Pulmonary Flashcards
ARDS (acute respiratory distress syndrome): definition
Inflammatory lung condition caused by direct or indirect injury to lungs (infection, trauma, HoTN)
ARDS: Dx criteria
Acute onset of:
- bilateral diffuse infiltrates caused by non-cardiogenic pulmonary edema/pulmonary capillary leak
- PAWP/PCWP , 19 mm Hg (no evidence of left atrial HTN)
- PaO2/FiO2 ratio of = 300 mm Hg
ARDS: initial ventilator management strategy
Initial: Vt= 8 mL/kg
Reduce to ideal Vt of 6 mL/kg (1 mL/kg reduction intervals at every = 2 hrs)
Acute asthma relievers (rescue)
SABA: - Albuterol (Proventil) - Pibuterol (Maxair) - Levalbuterol (Xopenex) Note: Also use 15-30 min before activity to prevent exercise-induced bronchospasm
Asthma controller meds: Inhaled corticosteroids (ICS)
- Fluticasone (Flovent)
- Mometasone (Asmanex)
- Budesonide (Pulmicort)
- Beclomethasone (QVAR)
- Ciclesonide (Alvesco)
Note: Preferred controller Tx for persistent asthma, requires consistent, daily use for optimal effect
Asthma controller meds: Inhaled corticosteroids/long-acting beta2-agonist (ICS/LABA)
- Budesonide + formoterol (Symbicort)
- Fluticasone + salmeterol (Advair)
- Mometasone + formoterol (Dulera)
Note: Only use in Pt whose asthma is not well controlled w/ an ICS alone
Asthma controller meds: Leukotriene receptor antagonist, leukotriene modifiers
- Montelukast (Singulair)
Note: Additional benefit w/ allergic rhinitis, most often used in conjunction w/ ICS
Asthma reliever meds: Aggressive Tx of inflammation during asthma flare
Systemic corticosteroids:
- Prednisone 40-60 mg/d x 3-10 days
Warning Sx of impending respiratory arrest
- Drowsiness or confusion
- Paradoxical thoracoabdominal movement
- Absence of wheezing
- Bradycardia
- Absence of pulsus paradoxus
- Initial PEF or FEV1 < 25% of personal best/predicted value
Obstructive pulmonary Dz: definition, examples
Limitation of air flow (reduced airflow rates) COPD Emphysema Bronchitis Asthma
Restrictive pulmonary Dz: definition, examples
Limitation of lung expansion (reduced volumes) ARDS Pneumonia Bronchiolitis Idiopathic pulmonary fibrosis
Chronic bronchitis: definition
Coughing with excessive mucus production for at least 3 or more months for a minimum of 2 or more consecutive years.
It has increased Hct
Emphysema: definition
Permanent alveolar damage and loss of elastic recoil result in chronic hyperinflation of the lungs. Expiratory respiratory phase is markedly prolonged.
It has increased AP diameter and hyperresonance to percussion
COPD medication: Category A (GOLD 1-2)Minimally symptomatic COPD (low risk of exacerbation)
Short-acting B2 agonist (SABA) PRN alone or in combination SABA with short-acting anticholinergic (more effective).
COPD medication: Category B (GOLD 1-2)More symptomatic (low risk of exacerbation)
Long-acting B2 agonist (LABA) or long-acting anticholinergic (newer name is long-acting muscarinic agent (LAMA). May use SABA for rescue PRN.
SABA: albuterol
LAMA: tiotropium bromide
COPD medication: Category C (GOLD 3-4)Minimally symptomatic (but high risk of exacerbation)
LAMA is first line. If poor control, use combination LABA and LAMA. Alternative is LABA with inhaled glucocorticoid, methylxanthines (theophylline).
LABA: salmeterol
LAMA: tiotropium bromide
COPD medication: Category D (GOLD 3-4)High risk
PDE-4inhibitor (only pulmonologist can Rx this); refer to pulmonologist
COPD exacerbations: definition
Acute event characterized by worsening of the Pt’s respiratory symptoms that is beyond the day-to-day variations and leads to a change in medication. Usually 2/2 respiratory tract infection.
- Outpatient Tx is usually sufficient
COPD exacerbations: Indications for hospital admission
- Marked increase in intensity of symptoms
- Acute respiratory failure
- Onset of new physical Sx
- Failure to respond to initial medicinal management
- Presence of serious comorbidities (e.g. HF)
COPD exacerbations: indications for ICU admission
- Severe dyspnea not responding to initial Thx
- Change in mental status
- Worsening hypoxxemia (PaO2 < 40 mm Hg)
- Worsening acidosis (pH < 7.25)
- Invasive mechanical vent
- Hemodynamic instability
