Pulm

Question 1

Hypoxia DDx

Answer 1

Airway Problems: Kinked, maintsem, extubated, laryngospasm, plugged
Ventilation: hypovent, pneumo, hemo thorax, pleural effusion, bronchospasm
Diffusion: Pulm edema, aspiration, PNA
Perfusion: PE, low CI, hypovolemia
VQ Mismatch - pulm/cardiac shunt
O2 deliv - methemoglobinemia, anemia, CO/CN toxicity, equipment failure

Question 2

Wheezing

Answer 2

Kinked ETT
Bronchospasm
Endobronchial Intubation
Aspiration
Pulmonary edema
LH Failure
AFE
Thromboembolic Phenomenon/PE

Question 3

OSA Eval

Answer 3

Snoring
Tiredness daytime
Observed Apnea
Pressures elevated (HTN)
BMI > 35
Age > 50
Neck circ > 40cm
Gender (male)
>/= 3 risk = high risk, > 5 mod/severe OSA

Question 4

Difficult Intubation Predictors

Answer 4

Dec intra-incisior distance
Inability to prognath the jaw
LImited neck mobility
Decreased TM distance
Neck circ > 16in
Hx Radiation therapy or previous diff a/w
Voice changes
Mallampati III

Question 5

Aspiration Prevention

Answer 5

Metoclopramide - increase emptying
H2 blocker - dec acid secretion
Non particulate Antacid (sodium citrate)
Preoxygenation
Reverse Trendelenburg
Cricoid Pressure

Question 6

Difficult Mask Predictors

Answer 6

BMI > 45
OSA
Beard
Lack of Dentition
Age > 55
Malampati III
Male
Airway masses

Question 7

Awake Intubation Airway Blocks

Answer 7

Glossopharyngeal - post 2/3 tongue, vallecula, ant surface epiglottis - spray, soaked pledgets, injection/infiltration
Superior Laryngeal - BOT, post epiglottis - infiltrate at thyrohyoid membrane OR -pledgets in piriform fossa
Recurrent Laryngeal - Transtracheal block

Question 8

PFTs

Answer 8

FEV/FVC and FVC - normal = normal
FEV1/FVC and FVC dec - obstructive
FEV 1/FVC normal but FVC dec - restrictive

Question 9

Smoking Preop Optimization

Answer 9

Quit 8 weeks - shifts oxy curve to right (nonsmokers)
Quit 4 weeks - dec post op pulmonary complications
Quit anytime - dec CO, nicotine levels, mucus production, airway reactivity

Question 10

Extubation Criteria

Answer 10

Objective
- adequate tidal volumes
- complete paralysis reversal
- awake/following commands
- hemodynamic, metabolic, temperature homeostasis achieved
Clinical - case specific to operation

Question 11

Hypercarbia Ddx

Answer 11

Tourniquet/Cross clamp release
MH
Sepsis
Thyrotoxicosis
Fever
Metabolic Acidosis
Decreased minute ventilation
Faulty valves - rebreathing of CO2
Bicarbonate administration, laparoscopic insufflation

Question 12

ARDS Treatment

Answer 12

Mechanical Ventilation - low tidal volumes, permissive hypercapnea, high PEEP to reduce lung injury

Prone Positioning

Fluids - avoid overload/pulmonary edema. diuretics use

Medications - sedation/paralytics PRN, antibiotics