Resp Flashcards
Acute exacerbation of COPD - tests (2) and results
CXR - hyperinflation
ABG - hypoxia, co2 retention, resp acidosis with metab alkalosis compensation
Acute exacerbation of COPD - Cardinal Sx (3)
Increased dyspnea Increased cough (frequent & more severe) Increased sputum production (change in colour and volume)
Acute exacerbation of COPD - management (6)
- O2 (target sat 88-92%)
- inh bronchodilators (eg albuterol) & anticholinergics (eg ipratropium)
- Systemic glucocorticoids
- antibiotics (eg levofloxacin) for: (a) pts with 2/3 Cardinal Sx, (b) mod-to-severe exacerbation, (c) mechanically ventilated pts
- noninvasive positive-pressure ventilation (NPPV) for mod-to-severe exacerbation (if not contraindicated)
- trach intubation if no improvement with NPPV & drugs OR if NPPV is contraindicated
ARDS characteristics (5)
- follows significant lung injury (pneumonia, sepsis, trauma, burns, severe bleeding, toxic ingest ions)
- acute resp failure (distress)
- dyspnea, tachypnea, severe hypoxemia
- diffuse alveolar damage due to inflamm mediators released due to tissue injury
- pulmonary edema not due to heart failure or volume overload
Acute massive PE - presenting Sx (2) and exam findings (2)
Syncope, hemodynamic collapse
Accentuated P2, elevated CVP (high JVP)
[Usually, RV dilatation (RVH outflow obstruction) - septum gets pushed toward LV, causing deceased LV preload & CO]
Criteria for obstructive pattern
FEV1/FVC < 70% predicted
Obstructive pattern DDx based on DLCO (3)
Low DLCO: emphysema
Normal: Chronic bronchitis
Increased: Asthma
Criteria for restrictive pattern
FEV1/FVC > 70% predicted
FVC < 80% predicted
(low VC)
Restrictive pattern DDx based on DLCO (low 4, normal 2, increased 1)
Low DLCO: Interstitial lung diseases, sarcoidosis, asbestosis, heart failure
Normal: Musculoskeletal deformity, Neuromuscular disease
Increased: Morbid obesity
DDx for normal spirometry based on DLCO (3 low, 2 high)
Low DLCO: Anemia, PE, Pulm HTN
Increased: Pulm hemorrhage, Polycythemia
Criteria for predominant chronic bronchitis COPD subtype
Chronic productive cough (3 months or more) over 2 consecutive years not due to other causes (eg. bronchiectasis)
Pt shows obstructive disease on spirometry; next test?
Bronchodilator challenge (increased FEV1 = asthma; no change in FEV1 = COPD)
Pt shows restrictive disease on spirometry; how to differentiate interstitial lung disease vs chest wall weakness?
DLCO
Normal DLCO = chest wall weakness
Decreased DLCO = interstitial lung disease
What is blastomycosis & where is it endemic?
How to Dx/Tx?
Pulmonary fungal infection; can become systemic (skin and bone lesions) (skin lesions = well-circumscribed verrucous, crusted lesions; bone lesions = lytic)
Endemic to Great Lakes, Mississippi & Ohio River basins
Dx: CXR, sputum culture
Tx: Itraconazole or amphotericin B (for systemic disease)
What happens to pulmonary vasculature when alveoli are hypoxic?
Vasoconstriction
Causes of chronic hypoventilation (3)
What happens to pCO2 and pH?
COPD
Obesity hypoventilation syndrome
Neuromuscular cuases
pCO2 gradually increases = resp acidosis; kidneys compensate by increasing bicarb retention so pH remains low-normal or just below normal (pH never normalizes or gets overcorrected)
Indicators of severity of an asthma attack (5)
Normal to increased pCO2 values (indicates CO2 retention due to severe obstruction and/or resp muscle fatigue) Speech difficulty Diaphoresis Altered sensorium Cyanosis "Silent" lungs
