is released by Hb when the tissue has a higher level of CO2

65
Q

How is o2 transported in the blood?

A
  1. 5% dissolved in plasma

98. 5% bound to haemoglobin

66
Q

Hb can unload Co2 and load o2 how many times faster than plasma?

A

60x

67
Q

What mmHg creates optimum binding to Hb?

A

60mmHg

68
Q

Full saturation of Hb occurs when PO2 is?

A

80-100mmHg

69
Q

What is the Haldane effect?

A

describes the effect of o2 on co2 transport.

deoxygenated blood can carry increasing amounts of co2, whereas oxygenated blood has a reduced co2 capacity.

70
Q

what are factors that affect gas diffusion?

A
  • lung disease
  • o2 concentrations
  • altitude
  • loss of lung tissue
  • PEEP, CPAP
  • poor perfusion
71
Q

What happens in physiologic dead space?

A

alveoli are ventilated but not perfused.

72
Q

What happens in a shunt?

A

There is perfusion, but poorly ventilated alveoli

73
Q

What is the 02 dissociation curve?

A

relationship between dissolves o2 and haemoglobin bound o2.

74
Q

what are the 4 factors that influence o2 binding to Hb?

A
  1. pH
  2. PCO2
  3. Temperature
  4. 2,3-BPG (also known as 2,3 DPG)
75
Q

What happens to dissociation curve when it shifts left?

A

Increased affinity

decreased temp
decrease 2,3 DPG
decreased H+
decreased Co

76
Q

What happens to dissociation curve when it shifts right?

A

Reduced affinity

increased temp
increased 2-3DPG
increased H+
Increased CO2

77
Q

What does a left shift on the dissociation curve mean?

A

higher affinity for haemoglobin and oxygen

o2 will stay bound to Hb and not be used, can result in hypoxia even when there is sufficient o2 in the blood

78
Q

What does a right shift on the dissociation curve mean?

A

decreases o2 affinity for Hb

blood will release o2 more readily.
Means o2 will be released to cells but also means less o2 will be carried from lungs.

79
Q

What are the factors that affect oxygenation?

A
  • amount of o2 available
  • good air entry
  • minimal obstruction at alveoli level for diffusion
  • good circulation of blood
  • good Hb levels
80
Q

Ventilation is regulated by what?

A
  • CNS
  • Central chemoreceptors
  • Peripheral chemoreceptors
  • Lung (stretch) receptors
  • Proprioceptors
81
Q

what do cenral chemoreceptors measure?

A

H+ and CO2 levels

82
Q

What do peripheral chemoreceptios measure

A

Po2, PCO2, H+

83
Q

What are the effects of age on resp & ventilation?

A
  • airways more rigid
  • chest wall more rigid
  • decreased lung capacity
  • decreased vital capacity (upto 35% at 70yo)
  • decreased activity of alveoli macrophages
  • diminished ciliary action in resp tract
84
Q

what is the normal pH level of arterial blood?

A

7.35-7.45

85
Q

what are the signs of respiratory acidosis?

A
  • hypoventilation -> hypoxia
  • rapid, shallow resps
  • decreased BP with vasodilation
  • Dyspnea
  • headache
  • Hyperkalemia
  • Dysrhythmias (increased K+)
  • drowsiness, dizziness, disorientation
  • Muscle weakness, hyperreflexia
86
Q

What are causes of respiratory acidosis?

A
  • respiratory stimulus (anaesthesia, drug OD)
  • COPD
  • Pneumonia
  • Atelectasis
87
Q

What are causes of respiratory alkalosis?

A
  • hyperexcitability of NS
  • Hyperventilation (anxierty, fear)
  • mechanical ventilation
88
Q

what are the signs of respiratory alkalosis?

A
  • seizures
  • deep, rapid breathing
  • hyperventilation
  • tachycardia
  • decrease or normal BP
  • hypokalemia
  • numbness & tingling of extremeties
  • lethargy & confusion
  • light headedness
  • nausea, vomitting
89
Q

what are complications of acidosis/alkolosis?

A

Cardiovascular: acidosis reduces cardiac contractility. Both cause dysrythmias

NS: acidosis causes impaired consciousness

PAR2012 - Respiratory (13 decks)

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