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Physiology Oxygen Calculations Decision Time Potpourri Cardiac Anatomy 10 Point 20 Points 30 Points 40 Points 50 Points 10 Point 20 Points 30 Points 40 Points 50 Points 30 Points 40 Points 50 Points Patient Cases
Respiratory Quotient
What is the ratio of carbon dioxide production to oxygen consumption?
The phenomenon of negative pressure inside the chest causing blood to be sucked up toward the right atrium via the vena cava from the lower extremities
What is the intrathoracic pump?
Poor humidity and high FiO2 impair function of these structures which can lead to lower airway infection and mucous plugging.
What is the mucous layer and cilia?
Your patient has increased expiratory work and collapse of small airways during forced exhalation
What are problems due to increased lung compliance?
Alveoli that have both poor ventilation and poor circulation.
What are silent units?
This formula is written as (Hgb X 1.34 X SaO 2 ) + (PaO 2 x 0.003)
What is Oxygen Content of Arterial Blood?
The formula for oxygen consumption.
What is V0 2 = (CO)[(C(a-v)O2) x 10]
Diagnostic criteria for ARDS is < 200
What is the P/F Ratio?
The amount (%) of oxygen normally extracted by the body.
What is 25%
This is the portion of the cardiac output that does NOT take part in gas exchange. Once the severity is established, treatment plans can be made.
What is the shunt equation?
Your AM ABG shows a PaO 2 of 165 torr on 55% O 2. You receive an order from Dr. Smith to reduce the FiO 2 for a target PaO 2 of 80 torr. Your new FiO 2 should be __________.
Question 1c
Your H1N1 patient has a PaO2 of 129 on a FiO2 of 50%. What is your assessment of oxygenation?
What is Acute Lung Injury?
Your patient comes into the emergency room with hypoxia. List two methods used to differentiate between hypoventilation and shunting.
What are ABG and a/A gradient calculation?
You receive a patient in the ER with the following ABG: pH 7.5, paCO2 32, paO2 76, SaO2 65%, COHb 25%. The pulse ox is reading 92%. Interpret the ABG and recommend treatment.
What is acute alveolar hyperventilation with severe hypoxemia secondary to carbon monoxide poisoning? Treat with 100% oxygen.
A patient arrives in the ER sent directly from his physician's office. He is a 62 Y/O male with a 25 pack year smoking history. His ideal body weight is 182 lbs. He had severe dyspnea and a weak cough effort. Auscultation reveals course expiratory crackles and inspiratory crackles at the bases, aeration is faint. The patient has JVD and it is noted that he has dependent edema 2+. His respiratory rate is 22 and shallow. Vital signs are: 167/66, HR 125, Temp C, pulse oximeter = 86% on 2 liters per minute nasal cannula. CO is 8 lpm. a.CXR – bilateral cloudy infiltrates with prominent vascularity b.ABG – 7.33 / 62 / 34, PaO2 – 52 torr and SaO2 – 83% c.CBC – WBC =18,000, H&H = 18/56 d.Electrolytes – all within normal limits 1.What is the DO2? 2.What factors are contributing to the patient’s hypoxia?
1. 2. hypoventilation, alveolar fluid, infiltrates, abnormal alveoli, possible COHb, altered cardiac function, increased oxygen consumption (fever, incr wob, tachycardia, stress, infection)
Your patient is bleeding and has a low CO. As a result, DO2 is ______.
What is decreased?
Your patient is anemic. The O2ER is ________.
What is increased?
You have been bagging on 100% O2 and the PaO2 is now 300 torr with a SpO2 of 100%. The SvO2 is ____.
What is increased?
Your patient has an increased VO2 and an increased O2ER. A clinical example of this condition would be…
What is fever or infection?
Your patient has polycythemia due to chronic hypoxia. The D(a-v)O2 is _____.
What is unchanged?
The a/A ratio.
What is a useful tool in titrating FiO2 with high paO2s?
A device used to open a blocked artery.
What is a stent?
A critical factor in coronary blood flow.
What is diastolic time?
4 causes of increased oxygen consumption.
What are Metabolic Rate Neurohormonal factors Stress /Pain/Anxiety Some medications Activity (baths/turning) Fever Infection
Three indications for oxygen therapy.
What are decrease work of breathing, decrease work of the heart, and increase PaO2?
The ____ valves are open during diastole.
What are mitral and tricuspid valves?
These valves are open during systole.
What are pulmonic and aortic?
Pericardial Effusion
What is fluid in the pericardial sac?
The difference between a pericardial effusion and tamponade.
What is significant cardiac compression causing impairment?
Stenosis
What is narrowing of vessels?
Make your wager
The relation of pulmonary shunt to myocardial blood supply.
What is used myocardial blood dumping into the coronary sinus causing a 3%-5% shunt?