Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPAP JUNIOR SEM. > Chest Pain To ARDS > Flashcards

Chest Pain To ARDS Flashcards

1
Q

Pain 2/2 to inflamation ion of the parietal pleura

Following a URI, Pneumonia or infection,

S/S: local sharp pain that increases with cough, sneezing, or deep RR that radiates to the ipsilateral shoulder
+/i a friction rub on lung auscultation

D/o and Tx?

A

Plurisy/ Pluertitis

Tx the underlying condition
+Indomethacin and Codine for cough suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Abnormal fluid in the lung space

S/s dyspnea, cough, respirophasic pain, Increased dullness to percussion, decreased RR sounds

Thoacocentesis reveals milky white fluid with a low pH and positive Gram Stain

A

Empyema

Dx Thoracocentesis (Dx and Tx)
-if unknown cause or
Clinically: bilateral effusion of CHF (obvious cause)

Tx: ABX and Tube Thoracostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Tx for frequent recurrent pleural effusions

A

Pluerodesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Abnormal fluid in the lung space

S/s dyspnea, cough, respirophasic pain, Increased dullness to percussion, decreased RR sounds

Thoacocentesis reveals sterile pleural fluid

D/o and Tx?

A

Uncomplicated pleural effusion

Dx Thoracocentesis (Dx and Tx)
-if unknown cause or
Clinically: bilateral effusion of CHF (obvious cause)

Tx: ABX for treatment of underlying pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Abnormal fluid in the lung space

S/s dyspnea, cough, respirophasic pain, Increased dullness to percussion, decreased RR sounds

Thoacocentesis reveals fluid with low glucose (less than 60) and low pH (<7.2) with negative Gram stain

D/o and Tx?

A

Complicated Plerual Effusion

Dx Thoracocentesis (Dx and Tx)
-if unknown cause or
Clinically: bilateral effusion of CHF (obvious cause)

Tx: ABX and tube thoracotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Effusions due to infection refractory to antibiotics and drainage require

A

surgical debridement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chest centesis reveals triglycerides >110 mg/dl

Think?

A

Chylothorax exudative pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Esophageal rupture leads to what types of effusion

A

Exudative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Centsesis reveals high amylase with a left sided effusion, think?

A

Pancreatitis, and or esophageal rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Plural effusion with frank pus in the plural space with a postive gram stain and refractory fevers

Think ? Tx?

A

Empyema (Exudative Plural effusion)

Tx Prompt Drainage and ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chest centesis reveals an empyma (infection) with cholesterol crystals

Think

A

Exudative Plueral Effusion 2/2 Rheumatoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Plueral centesis reveals e elated protein with no other findings think>?

A

TB (exudative effusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the fluid level requirement for centesis of the chest

A

Need at least 1 cm of fluid in the decubitus view to perform a blind centensis

Otherwise centesis should be guided by U/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the lowest level of fluid that can be detected by CT

(Plueral effusion)

A

10 Ml of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Difference between a hemorrhagic plural effusion and a hemothorax

A

Hemorrhagic pleural effusion—mix of blood & pleural fluid

Hemothorax—gross blood in pleural space
—Pleural fluid hct : blood hct > 0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

difference of Empyema vs chylous effusion

A

After centrifuge

Empyema—clear fluid over white cells

Chylous effusion—persistently turbid
—Chylomicrons & elevated triglyceride level >100mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define Lights Criteria

A

Effusion is exudative if

  1. Plerual fluid protein/ serum protein is greater than 0.5
  2. Plueral effusion fluid LDH/ serum LDH is greater than 0.6
  3. Plueral Fluid LDH is greater than 2/3 the ULN of the serum LDH.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common causes of exudative p. effusion?

A

CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tall thin male aged 2-40, with a hx of smoking. Euchroid proportions (marfans)

S/s sudden onset unilateral chest pain, at rest or awoken from sleep
With tachyHr, diminished breath sounds decreased tactile fremitus, and hyper resonance unilateral

D/o? CXR? Tx?

A

Simple Pneumothorax

CXR: Visceral Pleural Line
(Late complicated findings are tracheal shift, medistinal shift)

Tx: Needle decompression and possible chest tube

If less than 3cm can be treated outpt with f/u at 24hrs

> 3cm needle D to chest tube

20
Q

What conditions place a patient at risk of developing 2nd PneumoTHX ?

A

complication of pre-existing lung disease

  • COPD
  • asthma
  • cystic fibrosis
  • tuberculosis
  • pneumocystis pneumonia
  • interstitial lung disease
21
Q

Pts at increased risk of Simple Tension Pneumo should be counseled to…

A

Stop smoking, avoid high alt. Or scuba diving

22
Q

What is the Tx for recurrent tension Pneumos

A

Resection of blebs and pluordesis

23
Q

What is the O2 delivery of a NC

A

FiO2: 22-50%

with flow rate of 1-6 liters/min

24
Q

What is the O2 delivery of a simple face mask

A

Simple face mask can deliver oxygen concentrations of 40% to 60%
with flow rates from 6 to 10 L/min

25
Q

What is the O2 delivery of a Venturi Mask

A

Venturi principle masks 24% to 60% with flow rates from 4 to 12 L/min

26
Q

What is the O2 delivery of a NRB

A

Non-rebreather mask with reservoir: FiO2: 50-100%

with flow rates from 10 to 15 L/min

27
Q

What is the O2 delivery of a High Flow NC

A

High-flow nasal cannula 21-100% fi02 atflowrates of up to 60 liters/min

28
Q

Life threatening abnormal gas exchange with a PaO2 less than 60, SaO2 less than 90%
or a PaCO2 >45mmHg

Think ?

A

Acute Resp failure

29
Q

Primary causes of Hypoxemic Resp Failure

A 
ARDS 
Pneumonia 
Acute lobar acetlectasis 
Chronic Pulm Edema 
Lung Contusions
30
Q

Common causes of Primary hypercapnic Acute resp. Failure

A 
COPD 
Asthma 
GBS 
Rx 
MG 
Hypomagnesemia 
OHS
31
Q

Asterixis is a sign of…

A

Metabolic encephalopathy

Seen in acute Resp failure
As well as CKD, CHF, Liver failure

32
Q

A pt is at risk of Hypercapnic Resp Failure, and has an SpO2 less than 88.. what is the next intervention

A

Start O2 with NC 2-4 L.min on 28%

O2 target is 92%

+/- bronchodilator as needed

Obtain ABG

33
Q

A pt is at risk of Hypercapnic Resp Failure, and has an SpO2 greater than 88.. what is the next intervention

A

No O2 Tx is needed, Monitor and consider ABG

34
Q

A pt is not at risk of hypercapnic resp failure and has an SPO2 less than 85%, what is the best Tx

A 
Start O2 4L.min NC 
Or 
5-10L with a nimble mask 
Or 
15L/min of NRB

O2 goal of 92-96%

Obtain ABG

35
Q

A pt is not at risk of hypercapnic resp failure and has an SPO2 is less than 91%, what is the best Tx

A

Start 2-4 L NC or other suitable O2 delivery with a O2 goal of 92-96%

Consider ABG

36
Q

What is the 1st line O2 tx in pts with COPD

A

NIPPV (BiPAP)

37
Q

What are the 7 indications for intubation

A
  1. Hypoxemia despite O2 tx
  2. Upper Airway Obstruction
    (Laryngeal edema/ burns)
  3. Impaired Airway Protection
    (Less than 8 intubate)
  4. Inability to clear secretions
  5. Progressive general fatigue, tachypnea, use of accessory muscle use or AMS
  6. Apnea
  7. Severe hypoxemia at presentation
38
Q

Right stem intubation leads to what ADE

A

Atelectasis of the contralateral lung and over distention of the intubated lung

39
Q

Ventilated pt has SubQ emphysema
Pneumomediastinum and su Plueral air cysts

Think ?

A

Barotruama

Tx: hypoventilation to avoid baratura a

40
Q

What is the general supportive care for Acute Respiratory Failure

A

Nutrition, Monitor electrolytes, and ovoid oversedation, PPI to prevent ulcers and DVT prophylaxis

41
Q

Non cardiogenic pulmonary edema that leads to acute hypoxemia and RR failure

Resp Distress onset within 1 wk of insult, profound dyspnea, hypoxemia refractory to tx, labored RR, tachypnea, crackles, plus multiple organ failure

CXR: Bilateral ground glass appearance that spares the costophrenic angles with a NML hr size +bronchograms

WIth a PaO2 and FiO2 ration less than 300.

MC 2/2 sepsis, diffuse pneumonia, aspiration, or trauma

Think? Tx?

A

ARDS

Tx: Identify & treat underlying illness/injury
—Broad spectrum antibiotics for sepsis and/or infection

General supportive care

Tracheal intubation and mechanical ventilation
—The lowest levels of PEEP (used to recruit atelectatic alveoli) with supplemental O2 (FiO2 <60%) to maintain SaO2 >88%
—Low tidal volume (ideal weight based 6 ml/kg)

Prone positioning

Monitor cardiac & other organ functions

42
Q

Describe the pathological progression of ARDS

A

Injury to the lungs, capillaries, and endothelial cells

Leads to increased vasc. Permeability and decreased production/activity of surfactant

Result: interstitial and alveolar pulmonary edema, alveolar collapse/atelectasis, and hypoxemia

43
Q

What should you rule out before making the Dx of ARDS

A

Pulm. Edema 2/2 HF

44
Q

Define Mild ARDS

A

PaO2/FiO2 ration between 200 and 300

45
Q

Define Moderate ARDS

A

P/F ration above 100 and less than 200

46
Q

define Severe ARDS

A

P/F ration less than 100

47
Q

Hyaline membrane disease in infants and nearly all preterm pts

Caused by deficient pulmonary surfactant in an immature lung

Rapid accumulation of neutrophils in the lung that lead to pulmonary edema and actelectasis leading to cytokines inflammatory response

S/s tachypnea, cyanosis soon after birth, nasal flaring, with retractions and profound hypoxemia

Think ? CXR? Tx?

A

Neonatal Resp. distress Syndrome

CXR: low lung volumes,a nd classic reticulgranular ground glass appearances with air bronchograms

Tx: Prevention with antenatal steroids at 23-34 weeks gestation

Peep and Nasal CPAP leading up to intubation with exogenous surfactant admin.

Intubation criteria is requiring a FIO2 of 0.40% or higher to maintain an O2 sat of 90 or above or any apnea

IPAP JUNIOR SEM. (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions