Studied by 16 people
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
Note 
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