pulmonary pt. 4

Question 1

when do they start considering switching from oral intubation to trach?

Answer 1

after 7-10 days of intubation

Question 2

when does terminal vent weaning/withdraw occur?

Answer 2

prognosis is poor
informed patient/family requests it
interventions to save life are futile

Question 3

methods of vent withdrawal

Answer 3

rapid weaning - incremental dec. in PEEP, FiO2, and rate over 10-20 mins
immediate extubation

Question 4

what is the pulmonary manifestation of MODS

Answer 4

acute lung injury

Question 5

what is non-cardiogenic pulmonary edema that disrupts the albeolar capillary membrane?

Answer 5

acute lung injury

Question 6

what is the most severe acute lung injury?

Answer 6

ARDS

Question 7

direcr causes of ARDS

Answer 7

-aspiration
-infectious pneumonia
-lung contusions
-toxic inhalation

Question 8

indirect causes of ARDS

Answer 8

-sepsis
-burns
-trauma
-blood infusions

Question 9

what causes damage in ARDS

Answer 9

fluid in alveoli

Question 10

clinical manifestations of ARDS

Answer 10

REFRACTORY HYPOXEMIA
tachypnea
tachycardia
breath sounds clear -> crackles
restless, agitation
accessory muscle use

Question 11

how to calculate PaO2:FiO2 ratio

Answer 11

PaO2 / FiO2 x 100

Question 12

management of ARDS

Answer 12

prevention / early detection
high levels of FiO2 and PEEP!!
pressure control ventilation, others
NMBAs
antibiotics/steroids
continuous lateral rotation therapy
pronation

Question 13

air in pleural space with lung collapse

Answer 13

pneumothorax

Question 14

difference between open and closed pneumothorax

Answer 14

open has a visible wound

Question 15

assessment findings of pneumothorax

Answer 15

-SOB
-hyperresonance & dec. lung sounds on affected side
-pain
-subcutaneous emphysema
-can cause resp distress

Question 16

treatment for pneumothorax?

Answer 16

chest tube

Question 17

what is a pneumothorax that acts as a one way valve that air can enter but not escape?

Answer 17

tension pneumothorax

Question 18

what does pressure buildup from tension pneumo cause?

Answer 18

displacement of mediastinum and trachea to unaffected side
PMI displaced
neck vein distention

Question 19

treatment of tension pneumo

Answer 19

immediate needle aspiration of air

Question 20

blood in pleural space with collapsed lung

Answer 20

hemothorax

Question 21

assessment findings hemothorax

Answer 21

-hypotension
-dullness
-hypovolemic shock
-diminished breath sounds

Question 22

causes of hemothorax

Answer 22

chest trauma
rib fx
invasive procedures
anticoagulation therapy

Question 23

multiple rib fractures causing unstable chest wall

Answer 23

flail chest

Question 24

s/sx of flail chest

Answer 24

-paradoxial chest expansion
-ability to create negative pressure to draw air in
-dec tidal volume
-pain
-mediastinum shifts with each breath

Question 25

treatement of flail chest

Answer 25

pain control!
esure adequate oxygen/ventilation
mechanical vent in severe cases

Question 26

VTE that lodges in pulmonary vascualture

Answer 26

PE

Question 27

what causes 90-95% of PE

Answer 27

DVT

Question 28

assessment findings of PE

Answer 28

tachypnea & dyspnea
tachycardia
CP
cough/hemoptysis
syncope
clear/diminished lung sounds on affected side
risk/evidence of PE

Question 29

PE diagnosis

Answer 29

CTA (CT angio) (computed tomography angiography)!!!!!
d-dimer
V/Q scan
pulmonary angiography
CXR/echo
EKG changes

Question 30

hemodynamic consequences of PE

Answer 30

pulmonary HTN -> R ventricular failure -> dec. CO -> hypoTN -> shock

Question 31

PE treatment (meds)

Answer 31

anticoagulant
thrombolytic (if unstable)
hemodynamic support (fluid/inotropic agents)

Question 32

PE treatment (interventional)

Answer 32

percutaneous catheter embolectomy
surgical embolectomy
long term anticoagulation
ICV filter placed (if anticoag is contraindicated)