Pulm 9 - acute chest syndrome, asynchrony, GPA

Question 1

2 main indications for exchange transfusion in acute chest syndrome

Answer 1

1. severe hypoxemia (SpO2 ≤85% or PaO2 ≤60); 2. multilobar involvement

Question 2

What is reverse triggering?

Answer 2

mandatory breath causes pt to reflexively inhale (initiating a second breath)

Question 3

What is delayed cycling?

Answer 3

inspiratory time is too long for patient, so they start to exhale while positive pressure breath is still being delivered

Question 4

What does delayed cycling look like on vent pressure waveform?

Answer 4

spike in pressure at the end of breath delivery

Question 5

What does delayed cycling look like on vent flow waveform?

Answer 5

reversal of flow toward the end of delivered breath

Question 6

Proper ETT position relative to the carina

Answer 6

3-6 cm above the carina

Question 7

Cavitary lung disease + peripheral neuropathy

Answer 7

systemic vasculitis (esp. GPA)

Question 8

Name this sign and associated disease.

Answer 8

strawberry gums; GPA

Question 9

1st organ system typically affected by GPA

Answer 9

Upper respiratory tract / ENT

Question 10

Typical demographic for GPA

Answer 10

middle aged males

Question 11

type of kidney injury typical for GPA

Answer 11

crescentic glomerulonephritis

Question 12

96% of GPA is ___-ANCA-positive.

Answer 12

c

Question 13

Tx for GPA

Answer 13

corticosteroids and cyclophosphamide (or rituximab) (+/- PLEX) (c-ANCA –> c-treatments)