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164 Cards in this Set

  • Front
  • Back
9 cartilages of the larynx
1 epiglottic
1 thyroid
1 cricoid
2 arytenoid
2 cunieform
2 corniculate
What can you see in a grade 1 view?
epiglottis, vocal cords, glottis
The trachea starts at ____
C5-6
Which side is more likely to be inadvertently mainstem intubated??
R mainstem bronchial intubation more likely due to a straighter angle (25 degrees on right vs 45 degrees on left)
Which main stem bronchus is easier to occlude?
R side easier to occlude upper lobe bc only 1-2.5 cm diameter on right, (5 cm on left)
What are the names of the pores through which gas can travel between alveoli?
martin, lambert and kohn
MLK
Martin ducts go between
alveolar duct to duct
Lambert ducts go between
alveolar duct to alveolus
Kohn ducts go between al
alveolus to alveolus
During spontaneous ventilation in the upright person, VQ match is greatest at...
dependent areas (zone 3)
due to diaphragm descension, alveoli at bottom have less negative pressure and are less collapsed, so there is more ability to accept air
In spontaneous breathing, diaphragm descension causes an increase in..
negative intrathoracic pressure
In spontaneous breathing, gas flows from ____ pressure to ____ pressure.
higher to lower pressure
In spontaneous breathing, greatest gas flow is to
the bases
West Zone 1
PA>Pa>Pv

apex, maximally distended has greater pressure in it than the small capillaries
West Zone 2
Pa>PA>Pv

arterial capillaris have more pressure
West Zone 3
Pa>Pv>PA

arterial capillaries have most pressure, then veins, then alveolus
Which spontaneous ventilation, which zone am i?
apex alveoli are already distended from greater negative pleural pressure thus they have less compliance to expand and receive volume increases. Apex ribs are short and expand minimally
zone 1
During spontaneous ventilation, Which zone am i?
alveoli have the greatest gas flow due to greater change in thoracic pressures during inspiratory-expiratory phases -- due to inspiratory diaphragmatic downward movement
zone 3
Pail handle effect
internal intercostals pull downward, aid expiration, external intercostals elevate ribs, aid inspiration

pneumonic device: In-Ex, Ex-In
Alveoli are the biggest in zone ___ And the smallest in zone ___.
biggest in 1, smallest in 3
During inspiration there is ______ vertical and AP diameter.
increased
During inspiration, the external intercostals are ______.
contracted
During inspiration the internal intercostals are ______.
relaxed
During expiration the abdominals are _____.
contracted
During inspiration the diaphragm is _______ and the rib cage is _____.
Contracted, elevated
In non-anesthetized, spontaneously ventilating patients, ventilation is ______ to perfusion.
closely matched
What is normal VQ matching in the spontaneously ventilated pt and where does that number come from?
0.8

4 lpm flow to alveolus, 5 lpm flow of CO -- therefore 4/5=0.8
Causes of VQ mismatch during spontaneous ventilation.
physiologic shunt
hypoventilation
disease states
Hypoxic Pulmonary vasoconstriction
effectively redirects blood flow away from hypoxic or poorly ventilated lung areas to areas that are better ventilated
Pulmonary vascular endothelium releases potent vasoconstrictor peptides called
endothelins
Volatile anesthetics above ____ and N20 potentially block HPV.
1 mac
What can HPV be inhibited by?
- very high or very low PA pressure
- hypocapnia
- high or low mixed venous PO2
- vasodilators
- pulmonary infection
- IAs
The effect of HPV can be antagonized by factors that indirectly increase blood flow to the collapsed lung, such as...
- high MAP in ventilated lung (high TV)
- low FiO2 (produces HPV in ventilated lung)
- vasoconstrictors (will work on functional side, and that side may collapse too)
- intrinsic PEEP- stacking breathes w incr RR
During mechanical ventilation, blood flow is greates to _____ areas which depends on ______.
dependent areas, depends on positioning
During mechanical ventilation, gas flow is greatest to _______ which is dependent on ____.
apices,
dependent on position -- greatest ventilation is on nondependent area, pushing air to most compliant part (Zone 1)
During mechanical ventilation, the combination of gas flow to the apex secondary to positive pressure ventilation and blood flow to the bases secondary to gravity leads to...
VQ mismatching
During mechanical ventilation, poorly ventilated alveoli are prone to ______, thus increasing _____.
prone to atelectasis/collapse, incr VQ mismatch
The more anesthesia you give a patient, the ____ the VQ mismatch!
worse
Worsening VQ mismatch occurs with...
anesthetized, positive pressure/mechanical ventilation, paralysis (due to incr resistance to gas flow), atelectasis (lung collapse, shunt, perfusion w no ventilation, not dead space)
During a PE, the pt has _____ but no _____, creating a shunt.
ventilation, no perfusion
In a lung tumor, the patient has (shunt or dead space)?
dead space
What are the upper airways? Shunt or dead space?
dead space
What are the changes in ventilation dynamics that can be seen with an open chest?
paradoxical ventilation
closed/simple pneumothorax
communicating pneumothorax
tension pneumothorax
hemothorax
Paradoxical ventilation
when you inspire normally, your lungs fill up. In this situation, your lung is collapsing because there is a comunication between pleura and atmosphere and you lose your negative intrathoracic pressure, it becomes positive, and lungs have a natural tendency to recoil
Closed simple pneumothorax
- no atmospheric communication
- knick in the lung during placement of an invasive line, small hole, not growing with every breath
- treatment based on size and severity (Catheter aspiration, thoracostomy/chest tube, observation)
Communicating Pneumothorax
the hole that communicates between atmosphere and pleural space must be surgically patched, lung recoils on inspiration and expands on expiration
Tension pneumothorax
air progressively accumulates under pressure within the pleural cavity, compresses other lung and great vessels
- treatment is immediate needle decompression
- creates a one-way valve in which air enters the thorax but cannot leave
- can also occur during mech vent from the inside
- 14 gage needle decompr. at 2nd ICS MCL
- chest tube insertion site between 4th-5th ICS for air, and for hemothorax between 7th and 8th ICS bc will sit more dependent
- note shifting tracheal mediastinum
Hemothorax
accumulation of blood in pleural space
treated w airway management and support hemodynamics during evacuation
What are the 4 major subcategories for thoracic surgery?
- lung resection (tumor, bronchiectasis, infection)
- tracheal resection
- thoracoscopic surgery
- esophageal surgery
What type of tumors are usually found on lung resection
20% small/oat cell
80% non-small cell
Bronchiectasis
lung cysts/bullae
thin walled bronchogenic or alveolar cysts
may be post-infective, infantile or emphysematous
incr ventilatory volume, decr diffusion area
incr risk for rupture ***
dead space- no ventilation or perfusion
What are the anesthesia considerations for lung cysts and bullae?
induction: positive pressure ventilation < 10 cm H20 so do not bust the bubble, DLT may be used
no N20 bc expands closed spaces
extubation- smooth to avoid coughing
What happens if lung bullae rupture?
tension pneumothorax
Lung resection is often preceded by
bronchoscopy or mediastinoscopy
What is the position and incision site for lung resection?
lateral or post. lateral thoracotomy incision
lateral decub position
How is lung isolation achieved for lung resection?
use of DLT
What is the usual surgical time for lung resection, expected EBL, and mortality for lung resection cases?
- 2-3 hrs time
- <500 mL EBL
- 1% mortality
Post op, lung resection pts are observed in _____ with careful attention to their _____.
ICU, chest tubes
What are the pre-op considerations for a lung resection?
- lab tests
- prescreen for underlying pulm infection
- assess for tracheal stenosis (positional dyspnea, airway collapse, hypoxemia, anatomic narrowing, not tolerate supination)
- ABG, PFT, CXR, VQ scan, CT/MRI (for lesions and tracheal integrity), angiography
- coexisting pathology
What are the pre-op. Hematologic considerations for lung resection?
-transfuse pt w preop HCT <25%
- adequate O2 carrying capacity essential
- T&C 2-4 units PRBC
What are the pre-op. musculoskeletal considerations for lung resection?
lung CA pts may have myasthenic syndrome w incr sensitivity to non-depol. muscle relaxants
Myasthenic/Eaton-Lambert Syndrome
- autoimmune disorder, prejunctional decr ACh release, no improvement w anticholinesterases
- stems from underlying malignancy (small cell lung CA)
- peripheral muscles and pelvis most affected
- symptoms improve on exertion and weaken w rest
How do muscle relaxants affect people differently with myasthenic/eaton-lambert syndrome?
muscle relaxants agonize condition
What monitors are suggested for lung resection cases?
- ASA standard monitors
- foley if case > 3 hrs
- 2 large pore PIVs (no smaller than 18)
- radial art line (when in lateral decub position, place a-line in dependent arm!)
- PA cath/central line (when in lateral decub, place in nondependent side of neck)
How are pressure readings from PA caths and central lines altered during lung resection?
may be affected by open chest, lateral position, surgical manipulation
What are the anesthetic techniques available for lung resection?
- GETA with thoracic epidural
- may begin open thorax w bronch via Single lumen OETT
- induction agents and relaxants per procedure, may use IAs or TIVA
During lung resection, epidural analgesia reduces ____ requirements but may create ____ blockade and hypotension.
reduces IA req., sympathetic blockade
What is the fluid management approach to lung resection?
want to keep the patient dry!!
do not replace 12 hr fluid deficit
if pt needs volume for hypovolemia, use colloid (PRBC)
During lung resection, changes in hydrostatic pressure, oncotic pressure and lymph pressure can all potentially lead to...
incr fluid in the lungs!
What possible complications/risks are associated with open thoracic surgery?
1. open chest produces pneumothorax
2. manipulation of lung, heart and major vessels may interfere w ventilatory exchange and cardiovascular stability both intraop and post op
3. lateral decub position changes distribution of blood flow and pattern of ventilation and exposes lower lung to danger of contamination by secretions, blood or fluids
4. Dysrhythmia, PE, DVT, MI
5. Bronchopleural fistula
6. chylothorax
7. subcutaneous emphysema
8. phrenic nerve injury (C3,4,5 -- if above CN 5 pt will have breathing problems!)
9. RLN injury
Where is flow greatest in the lateral decub position during thoracic surgery? IF
gravity pulls blood flow to the dependent lung
This is a hole between bronchus and pleura (if pus, it is called empyema)
bronchopleural fistula
In bronchopleural fistulas, you want to avoid ventilating ...
above the hole
Chylothorax
pus in the thorax
What are the indications for tracheal surgery?
- stenosis
- tumor
- congenital defect (Rare)
What are the common symptoms of a pt presenting for tracheal surgery?
- wheezing
- flow volume loop may help deterine location of obstruction
- hx of vocal changes, difficulty eating/swallowing, prior neck/tracheal surgery (Suggest vocal cord involvement)
- inspisation- act of decr a lumen by hvaing dried secretions (Caused by anticholinergics)
Why do you want to give minimal if any premedication for tracheal surgery candidates?
need to avoid airway obstruction
What are induction considerations for tracheal surgery?
- consider inhalation induction or awake FOI to avoid complete obstruction with loss of muscle tone
- muscle relaxants may collapse airway
After tracheal resection surgery, it is important to position the head...
with neck flexion to reduce tension on th reanastomosis
During tracheal resection, a second lower _____ tube is attached to the vent/anesthesia machine.
armoured
A common technique for ventilating a patient duing tracheal resection is..
high frequency jet ventilation
Thoracoscopic surgery may be _____, _____ or both.
diagnostic, interventional
Interventional thoracoscopy is now used for ____ procedures that previously required open thoracotomy.
1/3 to 1/2
What are some interventions that can be done via thoracoscopy?
lung biopsy
wedge resection
lobectomy
esophageal procedures
pericardectomy
What diagnostic procedures can be done via thoracoscopy?
bronchoscopy
mediastinoscopy
bronchoalveolar lavage
The anesthetic plan for thoracoscopic surgery is similar to _____ procedures.
open thoracic
For a flexible bronchoscopy, you can use ____ or _____ anesthetic techniques.
MAC or GETA
For rigid bronchoscopy, you must use ___ anesthesia technique.
GETA
The anesthetist should consider the following conditions and techniques that accompany a rigid bronchoscopy...
- hypercapnea
- hypoxemia
- air leaks
- anesthesia machines vs HFJV
- side-arm ventilation ports
- sanders bronchoscopes (venturi effect w jet vent)
What complications are associated w bronchoscopy?
- facial, dental, laryngeal injury
- airway rupture
- pneumothorax
- hemorrhage
- airway obstruction (w blood, foreign body, edema)
What are the anesthesia considerations for bronchoscopy?
- small OETT vs double lumen tube
- laser tube and laser precautions
- short-acting hypnotic agent
- IAs vs TIVA
- short-acting narcotics
- short-acting muscle relaxants
- post op local anesthesia
This technique provides access to mediastinal lymph nodes and is also used to establish diagnosis or resectability of intrathoracic malignancies.
mediastinoscopy
What are the anesthesia considerations for mediastinoscopy?
GETA w NMB
single vs double lumen OETT
large bore IVs
NIBP measured on LEFT arm
SpO2/a-line RIGHT hand
What complications are associated w mediastinoscopy?
- #1 rupture/laceration to major vessels
- #2 pneumo/hemo thorax
- intermittent occlusion of innominate artery incr CVA risk
- air embolism
- tracheal collapse, tension pneumomediastinum, mediastinitis, chylothorax
- phrenic nerve or RLN injury
Why is it important to place the A-line and SP02 monitors in the RIGHT upper extremity during thoracic surgery?
lets you know if the innominate artery is being occluded during surgical manipulation
Bronchoalveolar lavage
used for patients w pulmonary alveolar proteinosis (overproduction of surfactant) or hypersecretions causing dyspnea/hypoxia;
10-20 L of warm saline is used for lavage and drained by gravity
What are the anesthesia techniques used during bronchoalveolar lavage?
1. GETA w DLT used for unilateral lavage- only 1 lung at a time
2. inflated cuffs should make a watertight seal to prevent spillage into the contralateral lung
3. both lungs suctioned and single lumen OETT placed at end of procedure
What are the indications for esophageal surgery?
1. resection of neoplasms
2. anti-reflux procedures
3. repair traumatic or congenital lesions
4. motility disorders
What are the anesthesia considerations for esophageal surgery?
1. pulmonary aspiration risk***
2. chronic malnutrition (from difficulty swallowing) and anemia (r/t CA, swallowing difficulty)
3. hypovolemia (due to difficulty swallowing)
4. ETOH abuse causes esophageal lesions
What are the anesthesia techniques for esophageal surgery?
- decr gastric contents pre-induction w medication (reglan, h2 blockers, PPI) or awake NG suction
- RSI w cricoid and HOB elevation
- possible awake FOI (for pts w systemic sclerosis/sarcoidosis)
- monitoring: a-line, CVP, PA cath w signifcant cardiac disease, foley
- have multiple large bore IVs, fluid warmer, and forced air warmer available
- GETA w double lumen tube to promote exposure
- epidural analgesia intraop/postop
Describe the operative approach for upper esophageal lesions:
upper: transverse cervical incision for proximal anastomosis, R side thoracic incision and midline abdominal incision for resection and closure
Describe the operative approach for middle esophageal lesions:
R side thoracotomy, Ivor Lewis approach
Describe the operative approach for lower esophageal lesions:
extended left thoraco-abdominal incision
Pts undergoing esophageal surgery may require post op intubation for ________.
aspiration precautions
What are the complications associated w esophageal surgery?
- HOB is 180 degrees away
- blunt dissection of esophagus from the posterior mediastinum by surgeons hand can cause profound hypotension and vagal stimulation, bradycardia
- post op: nerve injuries (phrenic, vagus, L RLN)
- aspiration
What is the pt position for open thorax cases?
lateral decub with flexed table (upside down V)
Due to the extended lateral position during open thorax cases, what precautions must be taken?
1. secure tubes and lines, take command of turning
2. proper padding and assessment of pressure points
3. head, neck, eyes neutral position
4. padding for axilla and lower extrem
5. nerves most commonly injured in upper extrem (ulnar nerve) and lower extrem (common peroneal nerve)
6. reassess breath sounds, VS, monitors, arterial and PA lines, and IVs w turning
7. neutral position, spine straight, head not rotated
Intraoperative techniques during open thorax cases
1. combined epidural and IA
2. OLV techniques for surgical exposure and minimal damage to operative lung
3. maintain O2
4. ensure pt is comfortable, warm and awake PRN at end of surgery
What are the induction considerations for open thorax cases?
- standard induction
- start w single lumen >8mm if FOI
- replace single with double lumen after bronchoscopy
Epidurals placed prior to induction for open thorax cases require this test dose:
3 mL lidocaine 1.5% with epi 1:200,000
Epidurals during open thorax cases can be given both during the procedure or...
bolused at the end of the procedure prior to emergence.
If epidural opioids are being given intraoperatively during open thorax cases, you should limit ______ to prevent post op respiratory depression.
IV opioid administration
Open thorax cases during the maintenance phase employ the following techniques:
-100% Fi02
- IAs, opioids (can use less if also using epidural)
- avoid N20 (Esp during OLV)
- epidural anesthetic of choice: lidocaine 10 mL via epidural q45 min
Describe the blood and fluid requirements for open thorax cases
1. 2 large bore IVs
2. central line?
3. restrict IVFs (1-1.5 L NS or LR total max)
4. have autologous blood available if possible, may need to have 1 unit in the room
If a pt becomes hypotensive during an open thorax case, it is best managed with...
ephedrine 5-10 mg IV bolus
or
phenylephrine 50-100 mcg IV bolus
What are the indications for lung isolation during open thorax cases?
- separate lungs to prevent contralateral contamination
- allow selective ventilation
-
At the conclusion of the open thorax case, prior to emergence, describe the technique used to reinflate the lungs...
- inflate lungs to 30-40 cm H20 to reinflate atelectatic areas and check for leaks
- turn APL valve to 30-40 and "valsalva" to hold the breath 5-10 sec - checks for air leaks and expands collapsed alveoli
Chest tubes are placed at the conclusion of open thorax cases because...
helps drain pleural cavity and aids in lung re-expansion
If a patient cannot be extubated at the end of an open thorax case, you must...
swap the DL-ETT for a SL-ETT if must stay intubated
After open thorax cases, chest tubes should be set to water seal and 20 cm H20 suction, except in...
pneumonectomy cases (whole lung removed) -- water seal only
Post open thorax, pts should be transferred in _____ position to the ICU on monitors and NRB O2.
head elevated
What are the resp complications of open thorax surgery?
- airway trauma from intubation -- tracheal lidocaine to aid in post op pain from huge OETT and prevent coughing/bucking during extubation
- tracheobronchial rupture
- bronchopleural fistula
- tension pneumothorax
- pneumonia
- thoracic duct injury
What are the positioning-related post op complications of open thorax surgery?
- pressure damage to ear, eye, nose, deltoid muscle, iliac crest
- neurological deficit - spinal cord damage, phrenic and RLN are most common nerve injuries
What are the cardiovascular complications from open thorax surgery?
- cardiac herniation
- bleeding
- Supraventricular dysrhythmias
- PE
What is the least often used lung isolation technique?
single lumen endobronchial tubes
Endobronchial blocker
lung isolation technique- thread through single lumen ETT, and under guidance from bronchoscope, thread blocker down whichever side bronchus and inflate the cuff
Double-lumen endobronchial tubes
one lumen stops short in trachea and the other goes to right or left (preformed for intended side)
What are the absolute indications for lung isolation?
1. control of foreign material- dont want to infect a healthy lung w junk from the other side (lung abcess, bronchiectasis, hemoptysis)
2. control of ventilation - bronchopleural-cutaneous fistula, surgery on major airway/tracheal-bronchial disruption, giant bullae
3. unilateral bronchoalveolar lavage
What are the relative indications for lung isolation?
1. surgical exposure - high priority (lung resection, esophageal surgery or vascular/aortic surgery, thoracoscopy)
2. surgical exposure - low priority (middle/lower lobectomies, esophageal resection, spine sx)
What are the disadvantages of the single-lumen endobronchial tubes, making them rarely used today?
- inability to clear material from operative lung - no other port for removal or blood/pus
- potential for limited ventilation - nonintubated surgical lung
What are the types of bronchial blockers?
- mcgill cath
- fogerty cath
- foley cath
- univent tube
Do you want to drop the lung on the same side or opposite side that you want to operate on?
same side!
Describe the procedure for placing a bronchial blocker
1. intubate w univent BB tube and inflate cuff
2. insert FOB through self-sealing diaphragm and decide R/L mainstem block
3. advance BB into mainstem bronchus to be blocked
4. inflate BB cuf 7 mL just below carina, can still see it
5. withdraw FOB and continue ventilating at 10 mL/kg to nonoperative lung
Double-lumen endobronchial tubes have been used since the _____ and are available in ____ and ____ Versions.
1940s
left and right-sided versions

some people only use L sided tube, others always just intubate nonoperative bronchus
Double lumen endobronchial tubes can be placed with or without the aid of ______, but then placement should be checked with it.
FOB
What sizes are there for DLTs?
men 39-41 Fr
women 35-37 Fr
The difference between R and L DLTs accounts for...
bronchial anatomical differences -- L tube more frequently used!
List the steps for auscultation of breath sounds after placement of a DLT:
1. inflate tracheal cuff
2. verify bilat equal breath sounds - if only present on 1 side, both lumes are in same bronchus - deflate and withdraw tube 1-2 cm at a time until breath sounds equal bilat
3. inflate endobronchial cuff
4. clamp endobronchial lumen and open its lumen cap proximal to clamp
5. verify breath sounds in correct lung and absence in opposite lung
6. verify breath sounds equal at apex of lung and lateral lung - if apex diminished, withdraw tube until upper lung sounds return
7. verify absence of air leakage through opposite lumen cap
8. unclamp endobronchial lumen and verify bilat breath sounds
9. clamp tracheal lumen and open its cap
10. verify breath sounds on side opposite lung w endobronchial lumen, and absence of breath sounds on the other
11. when absolute lung separation needed, (like bronchopulm. lavage), connecting a clamped lumen to underwater drainage system will show air bubbles if leak present
Most common placement error with DLTs is:
advancement of DLT too far in bronchus causing only distal lumen ventilation of one lung - can verify w FOB to prevent this
During OLV, VQ is altered by...
1. general anesthesia
2. lateral positioning
3. open chest
4. surgical manipulation
During OLV, the ______ is the main component of oxygenation.
amount of shunt
Hypoxic Pulmonary Vasoconstriction may limit shunting unless...
HPV is blunted
_____ pathology may limit shunting during OLV
pulmonary
_____ position decreases blood flow to the non-dependent lung by gravity.
lateral
During OLV, it is essential to monitor...
constant pulse ox and frequent ABGs
During OLV, you must maintain ETCO2 as with ..
2 lung ventilation
During OLV, you want to maintain PIP below
35 cm H20
During OLV, you want to maintain minute ventilation without causing...
auto peep!
allow enough time for exhalation, avoid high RR
Prior to switching between 2-lung and 1-lung ventilation, you shoud always..
hand-ventilate!
During OLV, the desired TV is _____ and PEEP is ____.
TV 8-10 mL/kg
PEEP 5 mmHg
During OLV, you should adjust the _____ to maintain PaCO2 within normal limits, and don't stack breaths.
RR
During OLV, compliance is ______ and resistance is _____.
compliance reduced, resistance increased!

one lumen instead of two!
During OLV, _____ will tend to be higher, but you do not want it to exceed 35.
PIPs
During OLV, some autopeep may be generated, depending on...
size of DLT
During OLV, if Spo2 drops below 94% or PaO2 <100, you should...
recheck placement of DLT or bronchial blocker
The greatest risk of OLV is...
hypoxemia because of shunt
O2 management during OLV if pt deoxygenates:
- d/c N20
- incr Fi02 to 100%
- check tube position and suction PRN
- CPAP to non-dependent lung at 5-8 cm H20
- give PEEP to dependent lung on expiration
- provide apneic oxygenation (not breathing but oxygenating - cut off end of nasal cannula and place down port of non-ventilated lung)
- reinflate Non-ventilated lung w 100% Fi02 PRN, revert back to 2 lung ventilation
- as a last ditch effort, can ask surgeon to clamp the non-ventilated lung's pulm artery or go to bypass
What are the possible complications of OLV?
- trauma (dental and soft tissue injury, large tube diameter causes laryngeal injury, tracheobronchial wall ischemia/stenosis)
- malposition (Advancement of tube too far or too proximal)
- hypoxemia (biggest complication!)
- aspiration
Spontaneous ventilation is a _______ process.
sub-atmospheric pressure

gas is "sucked" in!
Mechanical ventilation is a _____ process.
positive pressure/above atmospheric pressure

Gas is "pushed" in!
Blood flow to the lungs is primarily _____ dependant.
gravity
With spontaneous ventilation, negative pleural pressures coupled with the pail handle effect pulls more gas to...
the dependent areas of the lungs
Opening the thorax alters _______ altering lung dynamics.
negative intra-thoracic pressures -- may lead to pneumothorax or paradoxical breathing!
Single lung ventilation gives ____ to one lung, but blood flow is split between both lungs, creating a ______.
100% of gas, VQ mismatch