PAH, PTX, alveolar collapse, atelectasis Flashcards
PH - rare incidence but more common in _____
obese
PH mean pressure PAP ______
> 25 mmHg
requires ______ to definitively diagnose
RHC
5 main categories PH falls into
- pulm arterial HTN
- left heart disease with low EF
- lung dz/chronic hypoxia
- chronic thromboembolic
- unknown etiologies
PAH is an increase in ____
vascular tone
increased proliferation of pulm ______ ______ ______
vascular smooth muscle
initially reversible smooth muscle vasoconstriction progresses to ______ ______ _______ _____
irreversible smooth muscle hypertrophy
right ventricular overload can lead to ____ ______ with decreased _______ perfusion
cor pulmonale
coronary
_______ anesthetic if possible
regional
if GA then avoid ______ _______ changes
major hemodynamic
avoid _____ since it increases PVR
ketamine
avoid any situation that would increase SNS output and increase PVR, such as:
- hypoxemia
- hypercarbia
- acidosis
- pain
- hypothermia
caution in surgery with potential for _____, _____, ______ embolism
air, fat, cement
caution in surgery with ___ __________, ______, ________
[Anesthesia management of PH]
Elevated airway pressures, laparoscopic, tredelenburg position
___ Hypotension
[PH management]
Avoid
If hypotension fails to correct quickly, then suspect that the ____ may be from ___ and not a drop in ____.
[PH management]
Low BP, RV Failure, SVR
Lung parenchyma tear or rupture allows air from inside of lung to escape between___and ___ ___, non-communicating with no atmospheric access, no shifting ___ or ___
[Characteristics, simple pneumo]
lung, visceral pleura, mediastinum, hemi-diaphragm
Primary Pneumothorax:
absence of diagnosed lung disease, healthy
Causes: (3)
[Primary Pneumothorax]
subpleural bleb, smoking, Birt-Hogg Dube’ syndrome speculated drop in atmospheric pressure
Secondary Pneumothorax:
complication of lung disease
Causes: (9)
[Secondary Pneumothorax]
COPD, emphysema, cystic fibrosis, metastasis, necrotizing bacterial lung infections, pneumocystis, TB, pneumonia, fungal, viral
Traumatic pneumothorax: ___(closed/___) or ___ (open/___) ___ trauma (more common)
Blunt, non-communicating, penetrating, communicating, thoracic
Iatrogenic:
[Traumatic Pneumo]
medical procedure induced
Non-iatrogneic:
[Traumatic Pneumo]
External trauma
____/___ (more common):
[Traumatic Pneumo]
Communicating/open
___ penetrating injury, air comes from outside, with ___ ___
[Communicating Pneumo part 1]
External, atmospheric access
Atmospheric air enters and trapped between ___ ___and___ ___ during inspiration causing a ___ wound and exits chest cavity during ___
[Communicating Pneumo part 2]
parietal pleural, chest wall, sucking, expiration
___ moves away from ___ side during ___ and toward the ___ side during ___ (___ ___)
[Communicating Pneumo part 3]
Mediastinum, affected, inspiration, affected, expiration, mediastinal flutter
___ air enters ___ chest wound during ___
[Tension Pneumo 1/4]
Atmospheric, external, inspiration
___ is not able to ___ chest cavity during ___
[Tension Pneumo 2/4]
Air, escape, expiration
Air in chest rapidly accumulates ___ lung on ___ side
[Tension Pneumo 3/4]
collapses, affected
Continued ___ ___ builds
[Tension Pneumo 4/4]
intrapleural pressure
___, ___, ___ shift to unaffected side
[Tension Pneumothorax Physical Findings]
Heart, trachea, esophagus
Large vessels collapse and impede___ ___ into chest cavity resulting in ___ ___ ___
[Tension Pneumothorax Physical Findings]
venous return, decreased cardiac output
___ ___ ___ ___ (ventilated patient)
[Tension Pneumothorax Physical Findings]
Increased peak inspiratory pressure
Increased ___ and ___ ___veins
[Tension Pneumothorax Physical Findings]
CVP, distended neck
Dyspnea, ___, ___, ___
[Tension Pneumothorax Physical Findings]
respiratory distress, cough, tachypnea
___or absent ___breath sounds
[Tension Pneumothorax Physical Findings]
Decreased, ipsilateral
___(most common sign)
[Tension Pneumothorax Physical Findings]
Tachycardia
___ chest pain
[Tension Pneumothorax Physical Findings]
Ipsilateral
Hyp__emia
[Tension Pneumothorax Physical Findings]
Hypoxemia
Hyp___tension
[Tension Pneumothorax Physical Findings]
Hypotension
Hyp___carbia… but ETCO2 ___due to ___ CO!!
[Tension Pneumothorax Physical Findings]
Hypercarbia, decreased, low
Tension Pneumothorax Treatment (3)
Observation only
Decompression of Pleural Space
Supplemental Oxygen
___ or ___ then observation only
[Tension Pneumothorax Treatment]
Asymptomatic, < 15%
Decompression of pleural space
___ angiocath, ___ syringe, 3 ___ ___
Insert at ___intercostal space ___
Or…
Insert at ___intercostal space laterally
[Tension Pneumothorax Treatment]
14 g. , 50 cc, way stopcock, 2nd, anteriorly, 4th-5th, laterally
Supplemental oxygen ___ ___ ___
[Tension Pneumothorax Treatment]
accelerates air reabsorption
Inhalation of high concentrations of oxygen may speed the ___ of a pneumothorax by reducing the partial pressure of ___ in the pulmonary capillaries,. This should increase the pressure gradient between the pleural cavity, and pleural capillaries, so increasing the absorption of ___ from the pleural cavity
[Tension Pneumothorax Treatment]
resolution, nitrogen, air,
Optimizes ___ delivery and ___ ___
[Tension Pneumothorax Treatment]
oxygen, gas exchange
Inflammatory condition caused by ___ or ___
Most frequent bacteria: ___
[Pneumonia]
bacteria, virus, pneumococci
Alveoli membrane becomes ___ & ___
[Pneumonia]
inflamed, porous
Consolidation: Alveoli fills with ___, ___ ___.
Entire lobes can become ___
[Pneumonia]
fluid, cell material, consolidated
Reduction in ___-___ surface area
[Pneumonia]
gas-exchanging
V/Q ratios decrease: What does this mean? Increased shunt or deadspace? Hypoxemia, Hypercapnia or both?
[Pneumonia]
Shunt, Both
Treatment: ___, ___, ___ ___
[Pneumonia]
Antibiotics, Resp Rx, VC breaths
A reduction or absence of air in parts of the lung resulting in the collapse of ___, loss of ___ ___, ___-___ shunt and diminished gas exchange.
[Atelectasis]
alveoli, lung function, intra-pulmonary
___ reduction or absence of air in parts of the lung
resulting in the ___ of alveoli,
___ ___lung function,
intra-pulmonary ___
___ gas exchange.
Atelectasis, collapse, loss of, shunt, diminished
Oxygen concentration:
the fraction or percentage of inspired oxygen delivered (FiO2).
General Anesthesia causes ___
Atelectasis
General Anesthesia causes Atelectasis
Estimated incidence between ___-___.
50-100%
“The prevalence of atelectasis has been estimated to be as high as ___ in patients undergoing ___ ___”
100%, general anesthesia.
Average ___, can exceed ___ collapsed lung
[General anesthesia causes atelectasis]
3-4%, 20%
Difficult to ___postoperatively
[General Anesthesia causes Atelectasi]
reverse
Reduced inspiratory volumes and chest wall expansion resulting from ___ ___ ___ and a reduced ___tone
[General Anesthesia causes Atelectasi]
deeper anesthesia depth, muscle
___ ___ due to artificial creation of a significantly higher A-a gradient than ___
[General Anesthesia causes Atelectasi]
Absorption atelectasis, normal
Anesthesia= FRC Decreased, Lung Compliance Decreased, Airway Resistance Increased –> Loss of tone, smaller volume, reduced ___ ___ –> ___ ___ atelectasis
[General Anesthesia and Lung Volume]
airway dimensions, airway closure
Pressure of abdominal contents and resulting FRC
Initial upright position ___
Supine position ___
Induction of anesthesia ___
2300 ml, 1400 ml, 950 ml
Atelectasis forms regardless of ___ ___
patient position
high FiO2 is the main mechanism responsible for _______
atelectasis
