Mind Map Gallery Thoracic Anesthesia and the Respiratory System
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Thoracic Anesthesia and the Respiratory System
Two mind maps on seperate pages: Page 1: Respiratory System Page 2: Thoracic Anesthesia
Edited at 2021-02-12 08:15:23
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Respiratory
Laryngoscopic view
Mallampati
Cor Mc Lehane
improve view
cricoid pressure
decrease LES tone
may obscure view
C/i: vomiting, unstable C-spine
thyroid pressure
BURP maneuver=improve view/grade
Aiway Assessment
upper incisor lenght
maxilla-mandible rel'p
normal jaw closure
jaw protrusion/ prognation
inter incisor distance/ mouth opening
uvula visibility/ mallampati
shape of palate
submandibular space compliance
thyromental distance
neck
length
thickness
range of motion
Difficult Airway
CVCI
SGA: LMA
Invasive/ surgical airway
oxy-Hgb dissociation curve
tissue ph
acidosis
favors O2 release
alkalosis
P50: 27
Left shift
2,3 DPG
hypothermia
alkalosis
CO poisoning
fetal Hgb: 18-20
right shift
2,3 DPG
hyperthermia
Acidosis
sickle cell
maternal Hgb
hyperbaric oxygen
indications
air embolism
CO poisoning
Cyanide toxicity
CRAO
toxicity
seizure
tx: decrease iO2
o2 toxicity
tracheobronchial irritation
ARDS
100% O2 x 10-12hrs
sx:
seizures, n/v, twitching
myopia
narrowing visual fields
physiologic changes
Altitude
hyperventilation
inc MV(RR+TV)
HPV
pulmonary hypertension
HAPE
HACE
LUNG COMPLIANCE
dynamic complicance
reflect resistance to gas flow
peak airway pressure
decrease: ETT obst., Bronchospasm
Static Compliance
pressure required to hold lungs at end inspiration
plateau pressure
decreased: stiff lungs, pneumonia
change in volume/ change in pressure
OBESITY
normal lung compliance
PFT
decreased
ERV
FRC
rapid desat w/ apnea
increased O2 consumption
TLC
FEV1, FVC
restrictive ventilation
normal FEV1/FVC
supine: TV< closing capacity
OSA
STOP BANG criteria
>3: high risk
OSA vs. OHS
AGING
emphysema-like
RV, FRC
PaO2
alveolar surface area
lung compliance
closing capacity
closing volume
response to CO2 build up
resp. to low O2
chest wall compliance
airway reflexes
LAPAROSCOPY
Pneumoperitoneum
PaCO2-EtCo2 gradient
hypercapnea
respiratory acidosis
pulmonary HPN
compliance
Lung volumes and FRC
Trendelenburg position
migration of ETT
diaphragm compression
peak airway pressure
Reflex Pathways
Parasympathetics
@bronchi and Bronchioles
vagus
Ach M3
bronchoconstrictions
tx: glycopyrrolate, atropine
ipratropium
Sympathetics
B2 adrenergic
bronchodilation
salbutamol
epinephrine
Histamine
H1 receptor
bronchoconstriction
H2 receptor
bronchodilation
flow volume loop
inspiratory problem
extrathoracic pathology
expiratory problem
intrathoracic pathology
clinical
URTI
airway reactivity
6wks ff. URTI
risk
laryngospasm
bronchospasm
coughing
desturation
predictors of adverse events
airway surgery
hx of asthma
wheezing, rhonchi
passive smoke exposure
purulent/ productive secretions
Respiratory Failure
Acute RF
hypoxemia
hypoventilation
Preoxygenation/ denitrogenation
ETO2 >90%
CPAP/ PS
safe apnea time
FRC
Obese
pregnant
pediatric pt.
shunt physiology
o2 consumption
fever
Airway edema
ACE inhibitor induced
angioedema
Thoracic Anesthesia
Double Lumen Tube
Malposition
severe desat
resume 2 lung ventilation
gradual desat
ensure FiO2 1.0
check position w/ bronchoscope
ensure optimal CO
apply recruitment maneuver to ventilated lungs
apply CPAP to non ventilated lung
intermittent re- inflation of non-ventilated lung
partial ventilation techniques
o2 insufflation
HFV
lobar collapse w/ bronchial blocker
mechanical restrictio of BF to non vent. lung
Bronchial Blocker
best for difficult airway
easy recog of difficult airway
no cuff damage @ intubation
no need to replace tube after procedure
isolate at lobar level
Jet Ventilation
use
Rigid broonchoscopy
airway surgery
post catheter cricothyroidotomy
Sub Topic
type
High frequency JV
Low frequency JV
manually triggered hand held device
Complications
PaCO2 build up
dysrhythmias
respiratory acidosis
hypoventilation
Barotrauma
pneumomediastinum
pneumothorax
Airway Fire
decrease risk
flammability of ETT
flexible stainless steel
dual cuff
inflate w/ saline/ methylene blue
available FiO2
30%
avoid nitrous
Remove flammable metrial
management
Immediately remove ETT
stop flow of all airway gas
flood surgical field w/ saline
re establish ventilation
consider bronchoscopy
Negative pressure Pulmo edema
presentation
extubated
laryngospasm
tx w/ PPV, Larsen point pressure
large negative intrathoracic pressure inspiration vs. closed VC
relief of obstruction by intubation
pink frothy fluid out of ETT
-100cmH2O
non cardiogenic pulmonary edema
hydrostatic pressure
pulmonary capillary leak
Aspiration
risk of aspiration pneumonitis
ph<2-2.5
volume 0.4-1.0ml/kg
treatment
lateral head position
trendelenburg position
suction pharynx
ET intubation
PPV w/ PEEP
do not instill saline or bicarb
bronchoscopy
no prophylactic antbx needed
do not give steroids
dx
CXR
ABG
WBC