Respiratory Flashcards
What are some common triggers for ARDS?
Sepsis
Infection/Aspiration
Blood transfusions
What is ARDS?
Respiratory failure with lung edema and decreased compliance
What are the 3 initial tests to get when lung pathology presents?
ABG
CXR
A-a gradient
How will the CXR look with ARDS?
Bilateral ground glass appearance
What will the PaO2:FiO2 ratio be with ARDS?
< 300
Treatment for ARDS?
Intubation and mechanical ventilation
When a patient is intubated and mechanically ventilated, what 2 things need to be remembered?
- Prone position can help
- LOW tidal volume in order to prevent alveolar over distention injury
What defines Pulmonary HTN?
Pulmonary arterial pressure > 25mmHg
What defines Cor Pulmonale?
Alteration of RV structure/function due to disorder of the lungs
What will be some symptoms of Pulmonary HTN?
Dyspnea on exertion
Lethargy
Right CHF signs – edema, JVD, abdominal distention
What will be some symptoms of Pulmonary HTN?
Dyspnea on exertion
Lethargy
Right CHF sign – edema, JVD, abdominal distention
What may be heard with auscultation of the heart with pulmonary HTN?
Loud split S2
RV heave
What is the best initial test if you suspect Pulmonary HTN?
Echo to estimate pulmonary A. pressure and assess RV
What will a CXR show with Pulmonary HTN?
Enlargement of central pulmonary arteries with distal tapering
What may an ECG show with Pulmonary HTN?
Right ventricular hypertrophy
What is the most accurate test to diagnose pulmonary HTN?
Right heart catheterization!
What are 3 medication options for Pulmonary HTN?
- IV prostanoids
- Bosentan (endothelin antagonist)
- PDE inhibitors
What occurs with Alpha-1-Antitrypsin deficiency?
Proteases like Neutrophil Elastase go unchecked and destroy lung tissue
Alpha-1-Antitrypsin will present with what specific lung pathology?
Panacinar emphysema in the lower lobes
Alpha-1-Antitrypsin will present with what specific lung pathology?
Panacinar emphysema in the lower lobes
Patients with Alpha-1-Antitrypsin deficiency will also present with what other things besides COPD?
Liver diseases
- Cirrhosis
- HCC
On CXR, what word may be used to describe the COPD that is present with Alpha-1-Antitrypsin deficiency?
Basilar COPD
What physiology causes a Transudative pleural effusion?
Increased pulmonary capillary wedge pressure or decreased oncotic pressure
What are 3 common things that cause a Transudative pleural effusion?
CHF
Cirrhosis
Nephrotic syndrome
What is typical of the pH with a Transudative pleural effusion?
Alkalotic pH (high)
What physiology causes an Exudative pleural effusion?
Increased vascular permeability
What are some common things to cause an Exudative pleural effusion?
Pneumonia
Malignancy
PE
– All other things
How will a pleural effusion present?
Dyspnea
Pleuritic chest pain
Cough
What 2 lab values diagnose an Exudative pleural effusion?
Pleural protein:Serum protein > 0.5
Pleural LDH:Serum LDH > 0.6
What 2 lab values diagnose an Exudative pleural effusion?
Pleural protein:Serum protein > 0.5
Pleural LDH:Serum LDH > 0.6
What is present with an Uncomplicated Parapneumonic Effusion?
Pneumonia + Pleural effusion
– (-) gram stain with clear/cloudy fluid
Treatment for an Uncomplicated Parapneumonic Effusion?
Antibiotics
– Pneumonia + Pleural effusion with clear/cloudy fluid and a (-) gram stain
What is present with a Complicated Parapneumonic Effusion?
Pneumonia + Bacterial invasion into pleural space
What will the pH be of the pleural fluid if a Complicated Parapneumonic Effusion is present?
pH < 7.2
– Pneumonia + Bacterial invasion into pleural space
What is the treatment for a Complicated Parapneumonic Effusion?
Antibiotics + Chest tube
What is an Empyema?
Bacterial colonization of the pleural space that produces pus and purulent fluid
Treatment for an Empyema?
Antibiotics + chest tube
VIRchow’s Triad
- Vascular trauma
- Increased coagulability
- Reduced flow (stasis)
What is the best initial step if you suspect a PE?
Calculate the Well’s Score
If the Well’s Score is ______ a PE is unlikely
< 4
If a PE is unlikely, what test can be helpful to rule it out?
D-Dimer
If the Well’s Score is > 4, what test should be done?
CT with contrast
What is the most common finding on EKG with a PE? Rare finding?
Common = sinus tachycardia
Rare = S1Q3T3
If the probability of a PE is high, what treatment should be done and when?
Anticoagulation BEFORE confirmatory testing is done
In a patient that is on supplemental O2 who develops rapid neurologic decline, what should be suspected?
Hypercapnia from dead space ventilation
