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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
Reasons for diagnostic bronch (3)
Eval PNA Persistent atelectasis Hemoptysis
26
Epi dose 1:20,000
For endobronchial bleeding in bronchoscopy
27
Relative CI for bronchoscopy
Tachy/bradycardia, bronchospasm, hypoxemia, bleeding (Platelet 30-50K for BAl is preferred… Pt 50K for elective procedure), and HoTN/HTN `
28
Complication of bronch
Rarely…. Pretty safe MC complications from sedation (mild transient HoTN, N/V, arrhythmia)
29
Upper airway
level of larynx (surrounded by thryroid gland/cartilage, cricoid)
30
lower airway
trachea to lungs
31
LEMON
look (external structures) Evaluate (3,3,2) Mallampati Score Obstruction Neck (mobility)
32
Vocal cord dysfunction
Present with audible wheezes and asthma-like sxs Paradoxical vocal cord adduction…. Tx speech therapy May or may not respond to bronchodilators (psychogenic)
33
Laryngospasm
Closure of glottis by constriction of intrinsic and extrinsic laryngeal muscles, can completely restrict laryngeal muscles
34
larygngospasm cause
Ketamine, secretions, blood, vomitus, any stimulation of the upper airway
35
oropharyngeal airway
only useful for those without gag reflex/ unconscious
36
laryngeal airway
type of advanced airway blindly performed (positive airway pressure) useful for when you can't visual cords
37
MC BiPAP setting
10/5 inspiration/expiration
38
NIPPV benefits
Increase lung volume, decrease work of breathing Less complications Increase functional residual capacity Pulmonary fluid redistributed Preload and afterload are decreased
39
CPAP settings
5-15 cm H2O
40
who to NOT intubate
cardiac or respiratory arrest anticipated airway difficulties
41
failed airway
3 unsuccessful attempt to intubate failure to maintain oxygenation
42
induction agents used
etomidate propofol ketamine
43
Paralytic agents
Succinylcholine, Rocuronium, Vecuronium Only used for the initial RSI (not continued)
44
Propofol
Lipophilic, quick on and quick off….. Risk HoTN, myocardial suppression and vasodilation
45
etomidate
hypnotic with NO analgesia
46
ketamine
NMDA receptor agonist maintains respiratory drive and smooth muscle relaxation Analgesia, dissociative, amnestic
47
ketamine s/e
``` HTN increased Iop emergence rxn laryngospasm increased secretions ```
48
Succinylcholine
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
succinylcholine ADR:
hyperkalemia, can cause malignant hyperthermia (Dantrolene)
50
rocuronium
non depolarizing paralytic intermediate duration of action
51
ET tube length
Men: 8, Women: 7 Depth: 3x ET tube size marked at teeth
52
mac blade
curved less trauma less airway stimulation #3
53
miller blade
straight lifts epiglottis #2
54
Preoxygenation before intubation
BVM (90-97% O2) and high flow NC, have suction ready
55
Single vs. Double Comet
Ultrasound confirmation of correct tube placement: Appropriate placement → Single comet Inappropriate placement → Double comet
56
CI for trach
No trachs for kids younger than 8-10 years old (Alt: Jet insufflation)
57
suspect B pertussis
Cough > 7 days kids: whooping cough
58
likely PNA if:
``` HR > 100 Temp >100.4 RR > 24 Age > 64 no chest exam findings ```
59
procalcitonin
elevated in bacterial infection
60
SARS lab results
increased LFTs thrombocytopenia lymphocytopenia prolonged PTT

WI-18 Pulmonary (11 decks)

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