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Acute Care 5460 > Pulm > Flashcards

Pulm Flashcards

1
Q

3 subjective findings in ARDS (As)

A

Acute dyspnea
Anxiety/agitation
Air Hunger

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2
Q

patho phys of ARDS

A

alveoli damage
increased permeability to alveolar/cap membrane
cytokine increase
surfactant/compliance decrease

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3
Q

3 clues on CXR for ARDS

A

bilateral infiltrates
no clear diaphragmatic borders
white out

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4
Q

ARDS BERLIN diagnostic & range

Dx ARDS

A

Pa02/FiO2
200-300 mild
100-200 moderate
<100 severe

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5
Q

Tx of ARDS with mechanical ventilation

A

FiO2 <65%
lower TV for PIP <30
avoiding high PEEP

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6
Q

WHAT TYPE OF RESP FAILURE
PaO2 =/< 60mmHg
Inability to adequately oxygenate blood
oxygenation defect

A

Hypoxemic

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7
Q

acute lung injury, pulm edema, pneumonia, and R to L shunt without oxygen is a cause of what

A

hypoxemic resp failure

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8
Q

WHAT TYPE OF RESP FAILURE
PCO2 >50mmHg
inability to clear CO2
Ventilation defect

A

Hypercapnic Respiratory failure

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9
Q

obstructive disease, neuromuscular disease, central respiratory drive failure are all causes of what?

A

Hypercapnic respiratory failure

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10
Q

WHAT TYPE OF RESP FAILURE

hypoxemic (<50) and hypercapnic (>60)

A

mixed respiratory failure

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11
Q

what vent management helps with ventilation

A

Respiratory rate and tidall volume for CO2 removal

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12
Q

what vent management helps with oxygenation

A

FiO2 and PEEP

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13
Q

removal of CO2

A

ventilation

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14
Q

delivery of oxygen to tissue

A

oxygenation

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15
Q

how much pressure to hold alveoli open

A

PEEP

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16
Q

total pressure required to overcome airway resistance of elastic properties of chest/wall

A

peak pressure

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17
Q

pressure required to over come elastic recoil of lungs

A

plateau pressure

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18
Q

Peak pressures should be ______

Plateau pressures should be _____

A

PIP 35-40

Plateau: <30

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19
Q

helps overcome resistance of vent circuit/tubes

A

pressure support

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20
Q

Increasing what 2 vent measures will decrease CO2

A

TV and RR

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21
Q

indications for intubation

A

airway protection
resp failure
increased WOB
need for sedation/paralysis

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22
Q

decreased FEV1/FVC ratio =

A

obstructive

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23
Q

reduced FVC with normal FEV1/FVC ratio =

A

restrictive

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24
Q

easy tool for seeing if obstructive vs restrictive

A

plain spirometry

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25
lungs have difficulty EXPANDING; decrease in lung volumes (problem getting in)
Restrictive
26
difficulty in air flowing OUT of lungs; decrease air flow & cant get out
Obstructive
27
amount of air remaining in lungs after MAX expiration
residual volume (RV)
28
total air exhaled quickly after inhaling max volume
forced vital capacity (fvc)
29
amount of air expired during forced vital capacity (FVC) portion of the test but measured in seconds
forced expiratory volume (fev1)
30
after spirometry with bronchodilator; what result will you see with asthma
full return to normal FEV1
31
partial improvement with bronchodilator spirometry may indicated
COPD; bronchiolitis
32
CAP is typically in regular community (adeno, corona) what are some bacterias? TYPICAL ATYPICAL
Typical: step pna, h. influenzae, moraxella Atypical: legionella, mycoplasma, chlamydia
33
CAP treatment for healthy: comorbidities:
healthy: macrolide (azithromycin) or doxycycline comorbidities: levaquin, beta-lactam (augmentin plus azithromycin)
34
NON ICU management for CAP
change IV beta-lactam to ceftriaxone or ertapenemenand IV/PO fluoroquinolone
35
ICU management for CAP
IV beta-lactam PLUS azithromycin or fluoroquinolone
36
Pseudomonos CAP abx
zosyn, cefepime, imipenem, meropenem
37
MRSA or likely hood for CAP abx
vanc or linezolid
38
HAP bugs
LARGE causes: staph aureus, strep pneumo, pseudomonas, gram - bacilli
39
HAP abx coverage
High MRSA: vanc or linezolid low mortality: zosyn, cefepime, levaquin, imipenem, meropenem pseudomonas: aztreonam
40
pseudomonas coverage for PNA
Zosyn, cefepime, imipenem, meropenem Can add aztreonam
41
MRSA + PNA abx
vanc or linezolid
42
HAP & VAP occur when
48 hours after admit/intubation
43
inflamed/irritated airway that swells and narrows
asthma
44
asthma is what type of airway disease
restrictive (restricting air from entering)
45
3 types of asthma
1. allergy induced 2. occupational exposure 3. exercise induced
46
asthma is highest in what population and economic status in USA
african american / lower socioeconomic status
47
3 subjective findings of asthma
1. dyspnea 2. chest tightnesss 3. cough/wheeze
48
reduced air inhalation sounds expir wheezing is an example of
asthma
49
severe asthma exasterbation of asthma could have what.2 exam findings
minimal breath sounds | use of accessory muscles
50
PFT: reduced FVC with normal/increased FEV1/FVC ratio
ASTHMA
51
>12% increase in FEV1 or FVC post bronchodilator therpay is an indicator of
asthma | & bronchodilator responsiveness
52
symptoms <3days/week and <2 awakenings/month = intermediate asthma
patient just needs a rescue/ SABA
53
biggest difference mild persistant versus intermediate asthma is
>2 days/week and >2 days awakening/month | low dose ICS and SABA PRN
54
when do you intubate an asthmatic patient (3)
no breath sounds; fatigue; AMS
55
patients at this stage need to see a specalist and consider biologics (xolair)
STEP 5 SEVERE PERSISTANT
56
systemic miliary TB can cause several multi system organ issues such as
``` sterile pyuria ( high wBC in urine) meningitis pott disease (lumbar vertebrae) addisons disease hepatitis lymphadenitis in neck ```
57
testing for TB includes
PPD (skin test) (exposure at some point) IGRA (exposure; more specific) CXR
58
symptoms of TB
fever night sweats weight loss hemoptysis
59
Latent TB is treated with
isoniazid
60
active TB drugs
Rifampin Isoniazid Ethambutol Purazinamide
61
drug resistant TB strains
MDR-TB | XDR-TB
62
63
64
65
4 causes of pneumo
spontaneous trauma iatrogenic (line placement) pathology
66
dx of pneumothorax
no lung markings on XR | line through lung
67
pneumo management: no treatment guidelines
no SOB & <2cm | follow up CXR
68
pneumo management: treatment guidelines
SOB / > 2cm aspiration x 2 then chest drain
69
trauma to the chest wall that creates a one way valve lets air in and doesnt let air out of pleural space
tension pneumo
70
``` WHAT AM I tracheal deviation decreased air entry increased resonance increased hemodynamic instablity (tachy, low BP) ```
tension pneumo
71
tension pneumo treatment
insert a large bore cannula into the 2 ICS in the mid clavicular line * way for air to get out * dont wait
72
3 land marks for CT insertion | -triangle of safety-
5th ICS Mid-Axillary line Anterior Axillary line
73
difficulty breathing, fatigue, weakness, chest pain, dizziness, and syncope are initial symptoms of what
PAH
74
disorders taht may cause PAH
BMPR2 disorder scleroderma left to right heart shunts portal HTN
75
be sore to do WHAT when your patient has PAH
test for other underlying causes
76
77
most common symptom of a PE
shortness of breath
78
If a PE is suspected it is best to
act quickly image anticoagulate (check contradictions)
79
indefinite anticoagulation should include
patients with unprovoked PE, persistent risk facts, & repeat PEs
80
pleuritic chest pain, hemoptysis are s/s of what PE
infarction
81
hypoxemia, hypocpapnia, resp aklalosis s/s of
PE and abnormal gas exchange
82
RHF symptoms (fatigue, lighthead, SOB) are s/s of what
CV compromise with PE
83
-IUM are what drugs
LAMA (triotropium/spiriva)
84
Lowest symptom COPD patients are started on ?
Bronchodilator | Albuterol
85
-OL ending drugs are
LABAS (sameterol)
86
Other than bronchodilator, COPD starting drugs are
LAMA
87
Other than bronchodilator, asthma starting drugs are
ICS
88
Drugs ending in -ONE
ICS
89
Medicare home o2 requirements
Pa02 < 60 or Sa02 89% or less

Acute Care 5460 (3 decks)

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