Imported: Respiratorytest2_Ragosta_Lectures 1-3

Front 1

at what point in development does a neonate start to "breathe"

Back 1

20 weeks

start to ‘breathe’ -20 million alveoli-->fetus is moving fluid

Front 2

Adult versus Fetal alveoli:

potential space (what can this lead to?)

Back 2

fetal

Loose connective tissue b/t alveoli =Potential Space. Can lead to Alveolar Collapse

Front 3

Adult versus Fetal alveoli:

Pore of Kohn

Back 3

found in adult

path between alveoli to allow ventilation (If mucus plugs alveolar segment, Pore of Kohn allows ventilation b/t adjacent alveoli)

Front 4

Adult versus Fetal alveoli:

interdependence

Back 4

adult: high

fetal: low

Front 5

Adult versus Fetal alveoli:

alveoli are close together (what does this do)

Back 5

in adult

prevents collapse

Front 6

pediatric versus adult...

uses diaphragm for breathing mechanism (what does the others use?)

Back 6

pediatric

adult uses chest wall

Front 7

when does a baby get its immune defense..and how?

Back 7

3rd trimester...baby gets maternal IgG

so a TERM baby has mom's immunity for a couple months

Front 8

fetal or adult:

more ACIDOTIC & HYPOXIC

Back 8

fetus

Fetus must “steal” oxygen and “force” CO2

Front 9

does fetal or adult hemoglobin bind O2 better

Back 9

fetal

Front 10

do children or adults consume more O2?

Back 10

children

Front 11

how many CCs per breath do adults versus a fetus take in?

Back 11

adult: 5 cc/kg per breath

fetal: 1-2 cc/kg/breath

Front 12

when do type I pneumocytes develop in the fetus?

what implication does this have?

***

Back 12

1. **Magic # - 23 weeks. Usually b efore 23 weeks, fetus
cannot survive. No Type 1’s

Front 13

what do type II pneumocytes do? What does this help to do?

Back 13

produce surfactant

decreases surface tension, keeping the alveoli open

Front 14

what is the difference if you get a 1mm swelling of the lower airway in infants versus adults?

Back 14

1. Lower airway in infants-->has 75% of normal resistance
• So if 1mm swelling; get
o increase R by 16X
o cross sectional area decrease 75%
2. lower airway in adult-->40% of normal resistance
• get
o increase R by 3X
o Cross sectional area decrease 44%

Front 15

what lung gets 60% of blood air and aspirations?

Back 15

Right lung

Front 16

what is LaPlace's Law?

Back 16

As radius increases, need to decrease the pressure to maintain volume

Front 17

As radius decreases, what do you have to do to P to maintain volume? what does this demonstrte?

Back 17

increase P to maintain volume

this is Laplace's Law

Front 18

↑ in Radius = ? Volume

____Pressure needed to maintain volume

Back 18

↑ in Radius = ↑ Volume
-less Pressure needed to maintain volume

Front 19

what is the Bohr effect?

Back 19

o Hb binds O₂ @ lungs (when alkalotic)

o releases O₂ at muscle tissue (when acidotic)

Front 20

What is the difference btw atelectasis and dead space?

Back 20

atelectasis: blocked air supply (collapse)

dead space: blocked blood supply (PE)

Front 21

what happens to maintain the V/Q in atelectasis?

**

Back 21

Pulmonary Vasoconstrition-->Response to MAINTAIN V/Q ** by physiologically redirecting blood away from areas poorly ventilated

Front 22

Presented with a child with the whited out lung. X ray below (no air in lung). He is tachypenic, with breaths at 32/min (normal 16-20/min). Pulse ox measures 100% oxygenation. Give child a dose of albuterol. A few seconds later, his pulse ox drops. Why did this happen?

***

Back 22

The chuild most likely aspirated a marble, mucus, or peanut, etc. He blocked the airway to his Right lung. To maintain the V/Q ratio, his right pulmonary artery underwent physiological Hypoxic Pulmonary Vasoconstriction. He was tachypenic to maintain enough Minute ventilation thus CO2 elimination with his one functioning lung. Hence, 100% reading on the pulse ox. The β₂ agonist (albuterol) DILATED the Pulmonary artery, reversing the physiological Hypoxic vasoconstriction. Right ventricular blood now flows into the atelectatic lung, No gas in this lung, therefore blood can NOT get OXYGENATED. This increased the Venous Admixture and Pulse Ox drops . **** Your patient may actually be acting/feeling better inspite of saturation drop!!!
This is one reason you can’t use pulseox as the sole measure of illness…(many try!!)

Front 23

the following are signs of what?

tachympenic, CXR white out, pulse ox drops w/ b2 agonist

Back 23

Hypoxic Pulmonary Vasoconstriction

Front 24

dead space versus atelectasis:

V/Q abnormal

Back 24

dead space

both lungs are ventilated, but one may not be perfused enough...throwing off the V/Q

Front 25

What is FRC?

what does it prevent?
***

Back 25

after easy exhalation the volume that is left in your lung..keeps you pink

prevents atelectasis

Front 26

what do you do to get people back to normal FRC?

Back 26

lower the transpulmonary pressure

Front 27

- Asthmatics (obstructive lung disease) – How do you tx an asthmatic or COPD to get relief?

Back 27

-RESTORE FRC !!!! – Make it easier for them to breathe.

Front 28

3 organs with preferred circulation in Fetal Circulation

Back 28

liver
heart
brain

Front 29

where does the ductus venosis bring blood to first?

Back 29

the liver

Front 30

what gets first dibs at O2 rich blood?

Back 30

coronary arteries first

then brain

Front 31

where does the most acidic and hypoxic blood go to in fetal circulation?

Back 31

right ventricle-->ductus arterious-->des aorta-->placenta

Front 32

what happens during cord clamping?

Back 32

sudden loss of placenta (30% of Fetus’s blood supply) ->increased SVR
1. By clamping the cord, back pressure forms ( ↑ in Left Ventricular End Diastolic Pressure)
2. ↑ Pressure in L.A . Result – “closure” of Foramen Ovale → ↑ RV flow→ ↑Pulm. Artery Flow
3. Baby’s first breath of Room air (O₂) vasodilates Pulm Artery → Pulmonary Erection (lungs fill with blood supply) = Functional Residual Capacity ! !
4. Alveoli OPEN up after baby squeezes through the vaginal canal. (70-140 cm/H2O pressure)
• *Physical Squeezing of cartilaginous chest squeezes out Amniotic fluid out of lungs

Front 33

what removes amniotic fluid out of the lungs?

Back 33

• *Physical Squeezing of cartilaginous chest squeezes out Amniotic fluid out of lungs

Front 34

what is persistent fetal circulation?

Back 34

o - blood is still shunted through Patent Ductus Arteriosus BYPASSING LUNGS !!!
These kids look deathly ill

Front 35

Tx for Persistent Fetal Circulation

Back 35

Treat cause (in mother), Oxygen, support BP, Vasodilators, mechanical support, pH
O₂ , Dopamine, bicarb

Front 36

what is meconium?

**

Back 36

1st baby stool

should be past in the first 24 hours (not inutero)

Front 37

what can cause meconium to be passed inutero? what does this cause?

Back 37

fetus is stressed (hypoxic/hypotensive) leads to decreased sympathetics...loosening the rectal tone

this can then get aspirated and the baby can look hypoxic and have irritants to breathing

Front 38

the following describes what?

*Thickened Alveolarmembrane
*Neutrophilic infiltration
*Decreases Oxygenation
*Increases Work of Breathing

Back 38

• Respiratory Distress Syndrome (RDS) or Hyaline Membrane Disease

Front 39

early signs of this problem are a bell shaped chest and increased lung markings...later you will have a "ground glass" appearance, more lung markings, and loss of bell shape

Back 39

Respiratory Distress Syndrome (RDS)

Front 40

a child is born prematurely and has decreased surfactant and as a result is having trouble breathing..what do they have?

Back 40

Respiratory Distress Syndrome (RDS)

Front 41

treatment for Respiratory Distress Syndrome (RDS)?

Back 41

surfactant

Front 42

if you see ground glass bell shaped CXR what do you have?

Back 42

Respiratory Distress Syndrome (RDS)

Front 43

#1 cause of neonatal sepsis?

**

Back 43

• GROUP B STREP

Front 44

can you tell the difference btw group B strep (Strep agalactiae) and Respiratory Distress Syndrome?

Back 44

not initially!!

Front 45

what is the most common cause of Meningitis in newborns?

Back 45

Group B strep agalactiae

Front 46

if you see an onset of 24 hours, pneumonia, and sepsis, what is the likely cause?

Back 46

group B strep infection

Front 47

what is the most unforgiving infection seen in 1st month of life?

Back 47

neonatal herpies

Front 48

if you see a staccato cough, and conjuctivitis what is the cause?

Back 48

chlamydia

Front 49

what is Pneumocystis Carinii (PCP) in babies?

Back 49

Usually thought to be associated with cancer/chemo pts., but its also found in <1 mth olds because they are immunocompromised

Front 50

____ is characterized by inflammation and scarring in the lungs. More specifically, the high pressures of oxygen delivery result in necrotizing bronchiolitis and alveolar septal injury, further compromising oxygenation of blood

Back 50

Bronchopulmonary dysplasia

Front 51

what plays a large role in the problems seen in Bronchopulmonary dysplasia (BPD)

Back 51

O2 radicals

Front 52

O2 therapy is like what

Back 52

O₂ Therapy – painting rotten wood


***”It’s like Painting Rotten Wood”***

Front 53

what is the alveolar gas equation?

Back 53

[ (Baro Pressure – Vapor Pressure) × Fi O₂ %] - PCO₂ /R

Front 54

a person gets carbon monoxide poisoning. what does their pulse oximetry show?

***

Back 54

NORMAL LEVELS

it only functional Hgb, NOT dysfunctional

Front 55

in capnography, what do you need to see on the waveform?

Back 55

plateau of normal exhaled CO2 (about 40torr)

Front 56

definition of apnea?

(he had little arrows in his notes that he had on the ELMO..could be important to know this cold)

Back 56

15 second resp pauses assoc w/physiological change