"Other" Pulmonary Disorders Flashcards
Life threatening acute hypoxemia respiratory failure (organ failure from prolonged hypoxemia). Most commonly develops in critically-ill patients.
Acute respiratory distress syndrome (ARDS)
What is the hallmark of ARDS?
Severe refractory hypoxemia NOT responsive to 100% O2
What 3 things can help to identify ARDS?
- Severe refractory hypoxemia
- Bilateral pulmonary infiltrates on CXR
- Absence of cariogenic pulmonary edema (Pulmonary capillary wedge pressure
Inflammatory lung injury due to proinflammatory cytokines leads to diffuse alveolar damage which increases the permeability of the capillary barrier which causes pulmonary edema and alveolar fluid influx, loss of surfactant, and vascular endothial damage. This decreases blood oxygenation.
ARDS
What are the clinical manifestations of ARDS?
Acute dyspnea, hypoxemia, and multi-organ failure if severe
PaO2/FIO2 ratio 200-300mmHg + PEEP or CPAP > 5cm H20
Mild ARDS
PaO2/FIO2 ratio 100-200mmHg + PEEP >5cm H20
Moderate ARDS
PaO2/FIO2 ratio 5cm H20
Severe ARDS
What should you expect to see on a CXR in a patient with ARDS?
Diffuse bilateral pulmonary infiltrates –> white out pattern (CXR resembles CHF)
What does ARDS typically spare in a CXR?
Costophrenic angles
How do you tell the difference between ARDS and pulmonary edema?
PWCP
What is a normal PWCP?
12-18mmHg
(Low normal PWCP in ARDS)
(High normal PWCP in Pulmonary Edema)
How do you manage ARDS?
Noninvasive or mechanical ventilation
CPAP with full face mask, PEEP
Prevents airway collapse at end of expiration, increases FRC, decreases shunting and expands alveoli for increased diffusion
PEEP
PE shows tachypnea, frothy pink or red sputum, and diffuse crackles
ARDS
What are the three clinical settings that account for 75% of ARDS cases?
Sepsis syndrome
Severe multiple trauma
Aspiration of gastric contents
Most common cause of respiratory disease in the preterm infant, usually within the 1st month of life?
Hyaline membrane disease
What causes hyaline membrane disease?
Deficiency of surfactant
When does surfactant production begin?
24-28 weeks
When is enough surfactant produced for a baby to survive?
35 weeks
Caucasian, males, C-section delivery, prenatal infections, multiple births (esp. premature), and maternal diabetes are all risk factors for which disease?
Hyaline membrane disease
Presents shortly post partum with respiratory distress: Tachypnea, nasal flaring, cyanosis, chest wall retractions. May develop respiratory failure and apnea.
Clinical manifestations of hyaline membrane disease
CXR of infant shows bilateral diffuse reticular ground-glass opacities and air bronchograms*; poor expansion and domed diaphragms
Hyaline membrane disease
How do you manage hyaline membrane disease?
Exogenous surfactant given to open alveoli via endotracheal tube; CPAP, IV fluids
How do you prevent hyaline membrane disease?
Steroids given to mature fetal lungs if premature delivery is suspected between 24-36 weeks
What can you administer in the delivery room as a prophylaxis or rescue in established hyaline membrane disease?
Exogenous surfactants
What are some common foreign bodies that can be aspirated?
Gastric contents
Inert material
Toxic material
Poorly chewed food
In aspiration of foreign bodies, the degree of injury depends on ______
The substance aspirated
An epodes of choking and coughing or unexplained wheezing or hemoptysis should raise the suspicion of ?
Foreign body aspiration
What may result from the aspiration of obstructing material?
Asphyxia
What could develop secondary to the aspiration of toxic materials?
Pneumonia
What is one of the most common causes of ARDS?
Aspiration of gastric contents
What can you use to establish a diagnosis of foreign body aspiration and can also be used to help remove the foreign body?
Bronchoscopy
What is the treatment of choice when removing an aspirated foreign body?
Bronchoscopy
What do you do if you suspect post-obstructive pneumonia in a patient who has aspirated a foreign body?
Culture
Expiratory radiography may reveal ____ ____ in a patient who aspirated a foreign body?
Regional hyperinflation caused by a check valve effect
