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54 Cards in this Set
- Front
- Back
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T/F Lung cancer is currently the most common mortality in the US
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True
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High risk pulmonary pts
a) FEV < 40% or < 2L of expected b) DLCO < 40% of predicted c) VO2 < 10ml/kg/min or desaturation d) inability to climb 1 flight of stairs |
FEV < 40% or < 2L of expected
DLCO < 40% of predicted VO2 < 10ml/kg/min or desaturation inability to climb 1 flight of stairs |
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T/F If pt has interstitial lung dz or dyspnea a DLCO (Carbon Monoxide Diffusion Capacity) must be measured
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True
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When is an exercise test VO2 done?
a) FEV < 40% b) DLCO < 40% c) FEV > 80% d) VO2 > 20ml/kg/min |
FEV < 40%
DLCO < 40% |
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Low risk pulmonary pts for thoracic surgery
a) FEV > 80% b) VO2 max > 20ml/kg/min c) ability to climb 5 flights of stairs d) FEV > 40% |
FEV > 80%
VO2 max > 20ml/kg/min ability to climb 5 flights of stairs |
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When determining whether pt will be able to tolerate lung surgery
a) Vital capacity must be at least 2x VT for effective cough b) Vital capacity must be at least 3x VT for effective cough c) Vital capacity has nothing to do with determining whether pt will tolerate surgery |
Vital capacity must be at least 3x VT for effective cough
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Smoking Abstinence for 12 -24 hours
a) increases ciliary function b) decreases carboxy Hgb c) causes Right shift of oxy Hgb curve d) decreases sputum production e) increases O2 availability to tissue |
decreases carboxy Hgb
causes Right shift of oxy Hgb curve increases O2 availability to tissue |
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Smoking Cessation 8 - 12 weeks
a) increases ciliary function b) decreases carboxy Hgb c) causes Right shift of oxy Hgb curve d) decreases sputum production e) increases O2 availability to tissue |
increases ciliary function
decreases sputum production |
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When determining whether pt will be able to tolerate lung surgery
a) Vital capacity must be at least 2x VT for effective cough b) Vital capacity must be at least 3x VT for effective cough c) Vital capacity has nothing to do with determining whether pt will tolerate surgery |
Vital capacity must be at least 3x VT for effective cough
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What drugs should be avoided in Thoracic surgery patients? Why?
a) Vecuronium b) Atracurium c) Morphine d) Pavulon e) Sux |
Atracurium
Morphine Sux THEY ARE ALL HISTAMINE RELEASERS Vec, Pav, & Fentanyl are GOOD choices |
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What equipment do you need for 1 lung ventilation
a) Peds FOB b) ETT 8 or greater c) MAC blade d) Miller blade e) double lumen tube |
Peds FOB
ETT 8 or greater MAC blade Double lumen tube |
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Double lumen tube sizes
a) male 39 - 41 b) male 8 - 8.5 c) female 35 - 37 d) female 7 - 8 |
male 39 - 41
female 35 - 37 |
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Which double lumen tube is most commonly used?
a) Left sided tube b) Right sided tube c) They are both used equally |
Left sided tube
because anatomically the Right upper lobe is first to shoot off the bronchus L sided tube is curved to go to the left side and avoid blocking the right lungs |
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Absolute Indications for 1 lung ventilation
a) Isolation of 1 lung to avoid contamination b) Surgical exposure c) need for 1 lung lavage d) middle & lower lobectomies e) pneumonectomy |
Isolation of 1 lung to avoid contamination
need for 1 lung lavage |
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Relative Indications for 1 lung ventilation
a) Isolation of 1 lung to avoid contamination b) Surgical exposure c) need for 1 lung lavage d) middle & lower lobectomies e) pneumonectomy |
Surgical exposure
middle & lower lobectomies pneumonectomy One lung vent. for these surgeries helps surgeon |
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Why does a DLT have a large internal-to-external diameter ratio?
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it decreases resistance to ventilation and suctioning
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Right Bronchus
a) 1-2.5 cm from carina b) 5 cm distal to the carina c) diverges into 3 separate lobes d) diverges into 2 separate lobes |
1-2.5 cm from carina
diverges into 3 separate lobes |
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Left Bronchus
a) 1-2.5 cm from carina b) 5 cm distal to the carina c) diverges into 3 separate lobes d) diverges into 2 separate lobes |
5 cm distal to the carina
diverges into 2 separate lobes |
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How much air is placed in the tracheal cuff in a DLT
a) 7- 10 cc b) 2 - 3 cc c) as much air as it takes to give it a snug fit |
7- 10 cc
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How much air is placed in a bronchial cuff in a DLT
a) 7 - 10 cc b) 2-3 cc c) as much air as it takes for a snug fit |
2-3 cc (typically only need about 1 cc add air slowly)
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Which blade is the superior blade for placing a double lumen tube?
a) MAC b) Miller |
MAC there is more room for tube to pass when using MAC blade
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Once the bronchial tip of the DLT passes thru the cords...
a) remove blade b) keep blade in c) remove stylet d) keep stylet in place e) turn tube 90 degrees |
keep blade in
remove stylet turn tube 90 degrees |
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When placing Left sided DLT which way do you rotate the tube 90 degrees?
a) Right b) Left |
Left
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When placing Right sided DLT which way do you rotate the tube 90 degrees?
a) Right b) Left |
Right
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When verifying placement of Left DLT
a) clamping the the tracheal lumen of the DLT you will hear Right sided breath sounds b) clamping the the tracheal lumen of the DLT you will hear Left sided breath sounds c) clamping the the tracheal lumen of the DLT you will hear bilateral breath sounds |
clamping the the tracheal lumen of the DLT you will hear Left sided breath sounds
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After placing a Left sided tube
a) when tracheal and bronchial cuffs are inflated you should hear bilateral breath sounds b) when tracheal cuff is inflated you should hear bilateral breath sounds c) when bronchial cuff is inflated and tracheal cuff is clamped you should hear breath sounds on left side |
when tracheal cuff is inflated you should hear bilateral breath sounds
when bronchial cuff is inflated and tracheal cuff is clamped you should hear breath sounds on left side |
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Cartilaginous rings
a) posterior b) anterior |
Anterior
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Tracheal membrane
a) anterior b) posterior |
Posterior
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Migration of a DLT happens
a) during flexing of pt head b) during extension of head |
Flexing
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Decannulation of a DLT happens
a) during flexing of pt head b) during extension of head |
Extension
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Relative CONTRAINDICATIONS for DLT
a) Full Stomach b) Presence of lesion along DLT pathway c) pt who cannot tolerate extubation of single lumen long enough for placement of DLT d) small pt that a 35 fr is too big & 28 fr is too small |
Full Stomach
Presence of lesion along DLT pathway pt who cannot tolerate extubation of single lumen long enough for placement of DLT small pt that a 35 fr is too big & 28 fr is too small |
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T/F PFT's offer useful preliminary guidelines for assessing pt ability to tolerate lung resection
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True
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Lateral Decubitus position
a) decreased perfusion to nondependent lung b) increased perfusion to nondependent lung c) increased perfusion to dependent lung d) decreased ventilation to dependent lung |
decreased perfusion to nondependent lung
increased perfusion to dependent lung decreased ventilation to dependent lung |
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During Awake Spontaneous breathing in a lateral position
a) gas exchange is similar to upright position b) there is less ventilation to dependent lung c) there is adequate ventilation of dependent lung d) perfusion is greatest in dependent lung e) perfusion is greatest in the nondependent lung |
gas exchange is similar to upright position
there is adequate ventilation of dependent lung perfusion is greatest in dependent lung |
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T/F Lateral decub, anesthetized pt with closed chest cause decreased FRC
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True
further exacerbating the decrease in FRC from induction V/Q mismatch |
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T/F An anesthetized pt in lateral decub position who is mechanically ventilated has the same or similar V/Q mismatch that a non-ventilated pt in the same position
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FALSE V/Q mismatch increases and further decreases in FRC
(PEEP may help restore FRC & improve FRC) |
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An Anesthetized, lateral decub pt with an open chest
a) causes decrease in CO b) decreases ventilation to dependent lung c) increases ventilation to dependent lung d) negative intrapleural pressure is lost in the nondependent lung |
causes decrease in CO
decreases ventilation to dependent lung egative intrapleural pressure is lost in the nondependent lung |
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In Paradoxical Respiration in an anesthetitzed pt with open lung, and in lateral decub
a) inspiration causes collapse of nondependent lung b) inspiration causes inflation of nondependent lung c) expiration causes inflation of nondependent lung d) expiration causes collapse of nondependent lung |
inspiration causes collapse of nondependent lung
expiration causes inflation of nondependent lung |
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T/F Positive pressure ventilation decreases the effects of both paradoxical respirations & mediastinal shift
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True
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T/F The open-chest has a higher compliance & no resistance allowing the nondependent lung a higher proportion of ventilation which increases dead space
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True
The less ventilated better perfused dependent lung contributes to physiologic shunt |
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Which of the following interferes with Hypoxic Pulmonary Vasoconstriction
a) vasoconstriction b) vasodilation c) hypocapnia d) hypercapnia |
vasodilation
hypocapnia as well as extremes in pulmonary pressure & SVO2 |
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T/F When ventilation is interrupted to the ventilated lung the remaining blood left in that lung gets shunted
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True
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Which factors decrease blood flow to the nondependent lung
a) gravity b) surgical compression c) HPV d) ligation on nondependent lung vessels |
gravity
surgical compression HPV ligation on nondependent lung vessels |
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In the dependent ventilated lung
a) HPV may favor blood flow to nondependent lung b) atelectisis may occur c) secretions may be hard to remove |
HPV may favor blood flow to nondependent lung
atelectisis may occur secretions may be hard to remove |
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T/F When beginning one lung ventilation start Vt at 6ml/kg to keep PIP to 25 cmH2O
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True (Nagelhout)
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In One lung ventilation
a) PEEP is applied to dependent lung b) PEEP is applied to nondependent lung c) CPAP is applied to nondependent lung d) CPAP is applied to dependent lung |
PEEP is applied to dependent lung
CPAP is applied to nondependent lung |
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T/F CPAP to the nondependent lung is the best method to increase SaO2
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TRUE the lowest level should be used start @ 2 cmH20
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When switching back to 2 lung ventilation
a) give a few manual breaths and hold at pressure of 30 b) pull DLT back out of bronchus so the lung will inflate c) who knows |
give a few manual breaths and hold at pressure of 30
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Chest Tubes are inserted after a PNEUMONECTOMY the OR nurse places the chest tube to suction. Is this a problem?
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YES!!! it will cause a shift pulling lung over
DONT DO IT |
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T/F After lobectomy & pneumonectomy positive pressure should limited to < 30 cmH2O
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True, risk damage to bronchial stump
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T/F Contralateral positive nodes are an ABSOLUTE contraindication to thoracotomy
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True
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Your next pt is healthy and about to have a mediastinoscopy for monitoring you decide you need
a) EKG b) Swan c) A-line in left radial d) A-line in right radial e) SaO2 f) BP |
EKG
A-LINE IN RIGHT RADIAL ( fear of rupturing innominate artery) SaO2 BP |
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In a pt with Cysts & Bullae in their lungs
a) Desflurane should be avoided b) N2O should be avoided c) a DLT should be used d) Spontaneous breathing is advantageous |
N2O should be avoided
a DLT should be used Spontaneous breathing is advantageous (avoids rupture creating a pneumo) |
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With a tracheal resection
a) avoid SUX b) avoid Non-depolarizers c) RSI d) Slow inhalation induction |
avoid Non-depolarizers
Slow inhalation induction FEAR OF LOSING AIRWAY |
