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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
Q

lungs have difficulty EXPANDING; decrease in lung volumes (problem getting in)

A

Restrictive

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26
Q

difficulty in air flowing OUT of lungs; decrease air flow & cant get out

A

Obstructive

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27
Q

amount of air remaining in lungs after MAX expiration

A

residual volume (RV)

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28
Q

total air exhaled quickly after inhaling max volume

A

forced vital capacity (fvc)

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29
Q

amount of air expired during forced vital capacity (FVC) portion of the test but measured in seconds

A

forced expiratory volume (fev1)

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30
Q

after spirometry with bronchodilator; what result will you see with asthma

A

full return to normal FEV1

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31
Q

partial improvement with bronchodilator spirometry may indicated

A

COPD; bronchiolitis

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32
Q

CAP is typically in regular community (adeno, corona)
what are some bacterias?
TYPICAL
ATYPICAL

A

Typical: step pna, h. influenzae, moraxella

Atypical: legionella, mycoplasma, chlamydia

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33
Q

CAP treatment for
healthy:
comorbidities:

A

healthy: macrolide (azithromycin) or doxycycline
comorbidities: levaquin, beta-lactam (augmentin plus azithromycin)

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34
Q

NON ICU management for CAP

A

change IV beta-lactam to ceftriaxone or ertapenemenand IV/PO fluoroquinolone

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35
Q

ICU management for CAP

A

IV beta-lactam PLUS azithromycin or fluoroquinolone

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36
Q

Pseudomonos CAP abx

A

zosyn, cefepime, imipenem, meropenem

37
Q

MRSA or likely hood for CAP abx

A

vanc or linezolid

38
Q

HAP bugs

A

LARGE causes: staph aureus, strep pneumo, pseudomonas, gram - bacilli

39
Q

HAP abx coverage

A

High MRSA: vanc or linezolid
low mortality: zosyn, cefepime, levaquin, imipenem, meropenem
pseudomonas: aztreonam

40
Q

pseudomonas coverage for PNA

A

Zosyn, cefepime, imipenem, meropenem

Can add aztreonam

41
Q

MRSA + PNA abx

A

vanc or linezolid

42
Q

HAP & VAP occur when

A

48 hours after admit/intubation

43
Q

inflamed/irritated airway that swells and narrows

A

asthma

44
Q

asthma is what type of airway disease

A

restrictive (restricting air from entering)

45
Q

3 types of asthma

A
  1. allergy induced
  2. occupational exposure
  3. exercise induced
46
Q

asthma is highest in what population and economic status in USA

A

african american / lower socioeconomic status

47
Q

3 subjective findings of asthma

A
  1. dyspnea
  2. chest tightnesss
  3. cough/wheeze
48
Q

reduced air inhalation sounds
expir wheezing

is an example of

A

asthma

49
Q

severe asthma exasterbation of asthma could have what.2 exam findings

A

minimal breath sounds

use of accessory muscles

50
Q

PFT: reduced FVC with normal/increased FEV1/FVC ratio

A

ASTHMA

51
Q

> 12% increase in FEV1 or FVC post bronchodilator therpay is an indicator of

A

asthma

& bronchodilator responsiveness

52
Q

symptoms <3days/week and <2 awakenings/month = intermediate asthma

A

patient just needs a rescue/ SABA

53
Q

biggest difference mild persistant versus intermediate asthma is

A

> 2 days/week and >2 days awakening/month

low dose ICS and SABA PRN

54
Q

when do you intubate an asthmatic patient (3)

A

no breath sounds; fatigue; AMS

55
Q

patients at this stage need to see a specalist and consider biologics (xolair)

A

STEP 5 SEVERE PERSISTANT

56
Q

systemic miliary TB can cause several multi system organ issues such as

A 
sterile pyuria ( high wBC in urine)
meningitis
pott disease (lumbar vertebrae)
addisons disease
hepatitis
lymphadenitis in neck
57
Q

testing for TB includes

A

PPD (skin test) (exposure at some point)
IGRA (exposure; more specific)
CXR

58
Q

symptoms of TB

A

fever
night sweats
weight loss
hemoptysis

59
Q

Latent TB is treated with

A

isoniazid

60
Q

active TB drugs

A

Rifampin
Isoniazid
Ethambutol
Purazinamide

61
Q

drug resistant TB strains

A

MDR-TB

XDR-TB

62
Q
A
63
Q
A
64
Q
A
65
Q

4 causes of pneumo

A

spontaneous
trauma
iatrogenic (line placement)
pathology

66
Q

dx of pneumothorax

A

no lung markings on XR

line through lung

67
Q

pneumo management: no treatment guidelines

A

no SOB & <2cm

follow up CXR

68
Q

pneumo management: treatment guidelines

A

SOB / > 2cm
aspiration x 2
then chest drain

69
Q

trauma to the chest wall that creates a one way valve lets air in and doesnt let air out of pleural space

A

tension pneumo

70
Q 
WHAT AM I 
tracheal deviation
decreased air entry
increased resonance
increased hemodynamic instablity (tachy, low BP)
A

tension pneumo

71
Q

tension pneumo treatment

A

insert a large bore cannula into the 2 ICS in the mid clavicular line

  • way for air to get out
  • dont wait
72
Q

3 land marks for CT insertion

-triangle of safety-

A

5th ICS
Mid-Axillary line
Anterior Axillary line

73
Q

difficulty breathing, fatigue, weakness, chest pain, dizziness, and syncope are initial symptoms of what

A

PAH

74
Q

disorders taht may cause PAH

A

BMPR2 disorder
scleroderma
left to right heart shunts
portal HTN

75
Q

be sore to do WHAT when your patient has PAH

A

test for other underlying causes

76
Q
A
77
Q

most common symptom of a PE

A

shortness of breath

78
Q

If a PE is suspected it is best to

A

act quickly
image
anticoagulate (check contradictions)

79
Q

indefinite anticoagulation should include

A

patients with unprovoked PE, persistent risk facts, & repeat PEs

80
Q

pleuritic chest pain, hemoptysis are s/s of what PE

A

infarction

81
Q

hypoxemia, hypocpapnia, resp aklalosis s/s of

A

PE and abnormal gas exchange

82
Q

RHF symptoms (fatigue, lighthead, SOB) are s/s of what

A

CV compromise with PE

83
Q

-IUM are what drugs

A

LAMA (triotropium/spiriva)

84
Q

Lowest symptom COPD patients are started on ?

A

Bronchodilator

Albuterol

85
Q

-OL ending drugs are

A

LABAS (sameterol)

86
Q

Other than bronchodilator, COPD starting drugs are

A

LAMA

87
Q

Other than bronchodilator, asthma starting drugs are

A

ICS

88
Q

Drugs ending in -ONE

A

ICS

89
Q

Medicare home o2 requirements

A

Pa02 < 60 or Sa02 89% or less

Acute Care 5460 (3 decks)

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