Pulmonary Disorders Flashcards
PaO2 < 60, with or without elevation of PaCO2.
ph <7.3
Acute respiratory failure
Slow, shallow breathing, with or without clear lungs
Decreased level of consciousness
Hypercarbic respiratory failure
Fast breathing, adventitious breath sounds, accessory muscle use, cyanosis, agitation
Hypoxemic respiratory failure
CPAP or BIPAP?
Hypoxemic respiratory failure with increased work of breathing
CPAP
CPAP or BIPAP?
Cardiogenic pulmonary edema
CPAP
CPAP or BIPAP? Hypoxemic AND/OR hypercarbic respiratory failure
Bipap
What is IPAP for?
Ventilation (inspectors positive airway pressure)
What is EPAP for?
EPAP, like PEEP , is for oxygenation (exploratory positive airway pressure)
Patient is hemodynamically unstable but O2 sat 99%. Continue NIV?
No. Hemodynamics instability is a contraindication for NIV.
Suspected pneumothorax. Continue NIV ?
No. Suspected pneumothorax is a contraindication for NIV.
Inspiration is easier than exhalation.
Exploratory flow rates are low.
Air trapping and auto-PEEP are common.
COPD
True or false, overcorrexting hypoxemic can decrease the respiratory drive, so you should withhold O2 from severe COPD patients.
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%
PE causes right heart strain. What EKG changes are seen?
Right bundle branch block
STE in v1 and v2
Tall peaked P waves in lead 2
For a patient with PE , when is the best time to start Coumadin?
On the first treatment day (if no contraindication)
What is normal pulmonary artery mean pressure?
20 mmhg
Patient is receiving 50% FiO2 and the PaO2 is 90. What is the p:f ratio?
Does this indicate ARDS? Or ALI?
90/.5=180
ARDS (p:f ratio < 200.)
How does peep treat a shunt?
Helps by preventing alveolar collapse, does not necessarily decrease pulmonary shunting.
Type 2 alveolar cells produce SURFACTANT. When these cells are destroyed because of ARDS, what is the result?
Massive atelectasis, alveolar collapse
Decreased ffunctional residual capacity
Hypoxemia
How does sepsis lead to ARDS?
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. .
How does tidal volume affect the PaCO2 ?
How will this change the ph?
Low tidal volumes will cause an increase in PaCO2.
Increase in PaCO2 will drop the ph.
Should we ever give steroids to ARDS patients?
No!!!!
( no evidence shows that they prevent ARDS, or that short course of high dose steroids are effective in improving outcomes.)
How’s does ARDS lead to MODS?
Lack of oxygen to the tissues causes them to die
