Pulmonary Emergencies Flashcards
what blood gas abnormalities indicate acute respiratory failure from pulmonary causes?
PaCO2 > 50 with acidosis (pH < 7.25)
PaCO2 > 40 with severe distress
PaO2 < 60 or sat < 90% on 0.4FiO2
What are basic goal tidal volumes with intubation?
7-10mL/kg
Management strategies for acute primary hypoxemia
High-flow supplemental O2
PEEP - cpap or bipap
ETT
Assistad ventilation
Management of primary hypoventilaion
Supplemental O2
support ventilation with oral/nasal pharyngeal airway
bagmask ventilation
How can inspiratory:expiratory ratio be altered to improve obstructive lower airway disease?
increase I:E = extend exhalation time = better elimination of Co2
What doses of morphine can be used for sedation of an intubated patient?
0.1-0,2mg/kg q1-2 hrs
or
0.1mg/kg/hr continuous infusion
What dose of midazolam can be used for sedation in an intubated patient?
0.1-0.2mg/kg q1-2hrs or as continuous infusion
What is a reasonable course of action when aspiration has occurred and it is unclear if the patient is suffering from pneumonitis or pneumonia?
defer antibiotic treatment in favour of careful observation in a well-appearing child and empirically treat only those with tenuous respiratory status or compelling clinical evidence of infection
What are the 2 patterns of aspiration pneumonia?
localized necrotizing bacterial pneumonia, abscess or empyema - anaerobic organisms
large aspirates of acidic contents - aerobics eg. pseudomonas and Staph
Abx for aspiration pneumonia?
Pip tazo or clinda if pen allergic
what investigations should be obtained in a suspected CF exacerbation?
CXR
Sputum culture
chemistries
CBC
How can mild CF exacerbations be treated?
10-14 day course of oral abx covering the usual organisms affecting CF patients - H. flu, staph aureus, pseudomonas, stenotrophomonas, burkholderia cepacia, achromobacter
may need inhaled therapy as well
How should severe CF exacerbations be treated?
IV antibiotics and hospitalization
abx coverage based on prior resp culture results
always double cover for pseudomonas
Why do CF patients get pneumothorax?
mucous plugging and air trapping - increased intrapulmonary pressure and lung structure already weakened from chronic inflammation
What diagnosis is important to consider in CF patients with wheeze?
ABPA (Allergic Bronchopulmonary Aspergillosis)
What are the symptoms of ABPA?
chronic wheeze that is difficult to control decline in pulmonary function chronic cough transient infiltrated on CXR symptoms respond well to oral steroids
What are the diagnostic criteria for ABPA?
elevated total serum IgE
positive skin reactivity to Aspergillus
positive specific serum antibodies to Aspergillus
When is methylpred indicated in management of pulmonary hemorrhage?
allergic, vasculitic, and idiopathic hemorrhage
What is the preferred management for severe pulmonary hemorrhage?
Aggressive fluid resuscitation followed by positive-pressure ventilation with PEEP
What is the biggest risk factor for PE?
central venous catheter
What is the most common ECG finding in PE?
Sinus tachycardia
What ECG changes indicate cor pulmonale?
right axis deviation, new complete right bundle branch block, T-wave inversion in leads V1-V4, dominant R-wave in V1, right atrial enlargement, and the classic “S1, Q3, T3”
What CXR findings are suggestive of PE?
segmental pulmonary infiltrate with an ipsilateral elevated hemidiaphragm
Hampton hump and Westermark sign
For what type of PE is CTA less sensitive?
peripheral subsegmental emboli beyond main, lobar, or segmental pulmonary arteries
What is the treatment of PE?
IV heparin (1st line) IV LMWH (2nd line)
What are the common bacteria found in CF exacerbations?
Staph aureus
Pseudomonas Aeruginosa
Stenotrophomonas maltophilia
Bulkholderia cepacia
Groups at high risk for severe bronchiolitis
Infants born prematurely (<35 weeks’ gestation)
<3 months of age at presentation
Hemodynamically significant cardiopulmonary disease
Immunodeficiency
Indications for admission in bronchiolitis
Signs of severe respiratory distress (eg, indrawing, grunting, RR >60/min)
Supplemental O2 required to keep saturations >90%
Dehydration or history of poor fluid intake
Cyanosis or history of apnea
Infant at high risk for severe disease
Family unable to cope
