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Tech III
Unit One, Chapters 45/49
| Question | Answer |
|---|---|
| What is the overall goal of mechanical ventilation? | To fix the underlying reason the patient was ventilated for in the first place, thus leading to getting the patient off the vent. |
| When patients cannot breath effectively, they are in _____ _____. | respiratory failure |
| The inability to maintain the normal delivery of oxygen to the tissues or the normal removal of carbon dioxide from the tissues. | respiratory failure |
| Respiratory failure is marked by a PaO2 of less than _____ torr on room air. | 60 |
| Respiratory failure is marked by a PaCO2 of greater than _____ torr on room air. | 50 (with an acid pH) |
| True or False. Respiratory failure can be a cute or chronic. | True |
| How can respiratory failure be diagnosed as acute or chronic? | by interpreting the ABG |
| What are the 2 types of respiratory failure? | Type I - hypoxemic respiratory failure Type II - hypercapnic respiratory failure |
| What are the top 3 causes of hypoxemia? | V/Q mismatch shunt hypoventilation |
| More ventilation in the apices and more perfusion in the bases is known as _____. | V/Q mismatch |
| What is the overall V/Q ratio? | 0.8 |
| _____ occurs when disease disrupts the normal ventilation/perfusion balance. | V/Q mismatch |
| The most commonly pathologic mismatch is seen in areas of low V/Q where ventilation is compromised despite adequate blood flow. Name the pathologies. | CBABE - causing bronchospasm, mucus plugging, inflammation, premature airway closure |
| True or False. Hypoxemia that results from V/Q mismatch will respond to supplemental oxygen therapy. | True |
| True of False. Hypoxemia that results from a shunt will respond to supplemental oxygen therapy. | False. Shunts do not respond to supplemental oxygen. Treat with PEEP. |
| How do patients present with a V/Q mismatch? | increased use of accessory muscles. nasal flaring cyanosis |
| Bluish tint around the lips. | central cyanosis |
| If a patient has lower extremity edema, the cause of hypoxemia is more than likely _____ _____. | heart failure |
| Bluish tint in the extremeties. | peripheral cyanosis or acrocyanosis |
| Cyanosis is more common in patients with polycythemia. In prolonged hypoxemic respiratory failure, polycythemia may result when oxygen delivery to the tissue is compromised and _____ is released from the kidneys to stimulate _____ production. | erythropoietin red blood cell |
| Severe hypoxemia can lead to significant _____ dysfunction, ranging from irritability to confusion to come. | CNS |
| V/Q mismatch x-ray can present as _____ with large or hyperinflated lungs. | radiolucent |
| V/Q mismatch x-ray can present as _____ when alveoli are consolidated or atelectatic. | radiopaque |
| What is the normal anatomical shunt value? | 2-3% |
| An extreme version of V/Q mismatch in which there is no ventilation to match perfusion. | shunt |
| What are 2 types of shunts? | pathological anatomical (cardiac) physiological (alveoli) |
| Which shunt occurs as a result of right-to-left blood flow through cardiac (atrial/ventricular septal defects) openings? | pathological |
| Which shunt leads to hypoxemia when alveoli collapse or are filled with fluid or exudates | physiological |
| A shunt does/does not respond to supplemental oxygen. | does not |
| Why does a shunt not respond to supplemental oxygen? | A shunt does not respond to supplemental oxygen because the gas exchange unit is not open? |
| How should a shunt be treated to increase the FRC? | Treat with PEEP |
| How do shunts present clinically? | bilateral or unilateral crackles radiopaque on xray (diffuse, bilateral haziness in ARDS) |
| What is Type I Respiratory Failure? | Hypoxemic Respiratory Failure |
| What is Type II Respiratory Failure? | Hypercapnic Respiratory Failure |
| What is a rare cause of significant hypoxemia at rest called? | diffusion impairment |
| What pathologies are associated with interstitial lung disease? | pulmonary fibrosis asbestosis sarcoidosis |
| Thickening and scarring of the interstitium is called______. | interstitial lung disease |
| Which cause of hypoxemia usually happens on exertion? | diffusion impairment - DOE |
| Signs and symptoms: dyspnea, dry cough, fine basilar crackles on auscultation, digital clubbing. | interstitial lung disease |
| Signs and symptoms: right heart failure-edema, jugular vein distension, louder pulmonary component of second heart sound. | pulmonary hypertension |
| X-ray: normal film, reduced lung volumes with interstitial markings. | diffusion impairment-interstitial lung disease |
| X-ray: enlarged right ventricle and pulmonary arteries | diffusion impairment-pulmonary hypertension |
| X-ray: hyperinflated, dark | emphysema |
| A rare cause of hypoxemia found in individuals with liver disease and portal hypertension. | perfusion/diffusion impairment |
| Fluid that leaks out of blood vessels into nearby tissues. | exudates |
| Hypoxemia due to dilated intrapulmonary vasculature in the presence of liver disease or portal hypertension. | hepatopulmonary syndrome |
| Signs and symptoms: ascites, jaundice, spider nevi. | cirrhosis |
| The sensation of dyspnea when moving from the supine position to the upright position. | platypnea |
| A decrease in oxygen level when a patient moves from the supine position to the upright position. | orthodeoxia |
| Other than the top 3, what are other causes of hypoxemic respiratory failure? | diffusion impairment perfusion/diffusion impairment decreased inspired oxygen venous admixture |
| Which cause of hypoxemia occurs at high altitudes? | decreased (partial pressure) of inspired oxygen - barometric pressure decreases |
| Which cause of hypoxemia is a decrease in mixed venous PO2 returning to the heart? | venous admixture |
| If there is a decrease in mixed venous PO2 returning to the heart, what will need to happen? | There will be an increase in how much oxygen is needed to diffuse into the blood to bring arterial levels back to normal values. |
| What is the most common cause of low mixed venous oxygen level? | CHF - congestive heart failure |
| _____________ presents with a normal AaDO2. | hypoventilation |
| _______ and _______ both present with an increased AaDO2. | V/Q mismatch shunt |
| What range is the AaDO2? | 10-25 torr on room air |
| How is age-specific AaDO2 calculated? | [age/4]+4 |
| A significant response to applying even small amounts of oxygen identifies _________ as the cause of hypoxemia. | V/Q mismatch |
| Even with 100% oxygen delivery a true ______ will show little to no improvement in oxygenation. | shunt |
| How are shunts treated? | by adding PEEP |
| What is normal PaO2? | 80-100 mmHg on room air |
| A PaO2 of <70 torr on an oxygen mask(60%) indicates what? | inadequate oxygenation or lung failure |
| An AaDO2 is considered critical at what range? | > 450 torr on supplemental oxygen |
| The A-a gradient is used to estimate the degree of ________ and the degree of _______ _______. | hypoxemia physiological shunt |
| What are some causes of physiological shunts that can lead to hypoxemia? | atelectasis pulmonary edema pneumonia |
| What is the normal calculated shunt percentage? | 10% or less |
| What is a mild physiological shunt percentage? | 10% - 20% |
| What is a significant physiological shunt percentage? | 20% - 30% |
| What is a severe physiological shunt percentage? | > 30% |
| What is the cause of a high A-a gradient? | shunt diffusion defect V/Q mismatch |
| What formula is used to evaluate the arterial and alveolar PO2? | PaO2/PAO2 ratio |
| What is the normal arterial and alveolar ratio? | 0.75 - 0.95 ( 75% - 95% of oxygen in alveolus gets into the arteries) |
| What arterial and alveolar ratio value is considered critical? | 0.15 or less |
| What is the alveolar gas equation? | PAO2 = (Pb - Ph20)FiO2 - PaCO2 x 1.25 |
| What is a normal oxygenation ratio or P/F ratio? | about 475 |
| If a patient has hypoxemia accompanied by increased work of breathing and rising/falling PaCo2 and falling pH. What is the next step? | mechanical ventilation |
| What is another name for hypercapnic respiratory failure | ventilatory failure pump failure bellows failure |
| What rises if dead space (Vd/Vt) rises? | PaCo2 |
| What are disorders responsible for hypercapnic respiratory failure? | insidious exposure impairment in respiratory control impairment of respiratory effectors increased work of breathing |
| Cause of hypercapnic respiratory failure due to inhaling increased amount of CO2 . | insidious exposure |
| When CO2 scrubbers in the settings of anesthesia machines or life-support systems in closed systems are defective, what could occur? | hypercapnic respiratory failure due to insidious exposure |
| Occupational exposures, individuals who explore caves, individuals who work with dry ice, miners, and firefighters are all at risk of respiratory failure due to _______ _______. | insidious exposure |
| Due to factors such as drug overdose/sedation, brainstem lesions, hypothyroidism, morbid obesity (OHS), and sleep apnea, what disorder would lead to RF? | impairment in respiratory control |
| OHS | obesity hypoventilation syndrome |
| What is the Hallmark of impairment in respiratory control? | bradypnea and apnea (normal RR is 12 BPM) |
| What system is responsible for the operation of the lungs? | central nervous system |
| List the diseases associated with an impairment in respiratory effectors (muscles). (elevated CO2 and muscle fatigue) | ALS Guillain-Barre Myasthenia Gravis Muscular Dystrophy |
| What are common signs for ALS? | drooling weak cough dysarthria - impairment in uttering words |
| In what 2 common situations is increased WOB that leads to hypercapnic respiratory failure if the workload is not overcome? | increased dead space that accompanies COPD elevated Raw that accompanies asthma |
| A complication that can occur in mechanically ventilated patients in which the lungs don't fully deflate during exhalation. | intrinsic PEEP (auto-PEEP)/air trapping aka occult and inadvertent PEEP |
| List some causes of increased WOB. | extensive burns pneumothorax rib fractures/flail chest pleural effusions |
| The best indicator of adequate ventilation is the _____. | PaCO2 |
| Normal PaCO2 ranges from _____ to _____. | 35 to 45 mmHg |
| If PaCO2 is > 50 with an acidic pH what is the indication? | acute hypoventilation or hypercapnic respiratory failure |
| What leads to an increased cerebral blood flow and is often accompanied by headaches? | elevated CO2 |
| Severe hypercapnia will eventually lead to _____ _____, cerebral depression, coma, and death. | CO2 narcosis |
| What is the normal range for Vd/Vt? | 0.3 - 0.4 0.2 - 0.4 |
| A Vd/Vt of > 0.6 indicates a critical increase in _____. | deadspace |
| The best indicator of impending ventilatory failure is to watch for a rising _____ _____ with no change or only a slight increase in PaCO2. | minute ventilation |
| Type II /chronic hypercapnic respiratory failure elicits a renal response by which the kidney retain _____ to elevate the _____ _____. | bicarb blood pH |
| In a cute hypercapnic failure, the pH will drop _____ for every 10 torr rise in PaCO2. | 0.08 |
| In chronic hypercapnic failure, the pH will drop ) _____ for every 10 torr rise in PaCO2. | 0.03 |
| What is another name for acute-on-chronic respiratory failure? | exacerbation |
| What are the most common precipitating factors of exacerbations? | bacterial or viral infections CHF, pulmonary embolus chest wall dysfunction medical noncompliance |
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Respiratory22
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