PAR2011 - ALS > Week 5 > Flashcards

Week 5 Flashcards

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1
Q

The lungs are surrounded by 2 continuous pleural membranes called the what?

A
  • Visceral pleura attached to the lungs

- Parietal pleura attached to the thoracic cage

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2
Q

How long is the trachea and it’s diameter?

A

10 -12cm

2.5cm in diameter

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3
Q

What is the trachea made of?

A

Contains 16-20 cartilaginous C-rings, composed of hyaline cartilage

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4
Q

What do the C rings in the trachea do?

A

Maintain structure and prevent collapse

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5
Q

What is the last trachael cartilage called?

A

Carina.

has Highly sensitive mucose which causes violent coughing when irritated.

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6
Q

Where does the primary bronchi begin?

A

Primary bronchi divides at the carina

  • Occurs at T7 of spine
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7
Q

what is a Difference between right and left bronchi?

A

Right bronchus is shorter, wider

and more vertical than the left

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8
Q

What are the 3 functional components of the respiratory system?

A
  • Gas exchange
  • Air pump - Mechanics of breathing
  • Regulation - Driver of ventilation
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9
Q

What are the steps air from the atmosphere goes through to enter the airways and system?

A
  • Conducted through nose/muth
  • Down larynx
  • Down trachea
  • into bronchus
  • down to a bronchial
  • then to a terminal bronchial
  • then terminal bronchial unit
  • into alveoli
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10
Q

Where does gas exchange begin?

A

Terminal respiratory units (TRUs)

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11
Q

What are the bronchioles made of?

A

Walls consist of smooth muscle

  • They do not have connective tissue or cartilage
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12
Q

Gas exchange only occurs in the:

A
  • Terminal bronchioles
  • Alveolar ducts
  • Alveolar sacs
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13
Q

What happens if Alveoli is overinflated?

A

Can cause gas leakage into the surrounding lung tissues and possibly the thoracic cavity

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14
Q

What is the atmospheric pressure at sea level?

A

760mmHg

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15
Q

What is the oxygen content of atmospheric pressure at sea level?

A
  1. 9%

- 159mmHg

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16
Q

What is the CO2 content of atmospheric pressure at sea level?

A
  1. 04%

- 0.3mmHg

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17
Q

What are the 2 types of respiration?

A

External respiration
- exhcnahge of O2 & CO2 between alveoli and blood

Internal respiration
- exchange of O2 & CO2 between blood and tissue cells

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18
Q

What are the 2 forms that O2 is carries by in the blood?

A
  • Dissolved (1.5%)

- Attached to Hb (98.5%)

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19
Q

Which form of oxygen in blood can diffuse out of capillaries into cells?

A

Only the dissolved O2

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20
Q

What is required for O2 to dissociate from Hb and dissolve into Plasma for cellular diffusion?

A

Plasma O2 levels must always be greater than cellular O2 levels

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21
Q

What are the factors that influence O2 binding to Hb

A
  • pH
  • PCO2
  • Temperature
  • 2, 3-BPG ((Biphosphoglycerate –
    binds to haemoglobin,
    increases ability of
    haemoglobin to release O2)
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22
Q

How much CO2 is produced per minute in the body?

A

200mls

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23
Q

How is CO2 transported around the body?

A
  • Dissolved in plasma (7-10%)
  • Bicarbonate ion in plasma (about 70%)
  • Carbaminohemoglobin (20%)
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24
Q

How does alveolar ventilation impact the regulation of breathing?

A

Alveolar ventilation affects the level of CO2, which impact H+, which impacts regulation of breathing

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25
What muscles are used for Inspiration?
- Diaphragm | - External intercostals
26
What muscles are used for Expiration?
- Internal intercostals | - Abdominal
27
Whats another name for the pleural space?
Potential space
28
How do the 2 pleural membranes remain adhesive force?
Contains 3-5mls of serous fluid - constantly being excreted and absorbed - allows strong adhesive force
29
What creates the Negative Intrapleural pressure?
Results because the chest wall exerts pressure to pull the parietal pleura outward, while the elastic fibres in the lungs pull the visceral pleura inward - The constant pull of the pleural membranes causes pressure in the space to be SUBATMOSPHERIC
30
What causes pneumothorax?
atmospheric pressure entering the pleural space
31
What is the average adult Tidal volume?
500mls
32
What is tidal volume?
Breathing out
33
What is the formula for the minute volume?
MV = Tidal vol X resp rate
34
What is distensibility?
The ease of expanding the lung
35
What is resistance to airflow in the lungs dependant on?
Pulmonary compliance
36
What is pulmonary compliance?
Change in lung volume relative to a given pressure
37
What can reduce pulmonary compliance?
can be reduced due to degenerative lung diseases such as TB and pulmonary fibrosis. – Reduced compliance will affect how you ventilate a patient
38
Where is breathing regulated?
Brainstem, medulla, pons
39
What nerve regulates major output of breathing?
Phrenic nerve
40
What systems work together to form spontaneous ventilation and resp rate?
Ventral respiratory group (VRG) + Dorsal respiratory group (DRG)
41
What do central chemorecpetos detect when regulating breathing?
PCO2 + H+ Not PO2 of blood`
42
Where are the central chemoreceptors located for regulating breathing?
Ventral surface of the medulla
43
Where are the peripheral chemoreceptors located for regulating breathing?
carotid bodies at the bifurcation of common carotid arteries and below the aortic arch
44
What do peripheral chemorecpetos detect when regulating breathing?
decreases in arterial PO2 and pH increases in arterial PCO2
45
What other types of receptors exists with breathing regulation?
Lung receptors - Located in walls of bronchi and brochioles Pulmomary stretch receptors Irritant receptors J receptors - live in alveoli walls - stimulate ventilation in response to engorgement from interstitial fluid
46
What is the primary driver in ventilation?
PCO2 in arterial blood
47
What chemoreceptors are involved in hypoxia and hypoxaemia?
only peripheral receptors
48
What is the normal Tidal volume for an adult?
500mL
49
Why do we provide assisted ventilation?
- help maintain normal partial pressures of O2 and CO2 | - create positive partial pressure that pushes air into lungs
50
What happens to an indicated patient if you fail to provide adequate ventilation?
- Lead to hypoxia - CO2 retention - Development of acidosis - cardiorespiratory arrest
51
What are the indications for assisted ventilation?
- where spntaneous ventilation is inadequate or absent - Pts with life threatening respiratory emergency - > resp failure or resp distress
52
What are some symptoms of pt's in resp failure?
- do not show work of breathing as exhaustion has overridden - show signs of hypoxia and hypercapnia - decreased, asymmetrical or absent breath sounds - O2 sats < 90% on room ait, <92% on O2 - Tachycardia >120 or bradycardia as a late sign - Arrhythmias - Pallor and/or cyanosis - Cool pale clammy - Falling BP (late sign) - Changed GCS - Decreased consciousness - Exhaustion (+/- chest pain)
53
what can cause the chest NOT to rise during assisted ventilation?
- Obstruction in the airway - Insufficient volume of gas being blown into lungs - inadequate seal of mask
54
What are the sizes in mls of the Bag valve mask (BVM's)
- Adult - 1400 - 1600 mks - Paed - 500mls - Neonate - 240 mls
55
How many breaths per minute should you aim for with assisted ventilations?
12 - 16
56
If a patient has 8 breaths how many ventilation do you give in assisted ventilation?
4 - 8
57
How much oxygen to give to patients in assisted ventilations
10ml per kg
58
What are some problems associated with Assisted ventilation?
Positive pressure ventilations have been assciated with: - Decreased oxygenation - Gastric rupture - Lung injury - hyperventilation
59
Define aspiration
the inhalation of material into the airway below the level of the vocal cords
60
What acts as a valve preventing gastric reflux?
Lower oesophageal sphincter
61
What is barrier pressure?
the pressure difference between the Lower Oesophageal sphincter and the intragastric pressure. - Usually 25mmHG LOS and 10mmHG intragastric pressure
62
What is aspiration pneumonitis?
lung tissue damage as a result of aspiration of very acidic gastric fluid
63
What is aspiration pneumonia
result of inhaling infected material or bacterial infection
64
What is hyperventilation?
a negative intrathoracic pressure is created forcing air into the lungs - can impact the diameter of vena cava and cardiac chambers - > acts as thoracic pump drawing blood into the heart
65
Hyperventilation has been associated with decreased what?
decreased coronary and cerebral perfusion pressures
66
Hoew does hyperventilation affect coronary perfusion?
- Normally negative intrathorcacic pressures apply traction to the greater vessels leading to more venous return - non-typical respiratory activity affects the ability of thoracic pump and reduces venous return and CO - Greater vessles are down compressed by the positive pressure ventilation (PPV) leading to less venous return - in turn reduces coronary perfusion
67
What is capnography?
monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases.
68
What is the benefit of capnography?
provide clinicians with a sensitive indicator to the effectiveness of compressions and ventilation performance
69
What is End tidal CO2 (ETCO2)?
the maximum partial pressure of CO2 at end of breath
70
What is the value mmHG of ETCO2?
about 26-40mmHG in health adult
71
What does PaCO2 mean?
partial pressure of CO2 in the arterial blood
72
What is the normal range for PaCO2?
approx 35 - 45 mmHG - 3-5 mmHG higher than ETCO2
73
What is a capnogram?
the plot of ETCO2 vs time
74
What is the normal value of CO2 in the body?
35 - 45mmHG
75
What is the normal range of ETCO2 compared to CO2 in the blood?
Within 5mmHG
76
What is it called if ETCO2 is over 45mmHG?
Hypercapnia
77
What is it called if ETCO2 is under 35mmHG
Hypocapnia
78
What are the causes of Hypocapnia?
- Hyperventilation - Hypoperfusion - hypothermia
79
What causes hyperventilation?
When a patient blows off more CO2 than they're making
80
What information does a capnography provide?
Ventilation - How effectively CO2 is being eliminated by the lungs Perfusion - How effectively CO2 is being transported through the vascular system Metabolism - how effectively CO2 is being produced by cellular metabolism
81
WHat will paramedics use capnography to determine?
- Loss of ETCO2 may be first sign CPR is needed - Compression feedback - Guide ventilation rates and confirm airway placement through waveform capnography - Help determine when to terminate or continue CPR - Spike in ETCO2 is first sign of ROSC
PAR2011 - ALS
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