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19 Cards in this Set
- Front
- Back
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Low FEV1
Low FVC normal FEV1/FVC low TLC low RV normal DLCO |
Restrictive
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7.56 / 20 / 88 / 20
A. Acute asthma exacerbation in an otherwise healthy person. B. Trauma patient with a fall less than 30 minutes ago, workup reveals dense paraplegia from high cervical (C2) spinal cord injury. C. Severe COPD in exacerbation. D. Acute pulmonary thromboembolism in patient with underlying lung disease. E. Same patient in A, progressive worsening of symptoms despite 3 hours of treatment. |
Respiratory alkalosis
Elevated A-a gradient (37) Could be A or D |
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7.29 / 85 / 130 / 38 on 50% oxygen
A. Acute asthma exacerbation in an otherwise healthy person. B. Trauma patient with a fall less than 30 minutes ago, workup reveals dense paraplegia from high cervical (C2) spinal cord injury. C. Severe COPD in exacerbation. D. Acute pulmonary thromboembolism in patient with underlying lung disease. E. Same patient in A, progressive worsening of symptoms despite 3 hours of treatment. |
Respiratory acidosis
E or C A-a gradient on 50% oxygen. Can estimate with PAO2 = 7 * FiO2 Here A-a gradient estimate is >20. if FiO2 is off by 3 points, you can overestimate Even if give someone 100 |
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Explain why room air is used with the A-a gradient
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If give oxygen via a mask some will escape and will underestimate A-a gradient.
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7.40 / 40 / 92 / 24
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Normal
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7.25 / 60 / 70 / 26
A. Acute asthma exacerbation in an otherwise healthy person. B. Trauma patient with a fall less than 30 minutes ago, workup reveals dense paraplegia from high cervical (C2) spinal cord injury. C. Severe COPD in exacerbation. D. Acute pulmonary thromboembolism in patient with underlying lung disease. E. Same patient in A, progressive worsening of symptoms despite 3 hours of treatment. |
Acute respiratory acidosis
B A-a is 5 |
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7.20 / 15 / 110 / 6
A. Acute asthma exacerbation in an otherwise healthy person. B. Trauma patient with a fall less than 30 minutes ago, workup reveals dense paraplegia from high cervical (C2) spinal cord injury. C. Severe COPD in exacerbation. D. Acute pulmonary thromboembolism in patient with underlying lung disease. E. Same patient in A, progressive worsening of symptoms despite 3 hours of treatment. |
Metabolic acidosis
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7.45 / 25 / 110 / 17
A. Acute asthma exacerbation in an otherwise healthy person. B. Trauma patient with a fall less than 30 minutes ago, workup reveals dense paraplegia from high cervical (C2) spinal cord injury. C. Severe COPD in exacerbation. D. Acute pulmonary thromboembolism in patient with underlying lung disease. E. Same patient in A, progressive worsening of symptoms despite 3 hours of treatment. |
Respiratory alkalosis with a normal A-a gradient.
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An arterial blood gas machine reports back a PaO2. The partial pressure of oxygen (PaO2) in arterial blood is a measure of what?
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The amount of oxygen dissolved in the blood.
The amount of P2 dissolved in the blood is proportional to the partial pressure of O2 and its solubility coefficient. This mean that the PaO2 ia a measure of the oxygen physically dissolved in solution. |
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A 38 year old male with a hematocrit of 22% due to chronic untreated GI bleeding. The normal expected hematocrit for this man would be around 44%. If you were to draw a room air arterial blood gas on this patient you would expect which of the following (based solely on the change in his hematocrit)?
A. His PaO2 will be about normal for him. B. His PaO2 will be about half normal for him C. His O2 saturation of hemoglobin (% O2 sat) will be decreased by half. D. His blood oxygen will be nearly normal E. His blood oxygen content will be increased to compensate for the decreased hematocrit. |
A. His PaO2 will be about normal for him.
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A 58 y.o. smoker is 1 day s/p abdominal surgery and complains of SOB. An ABG is drawn and shows 7.46/35/65. On 100% inspired O2 the patients's PaO2 rises to 120. CXR shows atelectasis of the right lung. What is the physiologic mechanism underlying the patient's initial hypoxemia?
A. Low ambient inspired oxygen tension. B. Alveolar hypoventilation. C. V/Q mismatch. D. Right-to-left shunt. E. Membrane diffusion barrier. |
D. Right-to-left shunt
How to measure what is a good enough response: PaO2/FiO2 > 300 is normal 200 - 300 is V/Q mismatch < 200 is R-L shunt |
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A 49 y.o. female with a long history of illicit drug use is brought to the ER because of being found unresponsive. An ABG is drawn and shows 7.25/70/58. What is the physiologic mechanism underlying the patient's hypoxemia?
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B. Alveolar hypoventilation
A-a gradient is normal |
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A 33 y.o. female with asthma is brought to the ED in extreme respiratory distress. She is hypoxic on room air due to V/Q mismatch. Which of the following is most likely true?
A. A-a difference normal, substantial rise in PaO2 with 100% oxygen. B. A-a difference high, substantial rise in PaO2 with 100% oxygen. C. A-a difference high, modest rise in PaO2 with 100% oxygen. D. A-a difference normal, modest rise in PaO2 with 100% oxygen. E. A-a difference low, substantial rise in PaO2 with 100% oxygen. |
B. A-a difference high, substantial rise in PaO2 with 100% oxygen.
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Total lung capacity is equal to:
A. Residual volume plus vital capacity B. Functional residual capacity plus vital capacity C. Tidal volume plus vital capacity D. Residual volume plus tidal volume plus vital capacity E. Vital capacity minus residual volume. |
A. Residual volume plus vital capacity
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What is the FULL A-a gradient equation?
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FiO2(Patm - PH2O) - (PaCO2/R)
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What is a way to estimate PAO2?
What would the PAO2 be of someone on 50% oxygen? |
PAO2 = FiO2(Patm - PH2O)
This usually equals about 150 This equals approximately FiO2 * 7. For example the above equation equals 150, and with an FiO2 of 0.21 or 21, FiO2 * 7 = 21 * 7 = 147, which is pretty close. Someone on 50% oxygen would have a PAO2 of approximately 50 * 7 = 350 |
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Every liter of oxygen that you give a patient is equivalent to giving what percentage of oxygen?
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1 liter of oxygen = 2 to 3 percentage points higher.
If 21% oxygen (room air) and give 5L of O2, then the percentage should go to approx 27% O2 |
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Treatment of COPD exacerbation?
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Steroids + ABX
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How long can it take for someone like an asthmatic to go from a respiratory alkalosis to an acidosis?
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Respiratory status can change in as quickly as 20 minutes.
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