16050286
Description
Flashcards by Carly Pruemer, updated more than 1 year ago
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Created by Carly Pruemer
about 6 years ago
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| Question | Answer |
| V/Q ratio in upper lobe | 3.4 Ventilation>>>perfusion PA>Pa>Pv |
| V/Q ratio in middle lobe | 0.8- average Ventilation = perfusion Pa>PA>PV |
| V/Q in lower lobe | 0.63 perfusion>>> ventilation Pa>PV>PA |
| What can cause hypoxic pulmonary vasoconstriction | general anesthesia Lung injury/contusion systemic vasodilators (nitride/prostacyclin) |
| Lungs response to increase in CO2 | Hypoxic pulmonary vasoconstriction vasoconstricts to shunt blood to unaffected side |
| Pulmonary vasoconstriction results in | decreasing blood supply-pushing blood to dependent lung |
| Effect of PEEP on lung shunting | Shunts blood to non-dependent lung i |
| Continuous CPAP | Decreases shunting |
| Lung isolation options | single lumen ET tube Double lumen ET tube Bronchial blockers Univent ET tube |
| distance from mouth to carinia | 15 cm |
| distance from carinia to right main stem | 12 cm |
| Distance from right main stem to secondary bronchiols | 1.5-2 cm |
| Distance from left pain stem to secondary bronchiols | 4.5-5 |
| Double lumen ET size | Female: 35-37 Male: 37-39 measure Left Bronchus width (Xray)= tracheal with |
| Types of Double Lumen ET | Carlen White Robertshaw |
| Insertion of Double lumen | distal curved anterior Rotate 90 degrees counter clock and advance until resistance is met |
| Cuff inflation of double lumen | Tracheal cuff: 5-10 cc Bronchial cuff: 1-2 cc |
| Advantages of DL tube | best for absolute lung separation ability to suction Conversion from one lung to two lung vent with ease |
| Disadvantage of DL | selection of tube size tears in tracheal cuff during extubation tracheobronchial rupture |
| Complications of DLT | hypoxia (d/t malplacement or occlusion) Traumatic laryngitis Tracheobronchial rupture Suturing tube to bronchous during sx |
| Bronchial blocker advantages | easy recognition of anatomy good for difficult airways not cuff damage during intubation no need to replace ET tube if pt remains intubated |
| Bronchial blocker disadvantage | small suction channel conversion to one lung ventilation high maintenance device-dislodge easy |
| complications of bronchial blockers | severe hypoxia inclusion of BB in suture line lung rupture malposition and dislogment |
| Univent tubes advantage | single lumen with channel for BB Difficult airways Easy passage during awake intubation selective lobar blocker increase oxygenation easy conversion to ETT w/o tube exchange |
| Tidal volumes | 5-6 ml/kg + 5 PEEP < 8= atelectasis 10-12 ml/kg >15 ml increase shunting |
| Lung down recruitment strategies | Pressure control Sustained breath (PAW 30-40)-30-60 sec 100% O2 |
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