Pulmonology E1: Intro

The absence of oxygen supply

Anoxia

The absence of O2 and accumulation of CO2

Asphyxia

Low oxygen in the body

Hypoxia

Low oxygen in the blood

Hypoxemia

Where gas exchange with the blood occurs

Respiratory zone

Composed of the trachea, bronchi, and bronchioles that deliver air

Conducting zone

The trachea divides at the carina found at the _____ vertebrae

T4

What is the purpose of the alveoli?

To increase surface area for gas diffusion

What part of the brain controls voluntary breathing?

Cerebral cortex

What part of the brain controls involuntary breathing?

Medulla oblongata and pons

What nerve innervates the diaphragm?

Phrenic nerve (C3-C5)

What nerve innervates the intercostal muscles?

Spinal nerve (T1-T11)

Why is surfactant in the alveoli important?

Keeps the alveoli open for gas exchange

What cells secrete surfactant?

Type II alveolar cells

Oxygen is transported via _______

Hemoglobin (98%) and Plasma (2%)

CO2 is transported via _________

Bicarb in plasma (70%), Bound to Hgb as carbaminohemoglobin (20%), and dissolved in plasma (10%)

Standard/routine study in lung disease when looking for a diagnosis

CXR

Is a CXR a screening test for lung cancer?

No

Imaging valuable in detecting diseases of the chest wall, pleura, hilum, and mediastinum

Chest CT

If suspecting lung cancer or masses, you should order a _______

CT with contrast

What test is the gold standard for diagnosis of a pulmonary embolism?

CT pulmonary angiogram (CTA)

The apex of the lung will have a _____ VQ ratio due to ______ perfusion

High; Low

The base of the lung will have a _____ VQ ratio due to ______ perfusion

Low; High

V/Q mismatch or V/Q shunting: Which is a normal variant?

V/Q mismatch

When blood goes from the right to the left side of the heart without being oxygenated resulting in hypoxemia

V/Q shunting

Normal pulse ox range on RA

96-100%

Pulse ox that requires supplemental oxygen

< 88%

When should you obtain a sputum analysis?

Prior to treating with abxs

A sputum analysis is good at diagnosing ________

Lower respiratory tract infections

Direct visualization of the airways

Bronchoscopy

Indications for a bronchoscopy

- Tissue diagnosis or staging carcinoma
- Diagnosis of pulm infections
- Remove foreign bodies

Contraindications for a bronchoscopy

Unstable patient:
- severe bronchospasms
- cardiac arrythmias
- tracheal stenosis
- uncooperative patient

Surgically aspirating fluid/air from the pleural cavity

Thoracentesis

Indications for a thoracentesis

- Hypoxemia despite supplemental O2
- Determining cause of pleural effusion
- Therapeutic removal of pleural fluid
- Small pneumothoraces
- Instilling sclerosing compounds

Transudative or Exudative Pleural Fluid: Hemorrhage

Exudative

Transudative or Exudative Pleural Fluid: Infection

Exudative

Transudative or Exudative Pleural Fluid: Inflammation

Exudative

Transudative or Exudative Pleural Fluid: Malignancy

Exudative

Transudative or Exudative Pleural Fluid: Iatrogenic

Exudative

Transudative or Exudative Pleural Fluid: Connective tissue disease

Exudative

Transudative or Exudative Pleural Fluid: Endocrine disorder

Exudative

Transudative or Exudative Pleural Fluid: CHF

Transudative

Transudative or Exudative Pleural Fluid: Nephrotic syndrom

Transudative

Transudative or Exudative Pleural Fluid: Hypoalbuminemia

Transudative

Transudative or Exudative Pleural Fluid: Cirrhosis

Transudative

Transudative or Exudative Pleural Fluid: Atelectasis

Transudative

Transudative or Exudative Pleural Fluid: Peritoneal dialysis

Transudative

Transudative or Exudative Pleural Fluid: SVC obstruction

Transudative

Indication for a needle decompression

Tension pneumothorax

Needle decompression is placed over the ________

2nd ICS/MCL on side of pneumothorax

A thoracostomy (chest tube) is placed when ______

Thoracentesis alone will not manage the underlying issue

Indications for a thoracostomy (chest tube)

Pneumothorax, hemothorax, pleurodesis

Prevents obstruction by patient's tongue and other soft tissue

Oropharyngeal airway

Sits in the hypopharynx to allow ventilation, oxygenation, and administration of anesthetic gases

LMA (Laryngeal mask airway)

A nasal cannula delivers _____ L/min of oxygen

1-6

A simple face mask delivers _____ L/min of oxygen

6-8

A non-rebreather delivers _____ L/min of oxygen

8-12

FiO2 of a nasal cannula

25-40%

FiO2 of a high flow nasal cannula

up to 100%

FiO2 of a face mask

35-50%

When is a face mask not appropriate?

Delirious or agitated patients due to risk of aspiration

FiO2 for a venturi mask

24-50%

FiO2 for a non-rebreather mask

80-95%

Difference between CPAP and BiPAP

CPAP- single set pressure
BiPAP- 2 distinct pressures for inhale/exhale

When should you NOT perform a PFT?

- Short-acting bronchodilator within 6 hours
- Long-acting bronchodilator within 12 hours
- Sick/recently hospitalized
- Currently taking steroids

3 main categories of a PFT

Lung volumes, Flow rates, Diffusing capacity

Measures the volume of air exhaled at specific time points during a forceful and complete exhalation after maximal inhalation

Spirometry

Total Lung Capacity (TLC) =

IRV + TV + ERV + RV

The amount of air breathed in or out during normal respiration (spontaneous breath)

Tidal volume (TV)

The amount of air left in the lung at the end of normal exhalation

Functional Residual Capacity (FRV)

Functional Residual Capacity (FRV) = ______

ERV + RV

The amount of air that can be forced out of the lungs after a maximal inspiration

Vital Capacity (VC)

Vital Capacity (VC) = _______

IRV + TV + ERV

The volume that can be inhaled after a tidal breath out

Inspiratory Capacity (IC)

Inspiratory Capacity (IC) = _______

TV + IRV

In obstructive diseases, there is a _______ in FEV1

Decrease

In obstructive diseases, there is a _______ in RV

Increase

In restrictive diseases, there is a _______ in TLC

Decrease

In restrictive diseases, there is a _______ in FEV1/FLC

Can remain normal

Why is there a decrease in FEV1 with obstructive diseases?

Loss of elasticity, increased compliance, and inability to forcefully expire air as quickly

Restrictive or Obstructive: Increased RV & TLC

Obstructive

Restrictive or Obstructive: Decreased RV & TLC

Restrictive