Medical ppl help! Just to clarrify a few points...(note if u cant answer any pls dont post to say look it up)?

Question

1) T1 and T2 resp failiure are characterised by hypoxia and hypercarbia respectively... Does this mean certain resp conditions can only cause T1 or T2 - if so which ones... (I mean eg- asthma can obviously cause T1 resp fail, but I guess it could cause T2 as well?could it?)

2) Adrenaline is the same as epinephrine right? Just a different name isnt it? (I ask cos someone said adrenaline was the natural version of epinephrine - is that right?)

3) A MAP of above 65 is req to avoid renal failiure.. Does this mean kidneys are first to go in inadequate perfusion?

4) RE: Sepsis - one can be 'septic' if they have only 1 infection that affects the SIRS score adequately? t/f? (cos I thought that sepsis ((before)) that sepsis req more than 1 infection?)

5) Where are cardiac pacing wires inserted in the heart? And do they ever stay 'paced' on these wires for prolonged periods of time?

Thanks in advance, just wanted to clarrify a few questions, feel free to answer even 1or2 if u can thanks

Answer 1

1) You can have mixed features in respiratory failure, but in general hypoxia is caused by something stopping the oxygen from getting to the blood--like a PE, pulmonary edema or pneumonia. Hypercapnea is from air not getting in and out of the lungs, like COPD or asthma.

2) They are the same chemical, just different words. (Latin vs Greek roots) Latin is ad-("to or at") renal ("kidney") and Greek is epi-("on") nephron ("kidney"). Both words mean "on the kidney" because the adrenal glands (which produce epinepherine/adrenaline) sit on top of the kidneys.

3) Yes. Acute renal failure is one of the most common complications of shock.

4) True. Sepsis is end organ dysfunction from a single or multiple infections. SEVERE sepsis is determined by the SIRS score.

5) usually in the right ventricle, but you can also have a sensing lead in the right atrium which will sense when the heart wants to beat, and the use the right ventricle wire to actually make it beat.

Some people have every beat of their heart generated by a pacemaker, some only have one or two beats a year, if their heart slows down.

Answer 2

Sean did well with number 1.  

Adrenaline and epinephrine are exactly the same thing.  Just 2 different words.  Nothing natural or unnatural changes what we call it.  Where I work, we call it epi.  That's pretty much all I've seen in medicine.

MAP above 65 is required IN SOME PEOPLE to avoid renal failure.  In anesthesia, we are concerned most with perfusing the heart, brain and kidneys.  Those are the 3 that can be most easily damaged, and are vital to life.  Each person is different.  People with long-standing hypertension may require higher MAP to maintain perfusion, as might someone with renal artery disease.  You have to look at other things (like urine production) to make sure the beans are being perfused.  In some people, the first sign of inadequate perfusion may be ST changes, indicating myocardial perfusion problems.

Cardiac pacing wires are inserted through the veins (jugular or subclavian) into the RA and/or RV.  (Except during open heart surgery - they can just do that directly since everything is right there)  Permanent pacers are just that - they stay paced for the rest of their lives.  Occasionally, leads move or malfunction and need to be replaced.  Many people live decades with the same wires.  The pulse generator can run out of battery life and need to be replaced - that's much more common.  Patients then usually get an upgrade to a fancier model of pacer.  Some pts are pacer dependent, and need it for survival.  Others have one that just kicks in when needed.

Hope that helps!