Pulm Block 2 Flashcards
What is the trifecta of issues smoke inhalation has on the body?
Why is this type of injury so deadly?
What type of injury affects the whole airway
Thermal to upper airway
Impaired tissue oxygenation
Chemical to lower airway
CO binds to Hgb 250x easier than O2, leading cause of poisoning death worldwide
Steam
Smoke inhalation that causes thermal injury to the respirator tract can create ? sound to be heard during PE due to what characteristic injuries
How long can it take for these complications to show and why?
Cyanide poisoning inhibits ? enzyme causing Pts to present w/ ? Sxs
Inspiratory stridor due to bronchospasm/bronchorrhea
18-24hrs later
Neutrophilic inflammation causing edemal/ulceration
Cytochrome- shock, lactic acidosis, coma
What finding would be indicative PT has cyanide poisoning?
How are PTs w/ thermal injury smoke inhalation injuries Tx?
What secondary illnesses are present at specific times after the initial injury?
Inc venous O2 saturation
High humidity O2 Elevate head to 30* ABG/PO2 monitoring Topical Epi- reduces edema/ Suction, gentle
ARDS: 1-2 days
Pneumonia: 5-7 days
What Tx/management step is added to PTs w/ chemical injury to their airways from gases/products of combustion?
What two Tx types are avoided in these PTs?
PEEP for bronchiolar edema
Daily sputum Gram stains
CCS
ABX
Even if PTs w/ severe body burns and smoke inhalation survive, they need constant f/u monitoring for the development of ? which appears as ?
Bronchiolitis Obliterans
CT shows ground glass, bronchial wall thickening and honey comb appearance
Define Pneumoconioses
How do these PTs present?
How are they Tx?
Chronic fibrotic lung Dzs from inhalation of inorganic dusts
ASx w/ diffuse nodular opacities on CXR
Life shortening Dz w/ supportive Tx
What causes coal dust to be absorbed and turned into Black Lung Dz
What are the growths seen on CXR called?
Alveolar macrophages ingest dust and consolidate in upper lung areas
Coal macules: 2-5mm in upper fields
What is the difference between Simple and Complicated Coal Worker’s Dz?
Complicated Dz complications are similar and seen in ? other pneumoconiosis Dz?
Simple: ASx
Complicated: massive fibrosis w/ irregular masses >1cm w/ upper lung contractions
Complicated silicosis
What causes Silicosis lung dz?
How does this Dz on CXR?
Quarries/mines of quartz, granite, sandstone
Small round opacities
Calcification of hilar lymph nodes- eggshell calcifications
How does Simple Silicosis present?
How does Complicated Silicosis present?
ASx
Normal PFTs
Irregular masses >1cm
Inc upper lung densities
Obstruct/Restrictive PFTs
Silicosis PTs have an increased risk of contracting ? lung infection
Why is there this increased risk?
Infections requiring macrophage defenses: Fungi Atypical mycobacteria TB
Silica is cytotoxic to alveolar macrophages
All silicosis PTs need to have updated/on records results of ? 2 things?
How does asbestosis present?
TB skin test
CXR
Dyspnea
Inspiratory crackles
Clubbing/cyanosis
How does Asbestosis appear on CXRs?
What CXR finding holds the best Dx value?
Linear streaks in lower fields
Various size opacities
Honey comb changes if advanced Dz
Pleural calcifications
What image modality has the best imaging ability of asbestosis?
What does this imaging allow providers to see?
High Res CT
Parenchyma fibrosis
Pleural plaques
What would be seen on PFT in a PT w/ asbestos
What is done for these PTs as Tx?
Restrictive pattern
Reduced FVC and FEV1
Normal/Inc FEV1/FVC ratio
Reduced DLCO
O2 for SoB
Resp PT to remove secretions
Hypersensitivity Pneumonitis is AKA ?
What type of d/o is this?
Extrinsic Allergic Alveolitis
Inflammatory d/o involving alveolar walls and terminal airways
What causes Hypersensitivity Pneumonitis
What causes Bagassosis
Exposure to inhaled organic agent leading to an acute illness
Moldy sugar cane fiber
What causes Sequoiosis
What causes Suberosis
What causes Detergent Worker’s lung
Moldy redwood saw dust
Moldy cork dust
Enzyme additives
How does acute Hypersensitivity Pneumonitis present?
What will be seen on PE?
What would be seen on lab results?
What will be seen on CXR
What would be seen on PFTs?
Sudden F/C/N
Dyspnea
Crackles, Tachy/Tachy
Neutrophilia/L shift
Inc ESR/CRP
Nodular densities except in Apex/Bases
Restrictive dysfunction
Reduced DLCO
How does Subacute Hypersensitive Pneumonitis present
What is seen on CXRs
How is if definitively Dx?
Wks-Mon of:
Chronic cough
Dyspnea, Anorexia/Wt loss
Fibrosis/honey comb
Lung biopsy
How is Hypersensitive Pneumonitis Tx
What are the 3 types of obstructive airway d/os?
Acute- self limiting/recovery
Severe/protracted: PO CCS w/ 4-6wk taper
Byssiniosis
Industrial bronchitis
Occupational asthma
Define Industrial Bronchitis
This respiratory Dz rarely ?
Chronic bronchitis seen in coal miners, exposure to cotton, flax or hemp
Leads to chronic disability
Define Byssinosis
How does it present?
What happens if exposure is not d/c?
Asthma like d/o in textile workers from inhalation of cotton dust
Tight chest, Cough, Dyspnea- worse on 1st day back to work, better later in week
Chronic bronchitis
Define Silo-Fillers Dz
What is a common finding late in this Dz
Toxic lung injury causing pulmonary edema due to inhalation of N-dioxide
Bronchiolitis obliterans