Respiratory 2 Flashcards
Sarcoidosis typical pt?
female, black
SOB
Dry cough
erythema nodosum
Blood Test. for sarcoidosis?
Imaging?
ACE - raised
Calcium - raised
CXR - HILAR LYMPHADENOPATHY
HRCT - pulmonary nodules
what establishes dx in sarcoidosis?
ACE / calcium bloods
CXR -
Bronchoscopy w USS guided biopsy of MEDIASTINAL LYMPH NODES
histology of sarcoidosis?
non- caseating granulomas with epitheliod cells
Other tests for sarcoid?
U&Es
ACR - proteinuria
LFTs
opthal
ECG / echo
USS abdo
mx of sarcoid?
oral steroids ;
> bisphosphonate
2) Methotrexate
3) Lung transplant
prognosis of sarcoidosis?
resolves in 50%
<2 years
> Pulmonary fibrosis / pulmonary HTN
<10% overall mortality
Mx of pulmonary HTN?
manage cause / if idiopathic CCB
supportive : oxygen and diuretics
Ix pulmonary HTN?
bloods: NT-proBNP
Image:
CXR :
Dilated pulmonary arteries
Right ventricular hypertrophy
ECG: right sided heart failure
ECG changes in right sided HF - pulmonary HTN
p pulmonale - peaked p waves
R waves are tall in v1/v2 and DEEP S waves in V5/V6
Right bundle branch block
cause of Pulmonary HTN
1) idiopathic / connective
2) Congestive heart failure from an MI / HTN
3) COPD / pulmonary fibrosis so lung term lung disease
4) vascular - PE
5) Misc: sarcoidosis
when are ABGs useful?
type 2 respiratory failure - COPD
what is FiO2?
fraction of inhaled oxygen
room has fio2 od 21%
> venturi are good to control this
T2RF?
low oxygen and raised carbon dioxide
T1RF?
normal co2 and low o2
raised bicarb is a sign of ?
chronic Co2 retention
Respiratory alkalosis mainly occurs from?
breathing too fast
getting rid of too much co2
raised RR
1) hyperventilating
2) pulmonary embolism
benefits of prone positioning in ARDS?
reducing compression of the lungs by other organs
improves blood flow to the lungs
improve clearance of secretions
improve overall oxygenation
venturi mask colour that gives most Fi02?
least?
green
blue
what is PEEP?
end expiratory pressure
> remains in airways at end of exhalation
>
if you give additional pressure then airways remain inflated
++ atelectasis
improves ventilation
opens more areas for gas exchange
Positive end-expiratory pressure is added by:
high flow nasal cannula
NIV
mechanical
NIV?
essentially BiPAP
bilateral + airway pressure
cycle of high and low pressure to correspond wiht inspiration and expiration
NIV involves?
full face mask
hood
/ tigh fitting nasal mask
blows air into lungs and ventilates them
What does mechanical ventilation involve?
Fi02
respiratory rate
tidal volume
Ins:exp ratio
peak flow rate
peak inspiratory pressure
positive end expiratory pressure
what is ECMO
extracorporeal membrane
blood removed
passed through a machine where oxygen is added
CO2 is removed then pumped back
