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Pulmonary critical care Flashcards

0
Q

Causes of respiratory alkalosis

  • sepsis
  • pulmonary embolism
  • pregnancy
A
  • anxiety and pain
  • hypoxia
  • salicylate intox
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1
Q

causes of respiratory acidosis:

  • drug OD
  • CVA
  • asthma
A
  • COPD
  • obesity
  • sleep apnea
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2
Q

PFT
* DLCO reduced in diseases of lung itself

  • when lung volumes are normal, decreased DLCO suggests pulm vasc problem: PE, PAH, vasculitis
A

*high DLCO suggests: pulmonary hemorrhage, L-R shunt, polycythemia

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3
Q

Obstructive lung diseases

A

asthma
COPD
bronchiectasis
cystic fibrosis

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4
Q

Restrictive lung diseases of parenchymal

A

sarcoidosis
pulmonary fibrosis
pneumoconiosis
interstitial lung dz due to drugs or radiation

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5
Q

Restrictive neumuscular diseases

A

Gullain Barre syndrome
myasthenia gravis
muscular dystrophies
diaphragm weakness

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6
Q

Restrictive lung dx due to chest wall stiffness

A

kyphoscoliosis
ankylosing spondylitis
obesity

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7
Q

Methemoglobinemia

*clinical features: central cyanosis, SOA, blood appears BROWM

A
  • causes: benzocaine spray/local anesthesia, dapsone, nitrides
  • tx: IV methylene blue
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8
Q

hypoxia in COPD

indications for oxygen home therapy

A
  • PaO2 of 55 or less
  • saO2 of 88%or less
  • PaO2 56-59 or SaO2 89% or less if edema, P pulmonale on ECG,hematocrit >56%
  • noc sats 88% or less
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9
Q

stages of COPD

all COPD have FEV1/FVC ,70%

A

Mild FEV1 80% or more of predicted
moderate FEV1 50-79% predicted
severe FEV1 30-49% predicted
very severe <30% predicted

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10
Q

Tx exac of COPD

  • keep sats 90-92% and PO2 60-65
  • do ABG 30-60min on O2 to check for CO2 retention or acidosis
  • bronchodilators:ipatropium & albuterol
A
  • abx cover H influenzae, strep pneumonia, moraxela: quinolone, 3rd gen cephalosporin & macrolide
  • steroids IV/po x 2weeks
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11
Q

acute exac COPD - indications for noninvasive ventilation

A
  • moderate-severe dyspnea w use of accessory muscles
  • pH 45
  • RR >25
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12
Q

exac COPD indications for invasive ventilation

  • if they cant tolerate noninvasive ventilation
  • severe dyspnea with RR > 25
A
  • severe hypoxia, severe acidosis pH 60

* impaired mental status, hypotension, shock

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13
Q

Bronchiectasis

  • chara by permanent abnormal dilatation & destruction of bronchial walls
  • PFT: obstructive pattern
  • best dx test: HRCT
A
  • s/s: cough, mucopurulent sputum, dyspnea, hemoptysis, pleuritic CP
  • CXR: dilated & thickened airways, linear atelectasis, mucus plugs
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14
Q

causes of bronchiectasis

  • airway obstr: foreign body aspiration, tumors, enlarged nodes
  • lung infections: M avium, allergic aspergillosis
  • hypogammaglobulinemia,RA, scleroderma
A
  • Kartageners syndrome: bronchiectasis + sinusitis + infertility + situs inversus
  • cystic fibrosis
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15
Q

Cystic Fibrosis

  • CFTR gene mutation, autosomal recessive
  • dx: sweat chloride >60
  • s/s: recur lung infection (#1 pseudomonas), bronchiectasis, clubbing, steatorrhea,infertility, pancreatitis, DM, obstr biliary dz
A
  • Tx: acute tx infection, prevent infections w inhaled tobramycin
  • persistent airway secretions- aerosolized recomb human dnase
  • airway obstr- bronchodilators, steroids, chest physiotherapy
  • pancreatic insuff- pancreatic enzyme
  • severe hemoptysis-bronchial artery embolization
16
Q

causes of acute cough (<3 wks)

A
  • common cold
  • allergic or bacterial sinusitis
  • bordetella pertussis
  • exac of chronic bronchitis
17
Q

causes of subacute cough (3-8 weeks)

A
  • post infection
  • asthma
  • subacute sinusitis
  • B pertussis
18
Q

Causes of chronic cough (>8 wk)

A 
GERD
ACE inhibitors
cough asthma
postnasal drip
chronic or eosinophilic bronchitis
19
Q

factors assoc with increased risk of death from asthma

  • prior intubation or ICU admit
  • 2 or more hosp or 3 or more ER visits in past year
  • low socioeconomic status
  • use of >2 canister of short acting beta agonist/ month
A

Signs of life threatening asthma

  • altered MS
  • paradoxical chest or abdominal movement
  • absence of wheezing
20
Q

Mild intermittent asthma:
-day s/s 2or less times/week, noc s/s 2 or less/month
-tx: prn inhaled short acting beta agonist
Mild persistent asthma:
-day s/s>2/wk, noc>2/month, tx low inhaled steroid+prn beta

A

Moderate persistent:
-daily day s/s, >1/wk noc s/s, tx add low to med dose inhaled steroids + long acting beta agonist
Severe persistent: cont daily s/s, freq noc s/s, add high dose inhaled steroid + systemic steroids

21
Q 
Ventilator settings:
VT 5-10ml/kg  (ARDS 6ml/kg)
RR 8-14
Min vent pressure not >355
FiO2 lowest to maint PaO2 60 or sat 90%
A

Inspiratory flow: 60liter/min (most), COPD 100liter/min
trigger sensitivity -1 to -2cm
PEEP 5-10

22
Q

complications of mechanical ventilation:

-toxicity of oxygen-keep FiO2

A
  • hyperinflation (auto PEEP)
  • vent assoc pneumonia-onset at least 48hrs after on vent, gram -,staph, anaerobes-prevent w head elevation 45 degrees
  • deconditioning of resp muscles
  • stress ulcers-PPI or H2 prophylaxis
23
Q

hyperinflation -auto PEEP

  • decreases venous return, cardiac output, and decr BP
  • increases HR,incr workof breathing,wheezing,expir prolongation
A
  • tx:decrease minute ventilation=>increases expiratory time, increase inspiratory flow, bronchodilators, fluids
  • the need to decrease minute ventilation may require tolerating PCO2 above baseline - permissive hypercapnia
24
Q

Transudate pleural effusions:

  • protein 3 or less, effusion/serum protein ratio .5 or less
  • pleural/serum LDH ratio .6 or less
  • causes:
  • CHF, constrictive pericarditis
A
  • nephrotic syndrome
  • cirrhosis, hepatic hydrothorax, peritoneal dialysis
  • PE, atelectasis
  • myxedema, SVC obstruction
  • hypoalbuminemia
25
Q

Exudate pleural effusion

  • protein >3, effusion/serum protein ratio >.5
  • pleural/serum LDH ratio >.6, LDH >200
  • causes:
  • malignancy
A
  • infection: pneumonia, TB, empyema, intra abd abscess (very high WBC)
  • dresslers syndrome-pleuritis, pericarditis, pneumonitis
  • pancreatitis, esophageal perforation, PE,
  • RA, SLE
26
Q

pleural effusion with low glucose <60

A

bacterial infection
rheumatoid pleurisy
malignancy

GI (10 decks)

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