Categorisation exercises to drill for the viva exam! | Anaesthesia Coffee Break podcast

Episode description

Thanks for listening to Anaesthesia Coffee Break!

In this episode we categorise the key respiratory physiology topics

control of breathing
cause of A-a gradient
hypoxaemia
hypercapnoea
CO2 carriage in blood
2,3 DPG
venous admixture
airways resistance
compliance
work of breathing
FRC
dead space
and
pulmonary vascular resistance

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Transcript

Stimulus of respiratory rate

Blood (central)

· PaCO2

· PaO2

· pH

Lung

· J

· Stretch

· Irritant

Cortical

· Emotional stuff

Hormonal

· Pregnancy (progesterone)

Exercise

Causes of increase Aa gradiant

V/Q

Shunt

Diffusion

· Membrane

· PAO2 (FIO2)

· Transit time

Causes of low PaO2

· FiO2

· V/Q

· Shunt

· Hypoventilation

· Diffusion

Causes of Hypercapnoea

PaCO2 = CO2 production/alveolar ventilation

CO2 production

· Metabolic

· Substrate

· CO2 rebreathing

Ventilation

· UMN

· LMN

· NMJ

· Chest wall

· V/Q dead space

· Diffusion

· Shunt

CO2 elimination – linear curves and tightly controlled via chemoreceptors

CO2 carriage in blood

HCO3 90 60

Carbamino 5 30

Dissolved 5 10

2,3 DPG

O2

· COAD

· Altitude

· Exercise

· Pregnancy

· Alkalosis

CVS

· Anemia

Other

· Stored blood

Venous Admixture

True shunt

· phys

o bronchial veins

o thebesian veins (The Thebesian vessels or veins are embedded in the walls of the heart itself. They serve to drain the myocardium and are present in all four heart chambers)

· patho

o atelectasis

o consolidation

o AV malformation

o R-L shunt

o Malignancy

o Eisenmengers

VQ mismatch

Airways Resistance

Laminar

· Radius 

o Drugs, histamine, disease (asthma, inflammation, infection, neoplasm)

o Dynamic airway compression,, neural,

o CO2 dilates

o FB

· Length

· Viscosity

Turbulent

· Flow/resp rate

· Density

· Radius

Lung Volume

ETT

Compliance

Lung

· Volume

o Body size

o Disease – atelectasis, oedema, consolidation, lobectomy, pneumonectomy

o Gravity

o Age

· Elastic

o Emphysema

o Disease – fibrosis, oedema, ARDS

· Surfactant

o Decrease (IRDS, PE)

Chest Wall

· Kyphoscoliosis

· Ank spond

· Diaphragm – supine, pregnancy, obesity

Dynamic Compliance

· Increase AWR – bronchoconstriction

· Time constant

FRC

Chest wall

· Diaphragm (pregnancy, abdo mass, posture, aanesthesia)

· Burns

· Kyphosis

Lung

· Emphysema

· Pulm oedema, ARDS

AWR

· Dynamic hyperinflation

PEEP

Dead Space

ANATOMIC

Individual

· Age

· Size

· sex

Positional

· supine head

· flexion

Drugs

· bronchodilator, anaesthetic gas

ETT and Attachments

ALVEOLAR

West zone 1

· hypotension

· IPPV

· Erect

Work of Breathing

ELASTIC

Compliance factors

· Lung – surfactant, elastic, lung volume

· Chest wall – KP, AS, diaphragm

NON ELASTIC

Airways resistance

· Laminar, turbulence, lung vol, ETT

Tissue Resistance

· Friction associated with viscoelastic deformation at pleural/CW/Abdo interface

Pulmonary Vascular Resistance

Pulm artery pressure

– incr Cardiac output, gravity, Wests Zones.

Lung volume

- FRC

Hypoxic pulm vasoconstriction

Drugs

– NO, GTN< Milrinone, Volatile

Disease

- COAD

Neural – Alpha 1 increases, B2 decreases

Humoral – eicosanoid, 5HT, catecholamine increases

Viscosity - anemia

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