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Section 8: Pulmonary Disorders > Chapter 62: Respiratory Distress > Flashcards

Chapter 62: Respiratory Distress Flashcards

1
Q

This is a feeling of difficult, labored and uncomfortable breathing

A

Dyspnea

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2
Q

Dyspnea in the recumbinant position

A

Orthopnea (most often result fo left ventricular failue other cause are diaphragmatic paralysis and COPD)

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3
Q

Dyspnea associated with lying on one side (lateral decubitus position) but not the other side

A

Trepopnea (side of disease lungs to increase blood supply)

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4
Q

Dyspnea in the upright position

A

Platypnea

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5
Q

What are the causes of platypnea?

A

Loss of abdominal wall muscular tone and right to left shunt (patent foramen ovale)

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6
Q

The sensation of dyspnea occurs when imbalance exists among

A
  • Inspiratory drive
  • Efferent activity to the respiratory muscles
  • Feedback from these afferent
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7
Q

When patient presents with parodoxical abdominal wall movement it means?

A

Diaphragmatic fatigue

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8
Q

What is the prominent feature of acute heart failure?

A

Dyspnea

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9
Q

What symptoms patient with dyspnea suggest cardiac in origin than pulmonary?

A
  • S3 gallop
  • Pulmonary congestion/intertitial edema
  • Cardiomegaly
  • Neck vein distention
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10
Q

Causes of dyspnea in the ED can be identified by

A
  • History
  • PE
  • ECG
  • POCUS
  • Chest xray
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11
Q

Can use to diagnose dyspnea resulting from COPD

A

Bedside spirometric analysis

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12
Q

Can assess strength of the diaphragm and inspiratory muscle

A

Negative inspiratory force (use in neuromuscular disease)

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13
Q

Test can be use to identify ventricular overload

A

BNP

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14
Q

Normal level of BNP and pro-BNP

A

BNP <100

pro-BNP <300

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15
Q

BNP value that have no utility in excluding or including heart failure in the dyspneic patient

A

BNP 100 - 500

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16
Q

Test that can be helpful in evaluation dyspnea in the ED

A

BNP and D-dimer

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17
Q

In severe dyspnea what is the initial treatment goal?

A

PaO2 >60

SaO2 =/>90%

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18
Q

What is hypoxia?

A

Insufficient alveolar oxygen content or insufficient delivery of oxygen to the tissue

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19
Q

Oxygen delivery is a product of?

A

CaO2 multiply to cardiac output

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20
Q

Tissue hypoxia occurs in state of?

A
  • Low cardiac output
  • Low hemoglobin
  • Low SaO2
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21
Q

What is hypoxemia?

A

An abnormally low arterial oxygen tension (PaO2 <60mmHg)

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22
Q

What is the most common cause of hypoxemia?

A

Alveolar hypoxia

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23
Q

What is relative hypoxemia?

A

Term used when the arterial oxygen tension is lower than expected for a given level of inhaled oxygen

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24
Q

How to calculate Alveolar oxygen partial pressure?

A
  • Inhaled oxygen concentration (21%)
  • Atmospheric pressure (760mmHg)
  • Displacement by water vapor (47mmHg)
  • CO2
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25
Q

What is normal P(A-a)o2?

A

<10mmHg

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26
Q

Predicted formula for P(A-a)o2

A

P(A-a)o2 = 2.5 + 0.21 (age in years) (± 11)

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27
Q

Hypoventilation mechanism

A

increased PaCO2 and normal A-a O2 gradient

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28
Q

Why is there always a some degree of right to left shunting?

A

Direct left atria return from coronary and bronchial veins

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29
Q

Right to left shunt mechanism

A

Increase in the A-a O2 gradient

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30
Q

What is the hallmark of significant right to left shunting?

A

Failure of arterial oxygen levels to increase in response to supplemental oxygen

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31
Q

All the mechanism that increase A-a O2 gradient improves with oxygenation except?

A

Right to left shunting

32
Q

What are the mechanism of hypoxemia?

A
  1. Hypoxia
  2. Right to left shunt
  3. V/Q mismatch
  4. Diffusion impairment
  5. Low inspired oxygen (high altitude)
33
Q

However, the acute compensatory mechanisms are always activated when Pao2 reaches _____, and compensatory mechanisms fail when Pao2 falls below ____.

A

However, the acute compensatory mechanisms are always activated when Pao2 reaches 60 mm Hg (8 kPa), and compensatory mechanisms fail when Pao2 falls below 20 mm Hg (2.67 kPa).

34
Q

Define hypercapnia

A

Paco2 >45mmHg

35
Q

What are the causes of alveolar hypoventilation?

A
  • Decrease in respiration
  • Decrease in tidal volume
  • Increase in dead space
36
Q

How COPD can produce alveolar hypoventilation?

A

Increase in dead space

37
Q

Acute elevation of PaCO2 at what level can cause cardiovascular collapse?

A

PaO2 >100mmHg

38
Q

Acute CO2 - bicarbonate equilibrium

A

10mmHg:1mEq/L

39
Q

Chronic CO2 - bicarbonate equilibrium

A

10mmHg:3.5mEq/L

40
Q

How can hypercapnia treated?

A

Increase minute ventilation and tidal volume

41
Q

This drug is use as respiratory stimulant

A

Doxapram

42
Q

What is acute, subacute and chronic cough?

A

Acute <3 weeks
Subacute 3-8 weeks
Chronic >8 weeks

43
Q

Acute cough is usually cause by what?

A

Self -limited upper respiratory or bronchial infections

44
Q

What is the hallmark of acute bronchitis?

A

Productive cough

45
Q

Pertusis cough is acute ranging from?

A

1 - 6 weeks

46
Q

Most common cause of chronic cough

A
  1. Smoking (morning)
  2. Upper airway cough syndrome (postnasal discharge)
  3. Asthma (night)
  4. GERD
  5. ACE blocker
47
Q

What is the mechanism of cough in ACE inhibitor?

A

Accumulation of bradykinin and substance P taht stimulates pulmonary cough receptors

48
Q

Part of most proprietary cough preparations, soothe the pharynx and modestly alter the cough reflex

A

Demulcents

49
Q

Drug that reduces coughin in patients with acute bronchitis?

A

Naproxen

50
Q

For patient with intractable coughing paroxysmal in the ED, we can give what?

A

Lidocaine 4ml (40 or 80mg) neb - suppres gag reflex due to posterior pharyngeal anesthesia

51
Q

What is hiccups?

A

Involuntary spastic contraction of the inspiratory muscle

52
Q

What are the causes of hiccups?

A

Stimulation, inflammation and injury to the nerves (phrenic and vagus)

53
Q

What are the classifications of hiccups?

A

Benign <48 hours
Persistent <48 hours
Intractable >1 month

54
Q

What are the example of benign hiccups?

A
  • Gastric distention
  • Alcohol ingestion
  • Smoking
  • Changes in temperature
55
Q

Drug that stimulates hiccups

A

Chemotherapy and Dexamethasone

56
Q

If the hiccups is called psychogenic in cause what is the characteristic?

A

Resolution during sleep

57
Q

If patient with persistent hiccups what can you do at ED?

A
  • Look at external auditory canal
  • CXR
  • Fluoroscopy - diaphragmatic movement
58
Q

Method that can be use to eliminate hiccups

A
  • Swallowing a teaspoon of dry granulated sugar
  • Sip ice water
  • Drink water quickly
59
Q

What drug can you give with intractable hiccups?

A

Chlorpromazine (FDA approved) 25-50mg IV every 2-5 hours and Metoclopromide

60
Q

Give some example of persistent and intractable hiccups

A
  • CNS lesions

- Uremia, hyperglycemia

61
Q

If intractable hiccups does not resolve to Chlorpromazine you can give what?

A
  • Nifedipine
  • Valproic avid
  • Baclofen
  • Gabapentin
62
Q

Reason for patient with central cyanosis?

A

Inadequate pulmonary oxygenation and abnormal hemoglobin

63
Q

Cyanosis is usually visible when deoxygenated hemoglobin exceeds _____

A

Cyanosis is usually visible when deoxygenated hemoglobin exceeds 5 grams/dL (50 grams/L)

64
Q

This is called a bluish discoloration of skin due to drugs

A

Pseudocyanosis (normal lips and mucous membrane)

65
Q

Sample drugs that can produce pseudocyanosi?

A
  • Chlorpromazine
  • Minocycline
  • Amiodarone
  • Nicorandil
  • Gold
  • Silver
66
Q

What will pulse oximetry show in patients with methemoglobinemia and carboxyhemoglobinemia?

A
  • Methemoglobinemia (overestimate the true oxygen saturation)
  • Carboxyhemoglobinemia (read as oxyhemoglobin so overestimate)
67
Q

Administer oxygen to all patients with central cyanosis; failure to improve suggests what?

A
  • Shock
  • Abnormal hemoglobin
  • Pseudocyanosis
68
Q

In developed country, what is the most common cause of pleural effusion?

A
  • Heart failure
  • Pneumonia
  • Cancer
69
Q

How many ml of fluids per day is reabsorbed by visceral microcirculation?

A

8 L/d

70
Q

Pleural effusion in chest xray upright seen is about how many ml?

A

150-200ml

71
Q

How can you say that pleural effusion is significant?

A

A significant pleural effusion is large enough to produce a pleural fluid strip >10 mm wide on lateral decubitus radiographic views or by US

72
Q

How can diuretics obscure the distintion between exudates and transudates. If known transudative pleural effusions?

A

The resorption of water is faster than the protein. So protein concentration is increase in the range consistent with exudative etiology

73
Q

Thoracentesis is indicated with pleural effusion when?

A

If with dyspnea at rest (1-1.5L)

74
Q

What are the components of light criteria?

A
  • Protein

- LDH

75
Q

What is the normal pleural fluid ph?

A

Around 7.64

76
Q

Increase pleural fluid amylase indicates?

A
  • Pancreatitis

- Esophageal rupture

Section 8: Pulmonary Disorders (8 decks)

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