Apex Respiratory

Alveolar Gas Equation

Alveolar Oxygen= FiO2 x (Atmospheric pressure- water vapor)- (PaCO2/RQ)
Pb= Atmospheric pressure 760 normal
PH2O= 47mmHg
RQ= Respiratory quotient=0.8

Which Laryngeal muscles ADDuct or close the glottis?

• ThyroaRytenoid: They Relax= shorten

  • ADDucts and closes glottis

• Lateral CricoArytenoid: Let’s Close Airway= aDDuct LCAD

  • ADDucts and closes glottis

Which Laryngeal muscles open or aBduct the vocal cords?

• Posterior CricoArytenoid: Please come apart= aBduct Take away

  • Solely responsible for opening the vocal cords

Glossopharyngeal CN9: oropharynx to anterior side of epiglottis innervates?

Posterior 1/3 of tongue

oropharynx
Vallecula
Soft palate
Anterior side of epiglottis

How do you reduce trauma during airway instrumentation in nares?

direct device between inferior turbinate and floor of nasal cavity and orient bevel towards the turbinates.

Contraction of inspiratory muscles reduces thoracic pressure and increases thoracic volume is an example of ?

Boyles law P1*V1=P2*V2

Physiological dead spec can be calculated with ______ equation. Compares partial pressure of CO2 in the blood vs partial pressure of CO2 in exhaled gas

Bohr’s

What is most common cause of increased Vd/Vt under GA?

Acute EtCO2 decrease first rule out HypoTN

What increases dead space? 10

Facemask
HME
PPV
Anticholinergics
Old age
Extension
Decreased CO
COPD
PE (thrombus, air, amniotic fluid)
Sitting position

What decreases dead space? 3

Endotracheal tube
LMA
Tracheostomy

_________ is most common cause of hypoxemia in the PACU. Leads to R-L shunt, V/Q mismatch, and hypoxemia

Atelectasis

As the radius of a sphere or cylinder becomes larger, the wall tension increases as well. (Tension Pressure Radius) What law?

Law of Laplace

P50

P50 is the PaO2 where hemoglobin is 50% saturated with oxygen

What is 2,3 DPG? why is it important?

2,3 DPG is produced during RBC glycolysis.
Maintains the curve in a slightly R shifted position
Hypoxia increases 2,3 DPG production= facilitates O2 offloading
Important compensation mechanism for chronic anemia
Banked blood the concentration of 2,3 DPG falls which causes curve to left shift and reduce O2 available to tissue.
HgbF doesn’t respond to 2,3 DPG= L shift P50-19mmHg

Solubility is function of ________ Law

Henry’s

Conditions that shift CO2 curve down and to the right:

Volatile anesthetics
Opioids
NMBs
Metabolic alkalosis
Carotid enterectomy

________increase the resp rate in setting of pulmonary embolism or CHF. Causes tachypnea

J receptors or pulm C fiber receptors

What inhibits HPV?

Inhibited by volatile anesthetics >1.5 MAC, PDE, Dobutamine, hypervolemia, excessive PEEP and large tidal volumes

What do NOT inhibit HPV?

NOT inhibited by IV anesthetics: ketamine, propofol, and opioids

Blocks for Shoulder/Clavicle (2)

Cervical plexus
Interscalene

Blocks for Upper extremity (3)

Supraclavicular
Infraclavicular
Axillary

Blocks for forearm/Hand (3)

Radial median Ulnar nerve

The Haldane effect states that in the presence of deoxygenated hgb, the CO2 dissociation curve shifts to the

LEFT

What causes Rebreathing?

Causes of Rebreathing: exhausted soda lime, a faulty unidirectional valve in circle system and inadequate FGF in a Mapleson circuit.

have normal or decreased FEV1 and FVC and FEV1/FVC ratio is always decreased

Obstructive

disease have decreased FEV1/and FVC but FEV1/FVC ratio is normal

Restrictive

Blocks for Anterior thigh/knee (2)

Femoral
Adductor canal

Blocks for Ankle/Foot (5)

Posterior Tibial
Deep Peroneal
Superficial Peroneal
Sural
Saphenous

Blocks for Chest/Thorax (4)

PECS I & II
Paravertebral
Intercostal
Erector Spinae

Blocks for Abdominal/Back (3)

Transversus Abdominis
Quadratus Lumborum
Erector Spinae

Blocks for Hip (2)

Fascia iliaca
PENG

Blocks for Lower extremity (2)

Sciatic popliteal approach
Saphenous

What nerve Fibers function for touch and pressure?

A Beta moderate myelinated

What nerve Fibers function for motor?

A alpha heavy myelinated

What nerve Fibers function for proprioception?

Alpha gamma moderate myelinated

What nerve Fibers function for pain and temperature?

A delta & C light myelinated and 0

What nerve Fibers are preganglionic and autonomic?

B light myelinated

What nerve Fibers are post ganglionic and autonomic and dull pain?

C

Density is an element of ____ number which describes turbulent flow. Directly related to fluid density, linear velocity, and tube diameter. Inversely related to fluid viscosity

Reynolds’

Reynolds number <2000 reflects_____

laminar flow less density

Reynolds number >2000 reflects_____

turbulent flow density is higher

• increased PaO2

• hypocarbia

• Alkalosis hyperventilation

• spontaneous ventilation

• prevent coughing straining

• Inhaled nitric oxide

• Nitroglycerin

• PDE inhibitors

• Prostaglandins PGE1 & PGI2

• CCB

• ACE inhibitors

Decreases PVR

• hypoxemia

• hypercarbia

• acidosis

• hypothermia

• pain

• SNS stim

• hypothermia

• PEEP

• atelectasis

• Nitrous oxide

• ketamine

• Desflurane

• mechanical ventilation

Increases PVR

Equation for PVR

Equation PVR= PaP-PAOP * 80/ CO

Absolute indications for one-lung ventilation

Infection

massive hemorrhage

bronchopleural fistula

Relative indications for one-lung ventilation:

Improved surgical exposure

pulm edema

severe hypoxemia due to lung disease