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Respiratory Revision > Year 2 > Flashcards

Year 2 Flashcards

0
Q

What level of 02 does a Hudson mask give and how many litres do you need to use?

A

Medium concentration of 02 though unknown is estimated as 35-60%. Need to use more than 5L else get CO2 rebreathe

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1
Q

What level of 02 do nasal cannulae provide and how many litres do you need to use?

A

Low concentration O2 of unknown concentration. You need 4L else you can damage the nasal mucosa

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2
Q

How much O2 does a high concentration mask give and how many litres must you use?

A

60-90% O2 and must use 15L as it is a bag valve mask that needs to inflate

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3
Q

What is a fixed method of O2 delivery?

A

Venturi Mask - specific O2 delivery

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4
Q

What are the 4 indications for humidification?

A

1) Prolonged O2 use >4 L/ min for >24 hours
2) Thick or retained secretions
3) Hyperactive airways e.g. In asthma
4) O2 delivery passing the upper airways e.g. A trache

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5
Q

What is Type 1 Respiratory Failure?

A

Hypoxaemia - low O2 below 8kPa with normal pH and CO2. Is due to V/Q mismatch

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6
Q

What is Type 2 Respiratory Failure?

A

Hypercapnia - low O2 below 8kPa, high CO2 above 6 kPa and low pH. Is due to ventilatory failure

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7
Q

What are the causes of Type 1 Respiratory Failure?

A

Secretion retention, acute lobar collapse, fluid I.e. A pleural effusion or pulmonary oedema

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8
Q

What are the causes of Type 2 Respiratory Failure?

A

Decreased respiratory drive (e.g. Opioids), decreased muscle strength and increased load (e.g. In a COPD exacerbation)

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9
Q

What are the signs of Type 1 Respiratory Failure?

A 
Tachycardia
Tachypnoea 
Accessory muscle use
Cyanosis
Clammy
Altered mental state
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10
Q

What are the signs of Type 2 Respiratory Failure?

A 
All of the signs of Type 1
Confusion
Headache
Pounding pulse
Vasodilation
Decreased consciousness
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11
Q

What does IPPB stand for?

A

Intermittent Positive Airway Pressure

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12
Q

What does IPPB do?

A

Increases TV
Mobilises secretions via collateral ventilation
Decreases WOB
Good for: fatigue, high WOB, sputum retention, lobar collapse, weak cough and low TV

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13
Q

What does CPAP stand for?

A

Continuous positive airway pressure

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14
Q

What does CPAP do?

A

Applied throughout inspiration and expiration
Splints open alveoli and improves oxygenation
Increases intrathoracic pressure
Decreases WOB
Increases FRC
Good for: Type 1 respiratory failure (don’t use in Type 2 as hypoxia drive), decreased FRC, high WOB and atelectasis

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15
Q

What does NIV stand for?

A

Non invasive ventilation

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16
Q

What does NIV do?

A

Combination of IPPB and CPAP - get positive inspiratory and expiratory pressure (IPAP + EPAP).
IPAP - Bird - offloads respiratory muscles, increases TV and decreases WOB
EPAP - CPAP - splints open alveoli and increases FRC
Good for: Type 2 respiratory failure, weaning from mechanical ventilation

17
Q

What are the contraindications for positive pressure ?

A

Undrained pneumothorax, vomiting as can aspirate, severe haemoptysis, proximal tumour or obstruction as can cause hyperinflation and pneumothorax bullae, active TB, high ICP, recent lung/face/oesophageal surgery, haemodynamic instability as can decrease BP

18
Q

What is Respiratory Acidosis?

A

High PaCO2 and low pH due to insufficient ventilation

19
Q

What is Respiratory Alkalosis?

A

Low PaCO2 and high pH due to hyperventilation

20
Q

What is Metabolic Acidosis?

A

Low pH and low HCO3- due to ingestion of acids or loss of bicarbonate through diarrhoea

21
Q

What is Metabolic Alkalosis?

A

High pH and high HCO3- due to loss of acid from vomiting

22
Q

Explain the compensation of Respiratory Acidosis?

A

Renal compensation - the body increases adsorption of HCO3- to normalise pH

23
Q

Explain the compensation of Respiratory Alkalosis?

A

Renal compensation - adsorption of HCO3- decreases to normalise pH

24
Q

Explain the compensation of Metabolic Acidosis?

A

Respiratory compensation - ventilation increases to decrease CO2 to normalise pH

25
Q

Explain the compensation of Metabolic Alkalosis?

A

It cannot be compensated as ventilation cannot be decreased enough

26
Q

How do you systematically look at CXRs?

A

A - airways - is the trachea central?
B - bones - any #? Symmetry of ribs?
C - cardiac - heart <half the chest wide?
D - diaphragm - one dome higher, smooth lines?
E - expansion - 6 ribs visible anteriorly?
F - fields - symmetrical air volume in each lung?
G - gadgets
H - hilar - enlarged? Clear to see?

27
Q

What is a pneumothorax?

A

Air enters the pleural space through a hole in the chest wall

28
Q

What are the signs of a pneumothorax?

A 
CXR = peripheral lung markings absent
Clinically = decreased chest movement on affected side, decrease or loss of breath sounds, increased resonance to percussion, SOB and increased HR
29
Q

What is a tension pneumothorax?

A

The hole formed has a flap that acts as a valve. In inspiration the air enters the pleural space and can’t escape. There’s a mediastinal shift away from the affected side

30
Q

What is a pleural effusion?

A

Fluid that collects in the pleural space due to an imbalance in formation and reabsorption

31
Q

What are the signs of a pleural effusion?

A 
CXR = loss of costophrenic angle, white out, fluid line
Clinically = dull to percussion, absent breath sounds, decreased chest expansion, SOB, increased HR + RR, painful cough
32
Q

What is atelectasis?

A

Collapse due to a sputum plug or foreign body resulting in decrease lung volumes

33
Q

What are the signs of atelectasis?

A

CXR =white area of collapse, mediastinal shift towards area, higher diaphragm
Clinically = increased RR, decreased breath sounds, dull to percussion

34
Q

What is surgical emphysema?

A

Can result from a pneumothorax. It’s an air leak from the pleura that leads to an accumulation of air in the subcutaneous tissue e.g. Muscle

35
Q

What are the signs of surgical emphysema?

A 
CXR = can see muscle striations e.g. Pecs 
Clinically = bubble wrap sensation
36
Q

What is consolidation?

A

The alveoli becoming airless and filling with the products of inflammation

37
Q

What are the signs of consolidation?

A 
CXR = increased shadowing appearing patchy white, loss of structural borders
Clinically = dull to percussion, crackles, coarse breath sounds, painful cough. If infection: fever, increased RR + HR
38
Q

What are the signs of hyperinflation?

A

CXR = flattened diaphragm, long elongated heart, increased lung volumes, horizontal ribs, bullae

39
Q

What is pulmonary oedema?

A

An accumulation of fluid in the interstitial space between the alveoli and capillaries

40
Q

What are the signs of pulmonary oedema?

A

CXR = fluffy shadowing and engorged blood vessels around the hilar and base of the lungs

Respiratory Revision (5 decks)

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