Injury to Lungs

Question 1

Most common form of high altitude sickness? Symptoms?

Answer 1

Acute mountain sickness. Headache, malaise, dyspnea, anorexia, lightheadedness, fatigue, insomnia

Question 2

Most common fatal manifestation of sever high altitude illness?

Answer 2

High Altitude pulm. edema. Causes vasoconstriction in the lungs. Increased capillary permeability and pulm edema.

Question 3

Clinical presentation of pulm edema?

Answer 3

Begin dry, non-productive cough and DOE, Progess to dyspnea at rest, pink, frothy sputum & blood in cough, tachycardia, tachypnea, low grade fever, inspiratory crackles

Question 4

Treatment of HAPE?

Answer 4

Get down to lower altitude and supp. oxygen. Nifedipine (red. PA pressure and pulm vasc resistance) OR Tadalafil and sildenafil-vasodilators

Question 5

AMS can change to this?

Answer 5

High altitude cerebral edema. Vasodilation in the brain

Question 6

Manifestation of HACE?

Answer 6

Ataxic gait, lassitude, declining mental function and consciousness, can progress to coma and death.

Question 7

This is the earliest sign of HACE and last finding to resolve?

Answer 7

Ataxia

Question 8

Treatment of HACE?

Answer 8

Get down, oxygen, hyperbaric chamber, Dexamethasone, Acetazolamide

Question 9

Medications used to help with acclimatization?

Answer 9

Acetazolamide (DOC)- 125mg q12h. Dexamathasone 2mg q6h or 4mg q12h. Above 4000m, 4mg q6h for active exertion

Question 10

Type 1 decompression sickness (milder)

Answer 10

Joint pain (elbow/shoulder>hip/knee), numbness of extremities, skin pruritis, erythema, and cyanosis, lymphatic obstruction

Question 11

Type 2 decompression sickness (more severe)

Answer 11

Cardiopulmonary (cough, substernal chest pain, tachypnea, wheezing) neurologic impairment, otic damage, air embolism

Question 12

Other complications of scuba diving?

Answer 12

Nitrogen narcosis, otic narotrauma, pulm barotrauma, pneumothorax and pneumomediastinum

Question 13

Mechanism of injury in smoke inhalation?

Answer 13

Thermal injury to airways, toxicity froom soot and gases, hypoxia and asphyxiation

Question 14

Thermal injury generally occurs where?

Answer 14

Oropharyngeal airway

Question 15

Obstruction of the airways from soot can lead to?

Answer 15

Bronchoconstriction

Question 16

Clinical presentation of burns or smoke inhalation of the face and upper airways?

Answer 16

Burns, blisters or edema of mouth, hoarse voice, stridor, upper airway lesions of mucosa, black sputum

Question 17

Clinical presentation of burns or smoke inhalation of the lower airways?

Answer 17

Tachypnea, dyspnea, cough, wheezing, rales, decreased breath sounds, retractions

Question 18

These individuals should be intubated?

Answer 18

Stridor, use of accessory muscles, resp. distress, hypoventilation, deep burns of face or neck, edema or blistoring of oropharynx

Question 19

Because of the hypoxic events of burns and trauma, these levels can be measured?

Answer 19

Lactate levels

Question 20

Signs of carbon monoxide poisoning?

Answer 20

Headache (most common), nausea, dizziness, breathlessness, collapse, loss of consciousness

Question 21

Why should ABGs with oxyhemoglobin, methemoglobin, and carboxyhemoglobin be measured?

Answer 21

Because pulse ox cant differentiate b/w hemoglobin and carboxyhemoglobin

Question 22

Treatment of CO poisoning?

Answer 22

Remove pt from CO, ABGs, high-flow O2, hyperbaric oxygen treatment (CO>25%, LOC, metabolic acid ph

Question 23

These individuals will have the highest risk of radiation pneumonitis?

Answer 23

Lung cancer pt’s b/c they receive the largest volumes of radiation to the lungs

Question 24

Clinical manifestations of radiation pneumonitis?

Answer 24

Cough, pleuritic chest pain, fever, DOE, hypoxia, red. PFT

Question 25

Initial phase of radiation pneumonitis begins ______ after therapy ends with what complications?

Answer 25

3-4 weeks, alveolitis, inflammation, capillary leak, pulm. edema. Pt usually asymptomatic

Question 26

Early phase of radiation therapy beging ______ after therapy and has what complications?

Answer 26

3weeks-6months. acute pneumonitis, patient becomes symptomatic, alveoli desquamate and air spaces fill w/ fluid

Question 27

What happens in the late phase of radiation pneumonitis?

Answer 27

Pulm. fibrosis developes

Question 28

What is the mainstay treatment of radiation pneumonitis?

Answer 28

Oral corticosteroids. Prednisone 1mg/kg/day and tapered over weeks to months.

Question 29

After transfusion, these antibodies attach to leukocytes and release cytokines and oxidative products which cause damage to pulmonary capillary endothelium?

Answer 29

Neutrophil specific antibody

Question 30

TRALI presentation?

Answer 30

Minutes to 6 hours, hypoxia, bilateral infiltrates on CXR, pink frothy respiratory secretions, fever, hypotension, cyanosis