Respiratory Flashcards
A syndrome commonly associated with Small Cell Lung Cancer?
Lambert Eaton in Small Cell Lung Cancer? Why?
Autoantibodies against Ca2+ channels at the neuromuscular junction secreted in the setting of small cell carcinoma of the lung can cause Lambert-Eaton syndrome as a paraneoplastic syndrome.
Paraneoplastic Syndromes (NSCL/SC)
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Small cell
- ADH
- ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
- Lambert-Eaton syndrome
Squamous cell
- parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
- clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA)
- hyperthyroidism due to ectopic TSH
Adenocarcinoma
- gynaecomastia
- hypertrophic pulmonary osteoarthropathy (HPOA)
Biggest risk factor for men and women in chronic respiratory failure?
Men: smoking
Women: household pollution
What measurement scale is used to determine whether someone has acute respiratory failure?
Berlin score
- What are the components of the respiratory failure scales?
Timing (1 week)
Chest imaging (not explained by cardiac origins)
Chest oedema (bilateral infiltrates on chest x-ray)
Oxygenation: pO2/FiO2 < 40kPa (200 mmHg)
Cut off for Type 1 Respiratory Failure?
PaO2 < 60
Cut off for Type 2 Respiratory Failure?
PaCO2 > 45
What’s Type 3 Respiratory Failure?
Low functional residual capacity (atelectasis) → Hypercapnia/Hypoxemia
What’s Type 4 Respiratory Failure?
Patients on ventilation
Pulmonary causes of ARDS?
INFECTION
Aspiration
Trauma
Burns: Inhalation
Surgery
Drug Toxicity
Extra-Pulmonary cause
INFECTION
Trauma
Pancreatitis
Burns
Transfusion
Surgery
BM transplant
Drug Toxicity
Brief explanation of lung injury mechanism?
- Infection → Alveolar macrophage secrete TNF α + IL 8.
- Cause a protein rich oedema + degradation of surfactant → Lung cannot expand like normally.
- Leukocytes move from blood vessels to the alveoli causing gap between blood vessel and alveoli to increase → LESS EFFECTIVE GAS EXCHANGE OCCURRING
What are some molecules that are released during lung injury that can worsen prognosis?
Damage Associated Molecular Patterns
Increased shunt fraction is a feature of type 1 or 2 resp failure?
T1
2 types of (pro inflammatory) ARDS?
Hypo + Hyper
- Which type above seems worse?
Hyper
What are the upper and lower inflection points in PV loops of ARDS?
Explain Ventilator induced lung injury (what term is used to describe the phenomenon?).
Occurs if we drive the pressure too high. Causes too much air to stay in the lung because patients cannot exhale all of it out, building it up and building up the pressure especially in patients with underlying lung disease. Called ‘breath stacking’.
What scoring system is used to determine escalation of therapy of respiratory failure?
Murray Score
What are the components of the Murray score?
What score means the patient needs ECMO treatment?
3
Inclusion criteria for ECMO
- Severe resp failure (non cardiac, murray >3)
- Positive pressure ventilation is not enough
Exclusion criteria for ECMO
- Contraindication to continuation of active treatment
- Significance co-morbidity
- Significant life limiting co-morbidities.
Which vein is used in ECMO?
Femoral Vein (either to femoral of jugular)
Types of ventilation
Volume controlled
Pressure controlled
Assisted breathing modes
Advanced ventilatory modes
