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PhysiologyOxygen

CalculationsDecision

TimePotpourri

Cardiac Anatomy

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PatientCases

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 SaO2) + (PaO2 x 0.003)

What is Oxygen Content of Arterial

Blood?

The formula for oxygen

consumption.

What is

V02 = (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 PaO2 of 165 torr on 55% O2. You

receive an order from Dr. Smith to reduce the FiO2 for a target

PaO2 of 80 torr. Your new FiO2 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. 38.2 C, pulse oximeter = 86% on 2 liters per minute nasal cannula. CO is 8 lpm.

a.CXR – bilateral cloudy infiltrates with prominent vascularityb.ABG – 7.33 / 62 / 34, PaO2 – 52 torr and SaO2 – 83%c.CBC – WBC =18,000, H&H = 18/56d.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 areMetabolic Rate

Neurohormonal factorsStress /Pain/AnxietySome 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?