Pulmonary Diseases & Axis, Hypertropy, Enlargement Flashcards
Pulmonary embolism is a blockage of the ________ and is most likely caused by blood clots that travel to the ______ from another part of the body (most commonly the legs). In short, a PE is a complication of a _________.
pulmonary artery lungs DVT
What are the risk factors(3) for PE?
Venous stasis (immobility, reduced flow) Abnormal vessels/wall injury (trauma, phlebitis) Hypercoagulability (polycythemia, sickle cell, smoking, pregnancy)
What are the 9 clinical manifestations of Pulmonary Embolism?
- Acute dyspnea
- Tachypnea (>20 RR)
- Pleuritic chest pain
- Nonproductive cough
- Accentuation of pulmonic valve (S2)
- Rales
- Tachycardia (>100 bpm)
- Fever (38-39 deg C)
- Hemoptysis
What 4 diagnostic tools/test used to detect a PE?
- Perfusion lung scanning (V/Q scan)
- Venous ultrasonography
- Pulmonary angiography
- Spiral CT scan
Perfusion lung scanning (V/Q scan):
Medical imaging using scintagraphy and medical isotopes to evaluate the circulation of air and blood within a pt. lungs, to determine the ventilation/perfusion ratio.
Venous ultrasonography:
Sonogram of the lower extremeties to evaluate DVT (normal results don’t exclude PE)
Pulmonary angiography:
Injection of radiocontrast into circulation with fluoroscopy of the lungs.
Spiral CT scan:
CT slices in a helical pattern for increase resolution
What 5 things should be considered for treating PE?
- anticoagulant (heparin, coumadin)
- Inotropes for hypotension (dopamine, dobutamine)
- Airway management (intubate, MV w/ PEEP)
- Analgesics
- Pulmonary artery embolectomy w/ CPB (massive PE unresponsive to medical management)
Chronic obstructive pulmonary disease (COPD) encompasses__________ and ___________.
Obstructive bronchitis and emphysema
Chronic bronchitis is:
- Cough due to hypersecretion of mucus not necessarily accompanied with airfflow limitation.
- productive cough >3months in duration for >2 successive yrs.
Emphysema is characterized by:
- loss of elastic recoil in the lungs
- airway collapse occurs during exhalation, leading to increased airway resistance
- severe dyspnea with use of accessory muscles
What 4 diagnostic tools can be used to detect COPD?
- Physical exam: tachypnea, prolonged expiration w/ wheezing
- Pulmonary Function tests
- Chest Radiography
- ABG
What are the preoperative, intraoperative, and postoperative anesthetic considerations for COPD patients?
Preoperative: cessation of smoking and eradicate bacterial infections Intraoperative: REGIONAL Anesth for procedures on the extremeties or don’t invade the peritoneum. GENERAL Anesth for upper abdominal & thoracic proc Postoperative:analgesia and lung vol expansion techniques
List 5 other causes for airflow obstruction:
- Bronchiectasis
- Csystic fibrosis (common genetic dz in caucasions)
- Primary ciliary dyskinesia
- Bronchiolitis Obliterans
- Tracheal stenosis
Asthma is characterized by:
Chronic airway inflammation Reversible expiratory airflow obstruction Ariway (bronchial) hyperreactivity
T of F: Asthma is usually reversible.
True
What are the clinical manifestations of asthma?
Wheezing, cough, dyspnea
How do you treat Asthma?
Antiinflammatory drugs: corticosteroids, cromolyn, leukotriene inhibitors Bronchodilator drugs: B-Adrenergic agonists, anticholinergic drugs
What are the preoperative meds for asthma pts?
Bronchodilators: B-adrenergic agonists, anticholinergic drugs Avoid NSAIDs
What anesthetic considerations should you consider for ASTHMA pts during induction and maintenance?
Regional - when operative site is superficial or on extremeties General - adequate depth before DL (fentanyl, lidocaine, propofol-bronchodilating effects)
How do you treat intraoperative bronchospasm?
Increase depth and administer bronchodilator via ETT
What is Restrictive Lung Disease?
A decrease in total lung capacity usually caused by an intrinsic disease that alters the elastic properties of the lungs, causing the lungs to stiffen.
List 4 causes for acute restrictive lung disease (pulmonary edema):
Acute respiratory distress syndrome (ARDS), aspiration, upper airway obstruction, CHF
List 4 causes for Chronic intrinsic restrictive lung disease:
Sarcoidosis, hypersensitivity pneumonitis, drug-induced pulumonay fibrosis
List common causes for Chronic EXTRINSIC restrictive lung disease:
Obesity/ascites/pregnancy, deformities of skeletal structures/sternum, NM disorders (Guillan-Barre syndrome, Myasthenia gravis)
List 3 common causes of restrictive lung disease due to disorders of the pleura and mediastinum:
Pleural effusion, pneumothorax, mediastinal mass
What are the clinical manifestations of Restrictive lung disease?
Decreased VC Dyspnea Hypercarbia / arterial hypoxemia Weakness of expiratory muscles from NM dz