Pulm

Question 1

Criteria for ARDS

Answer 1

1. cause
2. acute onset
3. PAWP <18
4. b/l infiltrates on CXR
5. PaO2/FiO2 <200

TRALI clinically indistinguishable from ARDS, also has fever, chills

Question 2

Hypoxemia + PIP dec cause

Answer 2

air leak/cuff leak
disconnect
hyperventilation

Question 3

Hypoxemia + PIP inc + pPlat unchanged

Answer 3

Airway resistance problem

• aspiration
• bronchospasm
• secretions obstructing airways
• tracheal tube obstruction/kinked ETT

Tx = suction, bronchodilator

Question 4

Hypoxemia + PIP inc + pPlat increased

Answer 4

Dec compliance problem

• PTX
• atelectasis
• acute pulmonary edema
• PNA or ARDS
• abdominal distention/insufflation
• asynchronous breathing
• auto-PEEP

Question 5

Tx status asthmaticus

Answer 5

supplemental O2
Albuterol
Aminophylline (adenosine antagonist, PDE inhibitor)
Corticosteroids
Mag sulfate
Assess adequacy of oxygenation, ventilation (PaCO2 <50) - ABG, any respiratory fatigue –> intubation

Question 6

How would you evaluate pulmonary function in CF patient?

Answer 6

H&P progression and treatment of CF
Recent episodes of infections, resp failure, or intubation?
Quantity and quality of secretions
Exercise tolerance
Effectiveness of bronchodilators

Question 7

What is the pathophysiology of CF?

Answer 7

Inherited disease leading to abnormal movement of NaCl in and out of cells –> thick, viscous secretions, obstruction and glandular destruction of lungs, pancreas, liver, GI tract

Question 8

What are the sequale of CF?

Answer 8

mucous plugging
Chronic infections –> bronchiectasis
Emphysema, hypoxemia
Dec vit K –> coagulopathy and dec plasma cholinestease

Question 9

How is CF treated?

Answer 9

Prevention of infections
Promotion of drainage
Pancreatic enzyme replacement

Question 10

How would you treat pulmonary edema? Would you intubate this patient?

Answer 10

I would start by identifying and treating the underlying cause.

I would provide ventilatory support with PEEP, consider diuretic.

While mechanical ventilation may be necessary I would start with CPAP

Question 11

How does PEEP help with pulmonary edema?

Answer 11

PEEP recruits collapsed alveoli

Redistributes edema to areas less involved in gas exchange

Question 12

Considerations for lung resection/pneumonectomy

Answer 12

Mass effect

• PNA
• SVC syndrome
• Tracheal distortion/compression
• LEMS, SIADH

ppoFEV1 <40% —> RV failure
Chronic hypoxia —> RV failure