pulm 1 final test Flashcards
survive
upper airway obstruction-
definition-
sentinel signs-
causes -
blockage of the airway above the thoracic inlet
sentinal signs- stridor, suprasternal retractions, and change in voice
causes- tongue, trauma, foreign body, burns, infection-
upper airway obstruction H/P C/O
complains of difficulty breathing and unable to swallow, pain, stiffness, drooling.
upper airway obstruction H/P exam
anxious, altered mental status, panic, cyanotic, dyspneic, gasping for air, wheeze, stridor, unresponsive
upper airway obstruction eval and management
diagnostics-
management
diagnostics- direct visualization, chest x-ray, PFT
management- Treat life threatening symptoms first
dc foreign body
trache if airway is compromised.
aspiration - causes and complications
causes- chemical exposure, eosinophillic esophagitis,
complications- lung injury, pneumonia, ARDS, parapneumonic efffusion, empyema, lung abcess, bronchopleural fistula.
OSA- definition and causes
symptoms of nocturnal breathing disturbance or =======daytime sleepiness, ========fatigue despite adequate rest.
5 or more episodes of obstructive apnea or hypopnea per hour of sleep during a sleep study.
OSA risk factors
obeisity, male, family history, genetics, adenotonsillar hypertrophy, menopause, endocrine disorders.
OSA complications
poor QOL
HTN
Increased risk of CAD, CHF, dysrymias, stroke and DM,
OSA Diagnostics
sleep study- polysomnogram breathing 02sat body position and cardiac rythm MRI,CT,Fiberoptic endoscopy, ABG
Class I
uvula, fauces, soft palate, pillars are visable
class II
cant see pillars
class III
base of uvula visable, soft palate visable
Class VI
only hard palate visable
Apnea definition -
cessation of air flow for >10 seconds
hypopnea
> 30% reduction in airflow for at least 10 seconds with a >3% desat or arousal
resp effort related arousal:
partial obstructed breath, increasing effort, punctuated by an arousal.
flow limit breath
partially obstructed breath. flattened or scooped out inspiratory flow.
AHI
number of apnic or hypopnic breaths per hour of sleep.
Resp disturbance index-
apneas + hypopnes+ respiratory effort related arousal per hour of sleep
mild OSA-
AHI 5-14 events per hour
moderate OSA
AHI 15-29 events per hour
severe OSA
AHI >30 per hour
OSA TX
reduce risk factors, manage comorbidities, reduce weight, regulate sleep, treat nasal allergies, increase physical activity, no booze within 3 hours of sleep, minamize sedatives, CPAP, UVPPP
pleural effusion, definition
excess fluid in the plural space, small amount is normal, and is removed by the lymphatic system.
pleural effusion causes
HF, Hepatic hydrothorax, parapneumonic effusion, malignancy, mesothelemia, pulmonary emboli, TB, other infection, Hemothorax.
Transudative pleural effusion
CHF, Cirrhosis, nephrotic syndrome, peritoneal Dialysis, superior vena cava obstruction, myxedema,
Exudative pleural effusion
Malignancy, infection, PE, GI disease, collagen vascular disease, post cabg, sarcoid, asbestos exposure, drug induced, hemothorax.
pleural effusion diagnostics
CXR- fluid appears white
CT scan
US
thoracentisis
pleural fluid assessment- it is exudative if one critera is met
protein/serum protein >0.5
LDH/serum greater than > 0.6
LDH/Serum more than 2/3 of upper limit of normal for serum
pleural effusion management - LV heart failure
needs diagnostic thoracentisis - treat the heart failure
pleural effusion- hepatic hydrothorax
secondary to cirrhosis and ascites, peritoneal fluid moves through microscopic openings in the diaphragm
pleural effusion- parapneumoic efffusion,
theraputic thoracentesis, 2 attempts to drain fluid then needs chest tube or thorascopy
pleural effusion - malignancy
treat cancer, pleurodesis
Pleural effusion- PE
treat PE, and pleural effusion should subside
pleural effusion- - infection
tx underlying cause may need theraputic thoracentesis
pleural effusion- chylothorax
thoracentesis, fluid is milky white, chest tube pluse octreotide
pleural efffusion- hemothorax
chest thorascostomy
empyema - definition
associated with
caused by bacteria entering the pleural space
collection of pus in plural cavity (loculated), usually gram positive.
associated with pneumonia or thoracic surgery/trauma
-chest pain, pleurisy, cough, diaphoretic, night sweats, fever, chills, malaise, dyspnea
empyema dx and management
chest x-ray, ct scan, labs , pleural fluid culture - management is DC pus, and abx
ARDS - characterized by and caused by direct or indirect injury
Rapid onset
hypoxemia
diffuse pulmonary infiltrates,
respiratory failure
exeudative ards
day 0-7 alvoli are damaged, fluid accumulats, interstitial edema ensues, diminished aeration and atelectasis leading ot poor lung compliance.
proliferative ards
day 7-21, most recover but have dyspnea, tachypnea, and hypoxemia.
fibrotic ards
day 21-30 edematous alvoli become fibrotic if lung does not recover.
VAP 3 factors
clinical manifestations
can be MDR or non MDR -
colonization, aspiration, compromised immune system
fever, leukocytosis, increase in secretions, pulmonary consolodiation on physical exam.
VAP management - no risk factors for MDR vs risk factors
no risk 1 abx, risk factors = 3 abx.
TB
caused by -
primary-
secondary
caused by mycobacterium complex
primary TB - clinical illness directly after infection
secondary TB- bacteria is there for years with no infection, reactivated and is likley cavitation, more infectious than primary.
TB management goals,
prevent morbidity and death
prevent transmission
TB drug regimin
at least 2 months of INH 5mg/kg Rifampin 10mg/kg ppyrazinamide 25mg/kg ethambutol 15mg/kg
