Examen 3 Flashcards
pH
7.35-7.45
paO2
75-100
paCO2
35-45
paCO3
22-26
ARDS - phases
- Exudative: capillary congestion, alveolar necrosis…
- Proliferative: type 2 pnuemocyte, macrophages
- Fibrotic/Resolution: scar tissue and restructuring
ARDS
diffuse alveolar damage
noncardiogenic pulm edema
hypoxemia
ARDs - causes
- direct lung injury - pneumonia, trauma
2. indirect lung injury - sepsis, burn, pancreatitis
Post-Op Respiratory Failure
- atelectasis
- pneumonia
- pulmonary edema
- PE
PE - Classic Triad
dyspnea, chest pain, hemoptysis
PE - etiology
popiteal thrombi, gyne surgery, indwelling cath, hypercoag (HTN)
Pulmonary HTN
- primary- idiopathic
2. secondary- cardiac, pulm
SCI - Intro
- NT release - inflammation
- vascular injury- hematoma, ischemia
- microhemorrhage in gray matter
- edema- dec blood flow, ischemia
- spinal shock - hypotension
Central Cord Syndrome
- hyperextension
- greater motor impairment in upper vs lower
Sacral Sparing
- preserved voluntary rectal sphincter
2. perianal sensation
Anterior Cord Syndrome
- hyperreflexion
- m + s loss below site of injury
- fine touch preserved
Brown-Sequard
- penetrate one side’
- motor loss same side
- sensory loss opposite side
Spinal Shock
- transient
- initial HTN, then HoTN, loss motor fxn, muscle flaccidity, etc
Neurogenic Shock
-HoTN, brady, hypothermia
Autonomic hyperreflexia
- uncontrolled CV response from SNS
- paroxysmal HTN, h/a, brady
- full bladder and bowel
Parkinsons’
substantia nigra, dopa
Guillian Barre
AI myelin in PNS
Myasthenia Gravis
AI ACh receptors
ALS
- muscle atrophy & lacteral hardening of SC d/t nerve degeneration
- too much glutamate? unknown etiology
MS
AI myelin CNS
Peripheral Neuropathy
damage to nerves of the peripheral nervous system, which may be caused either by diseases of or trauma to the nerve or the side effects of systemic illness
Cerebral Palsy
motor conditions that cause physical disability in human development, chiefly in the various areas of body movement
-cerebral insult to immature brain
HCV
parenteral; no vaccine
Cirrhosis - Types
disrupt structure; replace w/ collagen and fat
- Laennec’s
- Biliary
- Post-necrotic
- Metabolic
- Other - tumor, trauma, infection, RVF
Cirrhosis - Sx
- Jaundice
- Infection Sx
- Immune Deposits
- Hypoalbuminenia
- Portal HoTN - ascites, varices, hepatic encephalopathy
- Coagulopathies: GI bleed, DIC
- F/E Imbalance - dec Na + K, vasodil, increased osmolarity–> peripheral edema
- Hepatorenal Syndrome
- Toxin accumulation - sex hxms
Hepatic Failure
80-90% loss
Peds
Jaudice, Kernicterus, biliary atresia, acute infection, Wilson;s
Hep Failure - Tx
- prevent infection
- Na restriction
- diuretic
- D/C hepatox drugs
- paracentesis
- portal caval shnts
- clotting factor replacements
- vit b12, thiamine, folic acid + lactulose
- low ptn diet
AST
5-60
ALT
5-43
ALP
30-115
Bili
0.2-1.2
Ptn
6.5-8.2
Albumin
4-6
Lab
- LFTs
- Bili
- Ptn
- Ammonia
- Clotting
Transplant - CONTRA
- end stage cardiopulm
- mets cancer
- active sepsis
- AIDs
- psych
Transplant - Complications
- rejection
- infection
- biliary anastamosis leakage
- hemorrhage
- hepatic artery thrombosis
- acute renal failure
Pancreatitis
non-bac inflammation
activate/liberate enzmes
autodigestion
–> edematous or hemorrhagic
Pancreatic Abcesses
amylase >2.5x, inc BS + K, low Mg, Ca, albumin
Tx - ARDs
nitrous oxide,
anti-inflammatories/steroids,
exogenous surfactant,
recombinant human protein C
PE
- fibrinolytics (tPa, alteplase, streptokinase),
- heparin (anticoag),
Pulm HTN
- prostacylin analogues (treprostinil)
- endothelin receptor antagonists (Bosentan)
- phosphodiesterase-5 inhibitors (Sidenafil, Revatio; open pulm BV)
- HI dose CCB
- anti-coag
- diuretics
Parkinsons’
- Levodopa (sinemet)
- anticholinergics
- dopamine agonists
Guillain-Barre
- plasmaphoresis
- IV Ig
MG
- anticholinersterase agents (neostigmine/pyridostigmine, inc NM transmission)
- immunosuppressants (prednisone, azthio, cyclo, tacro, myco…)
ALS
riluzole/rilutek (dec glutamate)
Cerebral Palsy
- baclofen (antispasmodic)
- botox
MS
- B-interferons (Avonex, betaseron, rebif): balances the expression of pro- and anti-inflammatory agents in the brain, and reduces the number of inflammatory cells that cross the blood brain barrier.
- Copolymer I/Copaxone: synthetic myelin ptn
- Novantrone/mitoxantrone: Immunosuppresants ; cardiac s/e
- natalizumab/tysabri: monoclonal Ab
- immunemodulators
Hepatitis
- antivirals
2. immune modulators (interferon, ribavim)
hep failure
vitamins, diuretics, vit k (aquametphyton), lactulose
Transplant
- Anti-rejection meds- tacro, etc…
- Antivirals- bactrim, acclovir, ganicyclovir
- PPI/H2- rantidine, pepcid