Classifications, Definitions 12 - Flashcards

Question

Pathophys of asthma

Answer 1

Chronic airway inflammation Smooth muscle hypertrophy Goblet cell hyperplasia Increased reactivity, oedema and secretions. Leads to mucous plugging and scarring - epithelial collagen deposition

Answer 2

Increasing symptoms PEFT 50-75% of best No severe feature

Answer 3

One of PEFR 33-50% RR>25 HR>110 Can’t complete sentences

Answer 4

``` Ix: PEFR < 33% SpO2 < 92% PaO2 < 8 Normal CO2 ``` ``` Clinical: Low GCS Exhaustion Hypotension Cyanosis Silent chest arrhythmia Low resp effort ```

Answer 5

Raised CO2 needing MV and raised inflation pressures

Answer 6

``` Poor or deteriorating resp effort Exhaustion Worsening hypoxia Drowsy Resp Arrest ```

Answer 7

Salbutamol 2.5 to 5mg inhaled Ipratropium 250-500mcg inhaled Steroids - pred 40 or hydro 100 Mg - 2g iv over 20 minutes OTHERS: Iv salbutamol Aminolphyline No role fo Abx

Answer 8

High resistance and obstruction to flow Gas trapping / breath stacking, dynamic hyperinflation Barotrauma - cardiovascular depression Low PEEP, 80% of iPEEP, do an expir hold Prolong IR 1:2, 1:4 ``` Controlled hypoventilation Slow rate 10-14 Low Tv Plat<30 Permissive hypercapnoea Decompress ```

Answer 9

``` Ketamine Sevo Aminophyline Paralysis VV ECMO ```

Answer 10

``` Previous ICU with MV Oral steroid daily use Increasing use of salbutamol Poor compliance Age>40 ```

Answer 11

Abnormal communication between the bronchial tree and the pleura Extrusion of Air from a normally gas filled cavity

Answer 12

Leaks - Cerfolio class - Continuous, inspired, expired, forced BPF - central - from tracheal and bronchi, peripheral from airways BPF - central bronchial tree to pleura, PTx - communication from rupture bleb or alveolar duct

Answer 13

Pulmonary resection (pneumonectomy > lobectomy) ``` Causes Trauma, ARDS Infection, pneumonia, TB Necrotising lung disease - chemo/radio Iatrogenic - lines PTx Mechanical vent ``` Risk Right side procedures Uncontrolled infection Pre-op steroid, infection, radiation Malignancy

Answer 14

CXR CT Bronch - methylene blue VQ - xenon

Answer 15

``` Can’t apply PEEP Loss of Tv Can’t re-expand Inappropriate cyclonic Delated wean ```

Answer 16

Minimise miunute volume and distension Reduce PEEP, Tv, Insp time and RR Permissive hypercapnoea and lower SaO2 Spontaneously vent Try and stop mechanical vent Consider - one lung ventilation, double ventilators, DLT, blocker

Answer 17

Systemic inflammatory response —-> permeability —> oedema Inhalation lung injury - ARDS/airway obstruction Hypermetabolism - (high protein catab, low synthesis) — immunosuppressed, wound healing, infections

Answer 18

Area or depth Area - Lund Browder, rule of 9s, palm area 1% Depth - Supeficial - dermis only Partial - superficial/deep dermal Full - all layers. Painless

Answer 19

ATLS. Get the extent of the burn and assess inhalation injury A +C spine - large tube, uncut. C - iv access, parklands D - avoid hypothermia and analgesia E - surgical -debride/escharotomy

Answer 20

Malignancy - myeloma, ectopic PTH Endocrine - Hyperparathyroid. (Adenoma, MEN). Hyperthyroid Granuloma - Sarcoidosis TB Drugs - thiazide, lithium, aminophyliine, Vitamin D Other - Rhabdo, renal failure, milk alkali

Answer 21

Short QTc Long PR Wide WRS Wide T waves AV block and arrest

Answer 22

Prolonged QTc AV block Torsades

Answer 23

Low Ca Release ca from bone, increased reabsorption of DCT Reduced PO reabsoprtion, therefore more Ca (less complexes) Vit D converts wot 1, 25 vit D3…increased GI Ca absorption

Answer 24

Thyroid C cells In response to high Ca Inhibit ca absorption Inhibit osteoclasts Stimulate osteoblasts Inhibit reabsoprtion in kidney, but inhibit phosphate reabs too

Answer 25

Primary hypoparathyroid Vit D deficiency Congenital deficiency - DiGeorge Malnutrition - less intake, malabsorption, Vit D ricketyts, Osteomalacia Misc - TLS, Rhabdo, renal failure, pancreatitis Drugs - furosemide, calcitonin, bisphos, phenytoin

Answer 26

RA - 3-8mmHg. 15-20cm RV - 25/0-10. 25-30 PA - 25/ 10-20 10cm after that PCWP - 4-12

Answer 27

``` Measured CO CVP RAP, RVP, PAP, PCWP SvO2 Temp ``` Derived (CO = (MAP-CVP)/SVR) ``` CI SV SVI SVR SVRI PVR PVRI ```

Answer 28

Stroke distance - Area under curve x CSA = SV Mean acceleration/PV, markers of contractility PV 90-120cms 20 year old reduces with age Flow time corrected -time spent in systole corrected to rate 60 Low - high afterload, high, Low afterload (vasoplegia)

Answer 29

Angle of probe to direction of flow is constant Ratio of flow in ascending to descending is constant Laminar flow CSA is a constant 70% of the CO is in the descending aorta

Answer 30

Evidence of tissue hypoperfusion due to primary cardiac failure, AFTER correction of pre load. Tissue demand for oxygen cannot be met . ``` Characterised: SBP <90 HR>60 Oliguria Organ congestion CI< 2.1 litres/m2/minute ```

Answer 31

``` Acute coronary syndromes Arrhythmias Valve - endocarditis, muscle rupture, decompensated AS Viral myocarditis - coxsackie Tampanade ``` High output failure - thyroid, anaemia Decompensating chronic failure- hypertensive, dilated cardiomyopathy,

Answer 32

Impaired LV systolic OR diastolic Diastolic: Increased LVEDP —> lungs congested —> hypoxaemia —-> ISCHAEMIA Systolic: Low SV —> low CO — hypotension, reduced systemic perfusion. Reduced coronary perfusion —> ischaemi Reduced systemic perfusion —> vasoconstriction and fluid retain. ALL LEADS TO MYOCARDIAL DYSFUNCTION

Answer 33

Adrenaline Dobutamine Consider vasodilator to reduce after load and therefore work Enoximone (PDE3–> increased cAMP) reduced SVR, inotropic GTN - venodikate Vasopressor if BP low - norad/vasopressin (V1 - constriction, 2 water retention) Levosimendin IABP/VAD

Answer 34

Reduce to oxygen demand —> reduce HR and afterload Improve deliver - perfusion (dilators/inotropes) O2 Delivery - FiO2, ?blood

Answer 35

Aortic regurgitation Dissection Severe PVD LVOT Sepsis Can’t be anti-coagulated Arterial tortuously

Answer 36

Bleeding, haematoma Pseudoanurysm Dissect/perf ``` Mesenteric and renal ischaemia Cerebral ischaemia Helium embolus Haemolysis Low platelets ```

Answer 37

CVS - Catecholamine storm on herniation. Constriction and tachy Increased afterload - ischaemia Cushings may occur - hypertension with brady Herniation - loss of tone, dilation, hypotension. Resp - pulmonary oedema, apnoea Endo - pit ischaemia, DI, fluid loss, electrolytes, low temp, hypothyroid Coagulapathy

Answer 38

``` Lung recruitment LPV 4-8, PEEP 5-10 Insp<30 Chest physio Head up ``` normal pH PaO2>10 CO2 4.5 to 6 SpO2 > 94

Answer 39

Metabolic - methylpred - reduced EVLW, improve O2 (Also improves organ survival) Warm to 36-37 Endocrine - insulin 4-10 Vasopressin T3 was but isn’t If high Na - water NG Haem - blood/products to optimise delivery. But transfusion affects transplant Correct coagulopathy

Answer 40

Urine output > 4ml/kg/hour Na>145 Serum Osm>300 Urine <200

Answer 41

Treat before results back DDAVP Fluid admin with minimal sodium

Answer 42

Alcohol Hep B/C Drugs - methotrexate, methydopa Cholestasis - primary biliary cirrhosis/sclerosis cholangisit Autoimmune hep Hereditary - Wilsons, Haemachromatosis Vascular - Budd Chiari Non alcoholic fatty liver

Answer 43

Child Pugh MELD Childs - Enceph, Ascites, Albumin, Bilirubin, INR A - 5-6 B - 7-9 C - 10-15 MELD Bilirubin, INR, Creatinine SOFA UK ELD - transplant scores

Answer 44

Bleeding - varices or coagulopathy Hepatic enceph, low GCS Alcoholic Hep AKI Sepsis

Answer 45

Pre renal AKI, not responsive to fluids in patients with fulminant liver failure ``` Criteria Cirrhosis and ascites Cr > 133 No change in Cr after two days dieuretic withdraw and albumin expansion No Shock No nephrotoxic S No parenchymals disease ```

Answer 46

1 - rapidly progressive decline in kidney function, mortality 50% 2 - indolent