PULM/CRIT-CARE Flashcards
When should you prone pts?
Prone positioning for 12 hours daily in pts with ARDS and arterial PO2/FIO2 <150 mm Hg, FIO2 ≥0.60 on PEEP>5 cm H2O, who have been intubated for less than 48 hours.
Tx for hospitalized patients suspected of having obesity hypoventilation syndrome?
Noninvasive ventilation with either bilevel positive airway pressure or volume-targeted pressure support.
Indication for Roflumilast?
Selective phosphodiesterase-4 inhibitor reduces symptoms & exacerbations in patients with severe COPD who have a chronic bronchitis phenotype or frequent exacerbations.
Transjugular intrahepatic portosystemic shunt (TIPS)?
After attempts in hemostasis via pharmacologic and endoscopic, helps in managing acute variceal bleeding and preventing recurrent variceal hemorrhage.
Why to avoid over transfusing pt Hgb > 10 in portal hypertension and acute gastrointestinal bleeding?
Rapidly increases portal pressure, putting the patient at significant risk for rebleeding.
What is recurrence prevention?
Catheter thoracostomy followed by pleurodesis in the second episode of pneumothorax on the same side in primary spontaneous pneumothorax and after the first occurrence in secondary spontaneous pneumothorax.
Treatment of nonexertional heat stroke?
Evaporative cooling (with water mist and fans) with or without ice packs to lower the core temperature to a safe temperature, usually 38.5 °C (101.3 °F).
Don’t use ice water immersions.
Low risk for malignancy nodule?
Smaller than 6 mm in size requires no further follow-up.
Tx of COPD?
Regardless of COPD severity, β2-agonists and anticholinergic/antimuscarinic agents are the mainstay of therapy.
Initial management of COPD?
SABA, but a LABA or LAMA should be added if symptoms remain poorly controlled.
How to tx pts with smoke inhalation?
Bronchoscopy, and chest physiotherapy are frequently necessary to facilitate continued airway clearance.
Workup if V/Q scan abnormal in suspicion of chronic thromboembolism pulmonary HTN?
Right heart catheterization and pulmonary angiography.
Inadequately controlled mild persistent asthma on an inhaled glucocorticoid?
Start combined therapy with a low-dose inhaled glucocorticoid and LABA in a single inhaler.
Azithromycin & COPD?
Long-term macrolide therapy reduces the frequency of exacerbations in patients with severe COPD and a history of frequent exacerbations.
Tx of malignant pleural effusion in patients with expandable lung ?
Indwelling pulmonary catheter or chemical pleurodesis with talc.
Neuroleptic malignant syndrome?
Fever, AMS, muscle rigidity, and dysautonomia and is seen with both first-generation antipsychotics and newer atypical antipsychotics and antiemetics.
Tx of neuroleptic malignant syndrome?
Stopping drug, active cooling, and supportive care.
ARDS?
1 week of known ARDS insult; bilateral opacities on chest imaging consistent with pulmonary edema; respiratory failure not related to cardiac failure or volume overload; and arterial Po2/FIO2 ratio less than 300 on at least 5 PEEP
Tx of VTE in pregnancy?
LMWH
Tx of idiopathic pulmonary fibrosis?
Pirfenidone or nintedanib decreases the rate of progression of idiopathic pulmonary fibrosis but is not curative. Lung transplantation is a life-prolonging therapy for those without comorbidities that may otherwise limit life expectancy.
Chlyothorax?
Triglyceride level greater than 110 mg/dL (1.24 mmol/L), and it is typically a lymphocytic predominant exudative effusion. Usually atraumatic cause is malignancy.
Tx of high-altitude pulmonary edema?
Reducing the pulmonary artery pressure; the patient should be given supplemental oxygen and advised to descend to a lower altitude as soon as possible and to limit physical exertion and cold exposure.
Sepsis & fluids?
30 mL/kg of intravenous crystalloid fluid be given within the first 3 hours. (LR)
Pulmonary nodule 6 mm or larger?
Follow-up chest CT at 6 to 12 months; if it persists but is unchanged in size, CT should be repeated at 2-year intervals for 5 years.
Diagnose a complicated parapneumonic effusion.
Pleural fluid pH level of less than 7.2 (or glucose <40 mg/dL) is the best indicator of a complicated pleural effusion that requires drainage.
Tx of exercise-induced bronchoconstriction?
Daily inhaled glucocorticoid plus a SABA or low-dose budesonide-formoterol before exercise.
Ideal patients for lung volume reduction therapy?
Upper-lobe-predominant emphysema, FEV1 and DLCO of 20% of predicted or higher, and low exercise tolerance after completion of pulmonary rehabilitation.
Indications for hemodialysis in the setting of ethylene glycol or methanol toxicity?
Severe anion gap metabolic acidosis and end-organ involvement (kidney impairment, visual changes).
Scoring system for ICU care?
National Early Warning Score (NEWS), systemic inflammatory response syndrome (SIRS), and Modified Early Warning Score (MEWS)
Pulmonary embolism EKG?
S1Q3invertedT3 pattern, right ventricular strain, and new incomplete right bundle branch block.
Test for cystic fibrosis?
Sweat chloride testing, with genetic testing confirming the diagnosis
Hydrocortisone in septic shock?
Dosage for refractory septic shock varies from a maximum of 200 mg to 400 mg daily.
Montelukast side effect?
Discontinued in patients with symptoms suggestive of depression. Anaphylaxis, angioedema, dizziness, dyspepsia, muscle weakness, and elevated transaminases
Lines in hemorrhagic shock?
2 peripheral IV lines: 18 gauge. Rapid and large-volume fluid administration = short and has a wide-diameter lumen will maximize flow rates.
Cholangitis?
Fever, jaundice, and right-upper-quadrant abdominal pain. Tx: Common bile duct stones should be removed urgently with ERCP and then elective cholecystectomy
Pancreatitis?
2/3 Criteria: (1) acute-onset abdominal pain characteristic of pancreatitis (severe, persistent for hours to days, and epigastric in location, often radiating to the back); (2) serum lipase or amylase levels elevated to three to five times the upper limit of normal; and (3) characteristic radiographic findings on contrast-enhanced CT.
Serotonin syndrome?
AMS, hyperthermia, diaphoresis, tremor, autonomic instability, muscle, and ocular clonus, and hyperreflexia. Tx: agitation with lorazepam IV»_space;> cyproheptadine
FEV1/FVC normal?
> 70%
FEV1 normal?
> 80%
DLCO normal?
> 75%
Why steroids in COPD exacerbations?
Improve FEV1 and hypoxia; decrease the need for hospitalization when used early; and decrease the frequency of treatment failures, length of stay, and time to subsequent exacerbations.
Tx: prednisone 40 mg/d for 5 days
Malignant hyperthermia?
Response to inhaled anesthetic agents or depolarizing paralytic agents such as succinylcholine, resulting in muscle rigidity, rhabdomyolysis, cardiac arrhythmias, and significant core body temperature elevation.
Tx of malignant hyperthermia?
Discontinuing the triggering agent, active cooling, and administration of the muscle relaxant dantrolene.
Rhabdomyolysis?
Elevated serum creatine kinase, potassium, and phosphorus levels and myoglobinuria
Central sleep apnea?
Pauses in breathing due to a loss of output from the central respiratory generators in the brainstem to the muscles that make up the respiratory pump. Associated with heart failure, atrial fibrillation, and opioid use.
Sleep test: crescendo-decrescendo pattern of airflow
Criteria for intubation?
Is patency or protection of the airway at risk?
Is oxygenation or ventilation failing?
Is a need for intubation anticipated (ie, what is the expected clinical course)?
Indications: significant hypoxia, inability to ventilate properly, and airway compromise.
COPD pts failing adequate oxygen?
Try BIPAP for 2 hours if still not improving then intubate.
Annual lose dose CT?
Age 50 through 80 years who have no symptoms of lung cancer, have at least a 20-pack-year smoking history, and are current smokers or have quit within the last 15 years.
Radiation pneumonitis?
Cough, shortness of breath, and radiographic infiltrates 4 to 12 weeks after radiation exposure.
When to start parenteral nutrition in critically ill pts?
After 7 to 10 days of inability to achieve more than 60% of energy and protein requirements by the enteral route alone.
CO poisioning?
Confusion, headache, and nausea/vomiting; more severe poisoning may result in seizures, coma, and death.
