Pulmonology

Question 1

severe LActic acidosis in status asthmaticus

Answer 1

stop or reduce the continuous albuterol

- proposed mechanism is albuterol working on N/K atpase with an increase in aerobic glycolysis

Question 2

mechanism of chloride gas injury to lungs?

Answer 2

hydration of chloride gas produced ompontents that at high enough levels can penetrate into alveolar spaces and produce parenchymal lung injury, ROS species are harmful to lung

Question 3

acute eosinophilc pneumonia criteria

Answer 3

febrile illness

• hypxemic resp failure
• diffuse pulmonary opacities
• BAL with >25% eosinophils

Question 4

MAssive hemoptysis classification?

Answer 4

100-600 cc of blood over 24 hour period

Question 5

imaging modalities for massive hemoptysis?

Answer 5

CXR first and then bronchial and intercostal angio if continued for the potential of embolization

Question 6

how does high flow oxygen improve gas exchange?

Answer 6

• high flow rate promotes effective washout of exhaled gases, in what is usually dead space
• ## decrease WOB, relives autpeep

Question 7

WHAT IS DRIVING PRESSURE? AND HOW DO YOU CALCULATE IT?

Answer 7

• the pressure change across the alveolar structures required to deliver a tidal breath
• plateau pressure -PEEP
• ideally in the range of 15-20

Question 8

why is it important to consider driving pressure in ARDS?

Answer 8

• the baby lung model suggests that there are areas of the lung that can be over distended and subject to VILI with normal lung protective TV. DP may be a stronger predictor of VILI than TV/IBW by having DP in a safe range you are minimizing the potential VILI in the at risk alveoli

Question 9

percentage of patients who self extubate in the ICU?

Risk factors?

Answer 9

7%

- low amount of sedation