Respiratory Flashcards
High altitude sickness blood findings
How long until equilibration?
New blood findings
pH will be high, pCO2 down, pO2 down
48 hours and bicarb will compensate
pH will be slightly high/normal
ARDS on CXR
Bilateral white opacities on CXR
No heart enlargement
Recent trauma
ARDS Pathophys
Injury/inflammation to alveolar pneumocytes and pulmonary endothelium
Neutrophils invade/release cytokines -> cycle
Hyaline membrane formation (protein rich, necrotic debris)
Need initial injury: smoke to pneumocytes or sepsis to endothelium
Acute MI leading to shortness of breath -> what would lung histology show?
Transudate accumulating in the alveolar lumen
Transudate is result of increased hydrostatic pressure, low protein, low SG
Causes of hypoxia
Decreased cardiac output
Hypoxemia
Anemia
CO poisioning
Causes of hypoxemia
Normal A-a gradient:
- High altitude
- Hypoventilation (ex opioids)
Increased A-a gradient:
- V/Q mismatch
- Diffusion limitation (fibrosis)
- Right to left shunt
Rinosinusitis
Obstruction of sinus drainage
Typically maxillary sinus to middle meatus
Viral, S. pneumo, H. flu, M. catarrhalis
Volumes and PFT’s in obstructive dz
RV, FRC, TLC all increased
FEV1 way down
FVC down
FEV1/FVC = down
Elastic problem
Types of obstructive dz
Chronic bronchitis
Emphysema
Asthma
Bronchiectasis
BACE
Bronchiectasis
Chronic necrotizing infection of bronchi
Associated with bronchial obstruction, poor ciliary motility (smoking, Kartgener, CF, ABPA)
Volumes and PFTs restrictive dz
Decreased FVC and TLC
FEV1/FVC somewhat preserved
Types of restrictive dz
Poor breathing mechanics (polio, MG, GB, scoli, obesity)
ILD (decreased diffusing, inc. A-a: ARDS, NRDS, pneumoconioses, sacoid, vasculitis etc)
Idiopathic pulmonary fibrosis - honeycomb appearance
Pneumoconioses
Asbestos is from the roof but on the floor
Silica/coal are from the floor but on the roof
ARDS causes
This is SPARTAS Sepsis Pancreatitis/PNA Aspiration uRemia Trauma Amniotic fluid embolus Shock
Types of PNA
BronchoPNA
Interstital PNA
Lobar PNA
