Day 6 - Pulm1 Tb, ARDs

Question 1

Ways PPD test can turn out if person has hx BCG vaccine

Answer 1

(1) Negative - more likely if given before 1 yo or > 10 yrs since vaccination (2) Positive - more likely if given w/i last 10 yrs but greater than 1 month ago (3) Negative => Positive - more likely if given

Question 2

Measures of oxygenation

Answer 2

(1) A-a gradient (2) PaO2/FiO2: a) 300-500 mmHg is normal b) gas exchange deficit c) severe hypoxia (ARDs)

Question 3

Tx ARDs

Answer 3

Tx underlying cause; Supportive care in ICU; Maintain ventilation w/ low tidal volumes to minimize injury and PEEP to keep end-expiration pressure in alveoli; Conservative fluid mgt (low CVP) to reduce pulmonary edema - may also use furosemide & albumin; Prone positioning (improves oxygenation, not survival); Minimize oxygen consumption by preventing fever w/ antipyretics; Minimize anxiety/pain w/ analgesics/sedatives; Minimize respiratory muscle use (e.g., paralytics, particularly in cases of asynchrony of ventilator); Transfuse only if Hb drops below 7 (may increase death; usually 10 in most patients);