Pulmonary Critical Care - Rob DeShane Flashcards

Question

what causes increased dead space ventilation

Answer 1

COPD interstitial pulmonary disease acute reduction in cardiac output PE acute pulmonary hypertension PPV: namely PEEP

Answer 2

low chest wall compliance (obesity, kyphoscoliosis, ankylosing spondylitis) low lung compliance (ARDS, PNA, fibrosis, atelectasis) hyperinflation (auto peep, high levels of PEEP)

Answer 3

best: ABG capnometry End tidal CO2 measurement transcutaneous COs not as reliable in adults as neonates CXR

Answer 4

may be subtle/non specific tachypnea/bradypnea irregular respiratory pattern: gasping, nasal flaring or use of accessory muscles intercostal retractions/paradoxical respiratory pattern tachycardia/HTN arrhythmias distress/apprehensive Diaphoresis AMG cyanosis

Answer 5

encephalopathy somnolence/coma asterixis seizure/tremors/myoclonic jerks papilledema and congested conjunctiva may be present

Answer 6

pH < 7.35 paCO2 >50mmHg

Answer 7

supplemental O2 non-invasive vent: BiPaP/CPaP mechanical vent

Answer 8

IF PE: systemic anticoag vs catheter directed lytic therapy vs thromboctomy if CHF: diuresis if PNA: aggressive pulmonary hygiene/mucolytics arrest seizure reverse narcotics with narcan

Answer 9

3-4% per 1L of O2

Answer 10

adult respiratory distress syndrome - non-cardiogenic pulmonary edema ---

Answer 11

diffuse inflammatory process involving BOTH lungs lung consolidation likely from systemic activation of circulating neutrophils which will become sticky and adhere to ......... fibrin deposition in the lungs - ultimately lungs filled with inflammatory exudate rather than watery edema fluid

Answer 12

chest trauma/ lung contusion acid aspiration near-drowning inhalation lung injury PNA

Answer 13

pancreatitis DIC cardiopulmonary bypass burns massive transfusion therapy fat embolism sepsis/shock elevated ICP (TBI/ICH)

Answer 14

significant respiratory distress dyspnea, tachypena increase work of breathing and accessory muscle use hallmark: hypoxemia despite high concentrations of inspired O2, evidence of an increased shunt fraction, decreased pulmonary compliance and increased VD ventilation

Answer 15

Berlin Criteria timing: within 72 hours of recognized risk factor and identified within 7 days of disease onset CXR: bilateral opacities consistent with pulmonary edema origin on Pulmonary edema: ARDS may be present in setting of coexisting cardiogenic edema or volume overload in the opinion of treating doc

Answer 16

identify/treat underlying or predisposing cause of ARDS LUNG PROTECTIVE ventilatory support strategy restore/maintain HD function (conservative fluid replacement strategy, vasopressors/inotropes) prevent complication of critical illness ** ASSESS for infectious or not

Answer 17

permissive hypercapnea hypercapnic acidosis may have potential benefits PEEP can have potential profound HD consequences need for NMB/sedating agents

Answer 18

pneumonia and COVID and early moderate to severe ARDS

Answer 19

cough most common less common: wheezing, dyspnea,....

Answer 20

neurological deficits with swallowing difficulties AMS NM disease ....

Answer 21

stridor persistent cough significant dyspnea loud wheezing localized to side of FB absence of breath sounds affected side

Answer 22

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