Pulmonary Flashcards

Question

Aspiration Pneumonitis s/s and treatment:

Answer 1

**_Acute Intrinsic restrictive disorder_** Gastric Acid aspirate is rapidly distributed through the lungs it destroys **surfactant** **producing** **cells** and **injures lung epithelium** 1. Results in capilary permability/atelectesis 2. **s/s:** * arterial hypoxemia (decreased sats) * Tachypnea * Bronchospasm * Pulmonary vascular constriction can causel pulmonary HTN * X-ray shows changes 6-12 hours later 3. **Treatment:** * Increase FiO2 * PEEP * B2 agonists (albuterol) bronchodilation * Bronchoscopy if suspect solid material * generally abx and steroid use is not used

Answer 2

**_Chronic Intrinsic restrictive disorder_** ## Footnote Systemic **granulomas** disorder that leads to **pulmonary** **fibrosis** leading to **cor** **pulmonale** and **pulmonary** **hypertension** * **Laryngeal sarcoid** = Decrease diameter of airway (**smaller** **tube** and **difficult****airway**/intubation) * **Myocardial sarcoid** = heartblocks, dysrhythmias, restrictive cardiomyopathy → cardiac involvement * Liver, spleen, unilateral **optic** and **facial** **nerves** **palsey** 1. Often present w/ **dyspnea**, **cough** & **rapid shallow breathing** 2. Cor pulmonale and pulm HTN are likely 3. Decreased alveolar diffusion capacity 4. Often haveng a **mediasinoscopy** →lymph node biopsy 5. Often times on **corticosteroids**→STRESS DOSE! 6. Check electrolytes; check for hyperclacemia r/t metabolism of granulomas

Answer 3

1. **Chest wall disorders** * decreased lung voume corespond with increased airway resistence 2. **Neuromuscular disorders** - * **Inefective** **cough**/clearance of secretions * prone to **infection**/pneumonia * high risk for **aspiration** d/t ineffective swallowing. 3. **Mediastinal tumors** * ****can compress the pumonary artery, myocardium or SVC * can occulde airway if given a muscle relaxant

Answer 4

1. Acute dyspnea 2. Ipsilateral chest pain 3. Decreased PaO2 4. increased PaCO2 5. **Hypo**tension 6. Tachycardia 7. Uneven/decreased chest wall movement 8. Hyperresonant percussion 9. Decreased or absent breath sounds

Answer 5

1. **AVOID \> T10 level** = loss of accessory muscles * vital esp in spont breathing patients 2. Good to note they don't tolerate sedation well so regional may be **benificial** for post op pain control

Answer 6

1. **Pre-meds:** Titrate pre-meds carefully to **avoid respiratory depression** (lose accessory muscle function easily) * they need high minute vent to compensate for low volumes 2. **Pre-oxygenation** critical d/t reduced FRC & decreased safe apnea time 3. Will have a **shorter apnea time** - work efficiently 4. Use **nitrous** with caution - risk for barotrauma!! 5. May need **etomidate** if CV comorbidities 6. Use short actinng NMB

Answer 7

1. AVOID **nirtrous** due to risk of barotrauma!! 2. Volitile agents have **accelerted** **uptake** * decreased FRC and increased RR 3. **Mechanical ventilation:** 1. USE: **ETT** (LMA not a good choice→loss of accessory mucsle and inability to maintain oxygenation) 2. Decreased Tidal Volume (**4-8 mL/kg**) 3. Increased RR (**14-18 breaths per minute**) 4. Expecct higher peak airway pressures but the goal is to keep \<30 cmH₂O 5. Consider the risk for **barotrauma** → high risk!!! 6. Avoid excessive FiO₂

Answer 8

Assessment: 1. What is their **exercise** **tolerance** & baseline dyspnea 2. Can use PFTs, flow volume loops & ABGs to **grade the severity** of the restrictive disease 3. **Increased risk:** * Decreased **Vital Capacity \<15 ml/kg (70 ml/kg is normal)** * Resting **Hypercarbia** **Optimization** (5 things) 1. Treat any active pulmonary **infection** 2. Improve **sputum** clearence 3. Treat **cardiac** dysfunction 4. IS- to improve respiratory muscle **strength** & stamina 5. **Smoking** cessation

Answer 9

**_Respiratory Criteria for extubation_** 1. PaO₂**\> 60** mmHg 2. SaO₂ \> **90%** 3. PaCO₂ **\<50** mmHg 4. Respiratory Rate breaths/minute 5. Tidal Volume **\> 300** mL (6 ml/kg) 6. Vital capacity **\> 10-15** mL/kg (or SV of 2-3 ml/kg) 7. Full reversal of NMB 8. Return of laryngeal reflexes 9. Adequate LOC & muscle strenght (head lift \>5 sec)

Answer 10

**_Have a lower threshold for:_** 1. Post -op mechanical ventilation 2. Monitoring in a postoperative bed & maybe a slow wean in ICU **_High Risk of Post-op respiratory failure!!_**_{d/t ↓ lung volumes & impaired cough} 1. **Transport** to PACU with supplimental **O₂** 2. treat **pain** adequately, but avoid respiratory depression * regional comes in handy * consiter the **surgical** **site -** thoracis surgery - you don't want splinting but try to avoid atelectasis remember, pts present with: 1. decreasde lung **volumes** and **impaired cough** 2. **rapid** **shallow** breathing pattern 3. abdominal **impingement** of diaphram

Answer 11

1. If the surgery is elective →**CANCEL** **IT!** 2. If **emergency** surgery indicated 1. Use **diuretics** for fluid overload 2. **vasodilators** and **inotropes** for cardiac failure 3. Consider **drainage** of pleural **effusions**/**ascites** pre-op 4. May need an **ICU vent** -(for the propper settings) 5. **AGGRESSIVE** **hemodynamic** **monitoring** * art line, CVP, +/- PA catheter

Answer 12

**BOTH Asthma and COPD** * Inhaled **ß-agonists** (albuterol) - bronchodilation * Inhaled and systemic **corticosteroids** - decrease inflammation * **Mast cell Stabilizers** (Cromolyn) - decrease histamine release * **Phosphodiesterase inhibitors** - bronchodilation via increased cAMP (Thophyline/methyxanthines) **COPD** - **parasympatholytics** - (atropine inhalers) **ASTHMA** - **leukotriene inhibitors** (singulair)