Pulmonary Disorders

Question 1

PaO2 < 60, with or without elevation of PaCO2.

ph <7.3

Answer 1

Acute respiratory failure

Question 2

Slow, shallow breathing, with or without clear lungs

Decreased level of consciousness

Answer 2

Hypercarbic respiratory failure

Question 3

Fast breathing, adventitious breath sounds, accessory muscle use, cyanosis, agitation

Answer 3

Hypoxemic respiratory failure

Question 4

CPAP or BIPAP?

Hypoxemic respiratory failure with increased work of breathing

Answer 4

CPAP

Question 5

CPAP or BIPAP?

Cardiogenic pulmonary edema

Answer 5

CPAP

Question 6

CPAP or BIPAP? Hypoxemic AND/OR hypercarbic respiratory failure

Answer 6

Bipap

Question 7

What is IPAP for?

Answer 7

Ventilation (inspectors positive airway pressure)

Question 8

What is EPAP for?

Answer 8

EPAP, like PEEP , is for oxygenation (exploratory positive airway pressure)

Question 9

Patient is hemodynamically unstable but O2 sat 99%. Continue NIV?

Answer 9

No. Hemodynamics instability is a contraindication for NIV.

Question 10

Suspected pneumothorax. Continue NIV ?

Answer 10

No. Suspected pneumothorax is a contraindication for NIV.

Question 11

Inspiration is easier than exhalation.
Exploratory flow rates are low.
Air trapping and auto-PEEP are common.

Answer 11

COPD

Question 12

True or false, overcorrexting hypoxemic can decrease the respiratory drive, so you should withhold O2 from severe COPD patients.

Answer 12

False

Too much oxygen can decrease respiratory drive
But o2 should not be withheld only bc hypoventilation MAY occur. Cells still need oxygen.
Maintain PaO2 > 60 or SaO2>90%

Question 13

PE causes right heart strain. What EKG changes are seen?

Answer 13

Right bundle branch block
STE in v1 and v2
Tall peaked P waves in lead 2

Question 14

For a patient with PE , when is the best time to start Coumadin?

Answer 14

On the first treatment day (if no contraindication)

Question 15

What is normal pulmonary artery mean pressure?

Answer 15

20 mmhg

Question 16

Patient is receiving 50% FiO2 and the PaO2 is 90. What is the p:f ratio?
Does this indicate ARDS? Or ALI?

Answer 16

90/.5=180

ARDS (p:f ratio < 200.)

Question 17

How does peep treat a shunt?

Answer 17

Helps by preventing alveolar collapse, does not necessarily decrease pulmonary shunting.

Question 18

Type 2 alveolar cells produce SURFACTANT. When these cells are destroyed because of ARDS, what is the result?

Answer 18

Massive atelectasis, alveolar collapse
Decreased ffunctional residual capacity
Hypoxemia

Question 19

How does sepsis lead to ARDS?

Answer 19

It all starts with the inflammatory response. The inflammatory response causes damage to the type 2 alveolar cells. Then the cells are damaged so they cannot produce surfaced. Consequently, there is alveolar collapse, decreased functional residual capacity, decreased compliance, and hypoxemia. .

Question 20

How does tidal volume affect the PaCO2 ?

How will this change the ph?

Answer 20

Low tidal volumes will cause an increase in PaCO2.

Increase in PaCO2 will drop the ph.

Question 21

Should we ever give steroids to ARDS patients?

Answer 21

No!!!!
( no evidence shows that they prevent ARDS, or that short course of high dose steroids are effective in improving outcomes.)

Question 22

How’s does ARDS lead to MODS?

Answer 22

Lack of oxygen to the tissues causes them to die