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WI-18 Pulmonary > Red Flag > Flashcards

Red Flag Flashcards

1
Q

transudative pleural effusion etiologies

A

CHF
cirrhosis
nephrotic syndrome
myexedema

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2
Q

exudates pleural effusion cause

A

bacterial PNA
malignancy
PE
trauma

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3
Q

throacentesis in kids

never go below?

A

8th rib space

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4
Q

Relative CI for thoracentesis

A

NO absolute contraindications

  1. Blood dyscrasia (Pt <50k or elevated anticoag study)
  2. Cellulitis or similar complicated skin d/o
  3. Mechanically ventilated
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5
Q

atropine use in pulm proceudres

A

vasovagal event

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6
Q

heparin

A

prevent pleural fluid from clotting

diagnostic purposes

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7
Q

why type of thoracentesis?

diagnostic

A

needle placement

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8
Q

why type of thoracentesis?

therapeutic

A

needle catheter

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9
Q

causes of dry tap

A

Needle is too short (Large body habitus?)
Or you picked wrong location (Air bubbles → Too high, hit parenchyma
If neither air nor fluid → Too low)

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10
Q

blood in pleural fluid cause

A

Trauma, malignancy, infarcted lung, even tTB

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11
Q

MC complication of thoracentesis

A

PTX

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12
Q

“small PTX”

A

< 3 cm

from the thoracic apex to the lung cupola

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13
Q

Thoracostomy CI

A

No absolute CI in unstable patient

If stable: Multiple adhesions, blebs, coagulopathies

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14
Q

where is a needle throacostomy inserted

A

2 or 3 iCS

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15
Q

ET tube size

A

ET tube size = (16 + age)/4

about 8 in men (32 Fr) and 7.5 in women (30 Fr)

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16
Q

tube thoracotomy placement

A

bt 4 and 5 ICS

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17
Q

Max dose lidocaine

+/- epi

A

7mg w/epi
4 mg w/o epi

risk for arrhythmia

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18
Q

lidocaine % dose

A

1% lidocaine, 10 mg per 1 mL

2% lidocaine, 20 mg per 1 mL

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19
Q

Blade used to make skin incision for chest tube

A

11

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20
Q

Surgical expansion after chest tube

Required when

A

an air leak persists > 72 hours or lung fails to completely expand

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21
Q

Milking v. stripping

A

Milk towards chest to break up obstruction/clot

Stripping clamps proximal duct.. Strip away from chest

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22
Q

what amount of blood to consider thoracotomy

A

1-1.5 L blood at time of placement

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23
Q

does a chest tube need ABX prophylactically?

A

NO need

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24
Q

Bronchoscopy

A

Performed w/ procedural sedation, often in OR suite

Allows access to third order bronchi

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25
Q

Reasons for diagnostic bronch (3)

A

Eval PNA
Persistent atelectasis
Hemoptysis

26
Q

Epi dose 1:20,000

A

For endobronchial bleeding in bronchoscopy

27
Q

Relative CI for bronchoscopy

A

Tachy/bradycardia, bronchospasm, hypoxemia,

bleeding (Platelet 30-50K for
BAl is preferred… Pt 50K for elective procedure),

and HoTN/HTN `

28
Q

Complication of bronch

A

Rarely…. Pretty safe

MC complications from sedation (mild transient HoTN, N/V, arrhythmia)

29
Q

Upper airway

A

level of larynx (surrounded by thryroid gland/cartilage, cricoid)

30
Q

lower airway

A

trachea to lungs

31
Q

LEMON

A

look (external structures)

Evaluate (3,3,2)

Mallampati Score

Obstruction

Neck (mobility)

32
Q

Vocal cord dysfunction

A

Present with audible wheezes and asthma-like sxs
Paradoxical vocal cord adduction…. Tx speech therapy

May or may not respond to bronchodilators (psychogenic)

33
Q

Laryngospasm

A

Closure of glottis by constriction of intrinsic and extrinsic laryngeal muscles, can completely restrict laryngeal muscles

34
Q

larygngospasm cause

A

Ketamine, secretions, blood, vomitus, any stimulation of the upper airway

35
Q

oropharyngeal airway

A

only useful for those without gag reflex/ unconscious

36
Q

laryngeal airway

A

type of advanced airway

blindly performed (positive airway pressure)

useful for when you can’t visual cords

37
Q

MC BiPAP setting

A

10/5 inspiration/expiration

38
Q

NIPPV benefits

A

Increase lung volume, decrease work of breathing

Less complications

Increase functional residual capacity

Pulmonary fluid redistributed

Preload and afterload are decreased

39
Q

CPAP settings

A

5-15 cm H2O

40
Q

who to NOT intubate

A

cardiac or respiratory arrest

anticipated airway difficulties

41
Q

failed airway

A

3 unsuccessful attempt to intubate

failure to maintain oxygenation

42
Q

induction agents used

A

etomidate
propofol
ketamine

43
Q

Paralytic agents

A

Succinylcholine, Rocuronium, Vecuronium

Only used for the initial RSI (not continued)

44
Q

Propofol

A

Lipophilic, quick on and quick off…..

Risk HoTN, myocardial suppression and vasodilation

45
Q

etomidate

A

hypnotic with NO analgesia

46
Q

ketamine

A

NMDA receptor agonist

maintains respiratory drive and smooth muscle relaxation

Analgesia, dissociative, amnestic

47
Q

ketamine s/e

A 
HTN 
increased Iop 
emergence rxn
laryngospasm 
increased secretions
48
Q

Succinylcholine

A

Depolarizing paralytic agent (MC)

Fast on (60 s) and fast off (2-3 minutes)

Respirations often resume within 12 min

Standard dose: 1.5 mg/kg

49
Q

succinylcholine ADR:

A

hyperkalemia, can cause malignant hyperthermia (Dantrolene)

50
Q

rocuronium

A

non depolarizing paralytic

intermediate duration of action

51
Q

ET tube length

A

Men: 8, Women: 7

Depth: 3x ET tube size marked at teeth

52
Q

mac blade

A

3

curved
less trauma
less airway stimulation

53
Q

miller blade

A

2

straight
lifts epiglottis

54
Q

Preoxygenation before intubation

A

BVM (90-97% O2) and high flow NC, have suction ready

55
Q

Single vs. Double Comet

A

Ultrasound confirmation of correct tube placement:

Appropriate placement → Single comet

Inappropriate placement → Double comet

56
Q

CI for trach

A

No trachs for kids younger than 8-10 years old (Alt: Jet insufflation)

57
Q

suspect B pertussis

A

Cough > 7 days

kids: whooping cough

58
Q

likely PNA if:

A 
HR > 100
Temp >100.4
RR > 24
Age > 64 
no chest exam findings
59
Q

procalcitonin

A

elevated in bacterial infection

60
Q

SARS lab results

A

increased LFTs
thrombocytopenia
lymphocytopenia
prolonged PTT

WI-18 Pulmonary (11 decks)

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