• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/50

Click to flip

50 Cards in this Set

  • Front
  • Back
What are the six risk factors that put patient at risk for post op pulmonary dysfunction, most common post op complication?
Pre-existing pulmonary disease
Thoracic and upper abdominal surgery
Smoking
Obesity
Age > 60 years
Prolonged general anesthesia > 3hours
What are the two strongest predictors of complications?
Operative site and duration of procedure
What test shows abnormalities early before symptoms of COPD occurs?
Maximal midexpiratory flow
What kind of changes occurs on obese individuals?
Decreased FRC, increased work of breathing, higher risk of DVTs
What kind of changes occurs with upper abdominal surgery?
Rapid shallow breathing, decreased sighs, ineffective cough due to pain, impaired mucociliary clearance, microatelecstasis
What problems occur with intrapulmonary shunting?
Hypoxemia
What can occur from atelecstasis and mucous or secretory retention?
Increased risk of pneumonia
What are some obstructive lung diseases?
Asthma, COPD, cystic fibrosis, bronchiectasis, bronchiolitis
What is the primary characteristic of obstructive lung disease
Resistance to airflow
What happens to the MMEF of patients with obstructive lung disease?
Decreased to less than 70% or <70%
What occurs primarily to the FEV1 of patients with obstructive disease?
The have a FEV1 is less than 70% of the predicted value
What occurs to the increased airway resistance in obstructive disease?
Increased air trapping, residual volume and total lung capacity increase
What are some of the physical characteristics of Asthma?
Episodic dyspnea, cough, wheezing
How is airway affected in asthma?
Bronchial smooth muscle constriction diminishes airway, edema and secretion
What are the classifications of asthma?
Acute and Chronic
What is the differentiation criteria for chronic asthma?
Mild, moderate, and severe persistent disease?
What are some of the pathophysiology of asthma?
Local release of mediators, overactivity of the PANS
How is bronchospasm initiated?
By activating the specific and non-specific immune system by degranulation of bronchial mast cells
Describe allergic asthma?
Antigen binds IgE on surface of mast cells causing degranulation
How does degranulation of mast cells trigger asthma?
Histaminic release, bradykinin, leukotrienes C, D, E and platelet activating factor; Protaglandins (PG) PGE2, PGF2alpha and PGD2, neutrophil and eosinophil chemotactic factors
Describe how the PANS system work with asthma?
PANS maintain normal bronchial tone, Vagal afferents in bronchi are sensitive to histamine, noxious stimuli, cold air, inhaled irritants and instrumentation
How does vagal activation cause bronchoconstriction at the molecular level?
It activates the increase in cGMP or cyclic guanosine monophosphate
How does Residual Volume and Functional Residual Capacity change during a severe asthma
RV increased 400% and FRC by 100%
What is the sign of respiratory failure in a patient with acute asthma attack?
High or normal paCO2 may indicate that the patient can no longer keep up with breathing
What does Beta 2 activation produce at the molecular level?
It activates receptors on smooth muscles that in turn activates adenylate cyclase, which increases cAMP
How does methylxanthines work?
They produce bronchodilation by inhibiting phosphodiesterase the enzyme that breaks down cAMP
What are other effects of methylxanthine?
Cathecholamine release, histamine release blockade, and diaphragmatic stimulation
What is the therapeutic blood level of theophylline?
10-20 ug/ml.
What measurement is ideal for patients with asthma during maintenance treatment?
Peak Expiratory Flow rate > 200L/min, if less than 50% can be indicative of severe asthma
Which induction agent is ideal for emergency surgery or hemodynamically unstable for a patient with asthma?
Ketamine has bronchodilating effect
How can reflex bronchospasm be blunted?
Use thiopenthal (1-2mg/kg), volatile agent at MAC for 5 minutes, IV or intratracheal lidocaine
Is succinocholline safe for patients with asthma?
It is generally safe, although it is associated with some histaminic release
Why is halothane avoided in adults with asthma?
Although a potent bronchidilator, halothane can sensitize heart to B2 agonists and can cause hepatotoxic side effects.
How is severity of bronchospasm related to end tidal CO2?
Severity is inversely related to rise of ETCO2
What are some intraoperative findings of bronchospasm
Increased peak inflation pressures, plateau pressure is unchanged, decreased exhaled tidal volumes, slow rise of wave form on capnograph
How do you treat bronchospasm? How do you prevent it?
Increase the volatile agents, treat with lidocaine bolus 1-1.5mg/kg or infusion of 1-2 mg/min
What is the diagnosis of COPD?
Productive cough on most days on 3 consecutive months for at least 2 consecutive years
What are some changes of COPD?
Erythrocytosis, pulmonary hypertension, right ventricular failure or cor pulmonale, CO2 retention, decreased ventilatory drive sensitivity to CO2 and more dependent to O2
What enzyme is associated with emphysema?
Elastase that destroy the alveoli, it is inhibited by alpha 1 antitrypsin
What are some dynamic findings in emphysema
Increased RV, FRC, TLC and RV/TLC ration
What are the complication of emphysema?
Increased dead space, although there are normal arterial and oxygen tensions, but only slightly reduced but CO2 is normal
What is the danger of administering O2 to patient with COPD / emphysema
The loss of hypoxic respiratory drive due to PaO2 greater than 60mm Hg, can cause extreme CO2 retention, hypercarbia and acidosis
How do you buff a patient with COPD?
Correct hypoxemia, relieve bronchospasms, mobilize and reduce secretions, treat infections
How long should smoking be stopped prior to elective operations?
6 to 8 weeks to decrease secretions, and reduce pulmonary complications
When should humidified air be used?
If surgery is greater than 2 hours
When should N2O be avoided?
Whenever a patient has a bullae and those with pulmonary hypertension. Bullae can explode while pulmonary artery pressures may elevate
What are the symptoms of tension pneumothorax as a result of a bullae blowing up?
Hypotension, hypoxemia, increased peak airway pressures, decreased tidal volumes, tracheal deviation and absent chest rise and movement in affected side
Which patients with COPD might require prolonged postoperative ventilation or ICU stay
FEV1 below 50%
What are signs and symptoms of intraoperative pulmonary embolism?
Unexplained hypotension, hypoxemia, and bronchospams, decreased ETCO2 concentration
What is the treatment for PE?
If air is identified in the right atrium, emergent central vein cannulation and aspiration of air is life saving