ARDS and osbtructive airway disease

Question 1

What are the most common causes of ARDS?

Answer 1

A: aspiration, acute pancreatitis, air/amniotic fluid embolism
R: radiation
D: drug overdose, diffuse lung disease, DIC, drowning
S: shock , sepsis, smoke inhalation

Question 2

What are the key labs that suggest ARDS?

Answer 2

ABG showing respiratory alkalosis, decr. O2, decreased CO2, tachypnea,
wedge pressure

Question 3

What is the significance of a normal CO2 during an acute asthma exacerbation?

Answer 3

signals impending respiratory failure and requires additional beta agonists, O2, and potentially ventilation

Question 4

What are potential side effects of theophylline?

Answer 4

interactions with other drugs, tachycardia, seizure

still occasionally used as adjuvant tx

Question 5

What is the definition of mild intermittent asthma? Tx?

Answer 5

less than 2X/wk, nocturnal awakening

Question 6

What is the definition and tx of mild persistent asthma?

Answer 6

bronchodilator use more than 2X/wk
nocturnal awakening more than once every 2 wks
for long-term control, give inhaled low dose corticosteroid. consider mast cell stabilizer (omalizumab), leukotriene inhibitor, or theophylline

Question 7

What is the definition of moderate persistent asthma? what is the long term control strategy?

Answer 7

dialy sx, daily bronchodilator use, sx that interfere with activity, or nocturnal awakening more than 1X/wk
give inhaled low-medium dose corticosteroid and long-acting beta 2 agonist; consider leukotriene inhibitor or theophyline

Question 8

What is the definition of severe asthma?

Answer 8

sx with minimal activity, awake multiple times per night, require multiple meds on a daily basis.
give inhaled high dose corticosteroids and long acting beta2 agonist and consider systemic steroids

Question 9

What is the diagnosis of chronic bronchitis?

Answer 9

history of productive cough for 3 months of the year for more than 2 yrs

Question 10

What is the treatment for a pt with chronic bronchitis?

Answer 10

smoking cessation, abx for URI becasue of greater incidence of bacterial etiology, and bronchodilators

Question 11

Who do you tell the difference between chronic bronchitis and emphysema?

Answer 11

diffusion. it is normal in chronic bronchitis but decreased in emphazema.
Also- chronic bronchitis pts tend to be “blue bloaters” because they develop cor pulmonale, which causes cyanosis and edema. emphysema pts are pink puffers- they have pursed lip breaths, dyspnea, and barrel chests

Question 12

What is the difference in the distribution of emphysema caused by smoking vs. alpha-1 antitrypsin deficiency

Answer 12

smoking: centrilobar distribution

A1AT deficiency- panlobar distribution

Question 13

What are the CXR findings that suggest emphysema?

Answer 13

flat diaphragm, hyperinflated lungs, subpleural blebs and bullae, decr. vascular markings

Question 14

What is the tx for emphysema?

Answer 14

smoking cessation, O2 (home O2 program needed for resting SaO2

Question 15

What are the causes of bronchiectasis?

Answer 15

chronic airway obstruction, chronic tobacco use, TB, CF, fungal infections, severe PNA

Question 16

What are the H/P of a patient with bronchiectasis?

Answer 16

productive cough, hemoptysis, freq resp infections, dyspnea, copious sputum,

Question 17

What is the tx for bronchiectasis?

Answer 17

pulmonary hygiene, chest PT, abx if sputum increases, inhaled beta 2 agonists and corticosteroids may reduce sx; resection of severely diseased lungs for hemorrhage or substantial sputum production

Question 18

What are the complications of bronchiectasis?

Answer 18

cor pulmonale, massive hemoptysis, abscess formation