lecture 8 Flashcards
when someone is in acute asthma, what occurs in terms of their breathing
- they have a decrease in maximum lung capacity
- they have a decrease in inspiration but prolonged expiration (wheezing)
what are the two components of therapeutic treatment for asthma
- use of rescue reliever- bronchodilator
- use of controller treatment that modify the asthmatic airway environment so that acute airway narrowing occurs less often
what are the 2 rescue treatments for asthma
b2 agonists- stimulate receptors to cause vasodilation
anticholinergics- decrease parasympathetic activity by binding to M3 receptors- vasodil
what are some of the controller treatments for asthma
inhaled corticosteroids- prevents inflammation
antileukotriences- decrease activity of inflame. mediators
long-acting beta2 agonists
theophylline-block phosphodiesterase activity in SM of bronchiole
systemic corticosteroids- no common- anti-inflammatory
anti-IgE treatment-against specific antigen
obstructive vs restrictive pulmonary disorder
obstructive- and restriction in airflow to the lungs
restrictive- decreased EXPANSION of the lungs due to alterations of the lung parenchyma, pleura, chest wall or neuromuscular function
what is ARDS
- adult respiratory distress syndrome
- damage to the alveolar-capillary membrane
- get alveolar infiltrates with dyspnea
- associated with- trauma, sepsis, aspiration of gastric acid, fat emboli, shock
- ALWAYS PRESENT WITH SEVERE DECREASE IN PaO2 THAT IS UNMANAGEABLE WITH SUPPLEMENTAL O2 THERAPY-
- mortality 30-60%
what are the three pathological features of ARDS
- noncardiogenic pulmonary edema- because of damage to the capillary, not hydrostatic pressure
- atelectasis associated with lack of surfactant (can be acute)
- fibrosis (hyaline membranes) associated with inflammatory deposition of proteins
what are 5 common findings in ARDS
1) severe hypoxemia caused by intrapulmonary shunting of blood
2) decrease in lung compliance
3) decrease in functional residual capacity
4) diffuse, fluffy alveolar infiltrates on chest x-ray- WHITE OUT
5) non cardiogenic pulmonary edema
what is the treatment for ARDS
- mostly supportive
- enhance tissue oxygenation until inflammation resolves
- identify and correct underlying cause
- block inflammation
- maintain electrolyte and fluid balance while avoiding overload
- oxygenation in undamaged areas of the lungs
- mechanical ventilation with positive end expiratory pressure (PEEP)- increases and prevents alveolar collapse at end of expiration and forces edema out of alveoli
- high frequency jet ventilation- pulsating
- inhaled NO- relax muscle/bronchioles
- supplemental oxygen- >60% with fio2 decreased as fast as possible to avoid absorption atelectasis
what is absorption atelectasis
- occurs when the FIO2 is too high for too long
- normally we breath 21% oxygen and rest nitrogen. since we do not use the nitrogen it stays in our lungs as residual volume.- when you deliver too much oxygen for too long, we use the oxygen and there is not residual volume left
