respiratory Flashcards
ards
diffuse alveolar damage (capillary) char by rapid onsef of severe life threatening respiratory insufficiency, cyanosis and severe arterial hypoxemia that is refractory to o2 therapy
xray- ARDS
diffuse alveolar infiltration
causes of ARDS
diffuse alveolar damage infection, chemical injury, physical injury, inhaled irritants, hematologic, pancreatitis, cabg
emphysema
abn permanent enlargement airways distal to terminal bronchiole. + obstruction of their walls without obvious fibrosis. enlargement without destruction equals overinflation
xray emphysema
hyperinflation
s/s emphysema
pink puffer- airway resistance increased, low elastic recoil, severe dyspnea, scant sputum
chronic bronchitis symptoms
mild dyspnea, copious sputum and cough, cor pulmanale common, increased airway resistance, normal elastic recoil, blue bloater
chronic bronchitis
chronic overinflation- air trapped, lung expands because air trapped in
xray chronic bronchitis
prominent vessels, large heart
bronchiolar and bronchial injury leads to
infection, bronchospasm, hypersecretion of mucous leads to reversible obstruction of bronchioles and small bronchi with repeated injury leads to chronic bronchitis, with destruction of alveolar walls leads to chronic bronchitis and emphysema
obstructive diseases PFTs
decrease fev/fvc, decreased fev1
obstructive disorders
emphysema, osa, asthma, obesity, bronchiectasis, chronic bronchitis
emphysema
damage at acinar level
bronchitis
damage at bronchial level
fev/fvc levels and severity
> 80% mild, 50-79% mod, 30-49% severe, < 30 very severe
copd+ air trapping equals
v/q mismatch
emphysema
abnormal permanent enlargement of air spaces enlargement and destruction of alveolar walls with loss of elasticity and air trapping.
chronic bronchitis
inflammation and thickening mucous membrane with accumulation of mucous and pus leads to obstruction
bronchiectasis
perm dilation bronchi and bronchioles, secondary to permanent muscle and elastic tissue secondary to chronic necrotizing infections
ex of bronchiectasis
cystic fibrosis, severe pneumonia, bronchial obstruction
anesthesia and copd
assess changes in symptoms, avoid smoking,
adenocarcinoma
originates in epithelial tissues that line body cavities and glands
squamous cell
originates in columnar epithelial cells-skin, digestive tract, lungs
non small cell ca
epithelial cell insensitive to chemo (80% lung ca)
small cell
usually in lungs, sensitive to chemo
presentation lung ca
couhing, smoker (90%), hemoptysis, sob, pain with breathing, fever
where are lung tumors normall located
proximal/central bronchi
when bronchial lumen is filled with tumor
gas exchanging units distal dont function, atelectasis, secretion trapping and pooling, infection, scarring
anesthetic implications airway tumor
expect higher airway pessure, dual lumen tube, airway recruitment maneuver, higher fio2
s/s upper airway tumors
slow onset, dyspnea, voice changes, swallowing trouble, stridor, hemoptysis, stertor
risks of upper airway tumors
smoking, tobacco chewing, HPV
anesthesia implications
DIFFICULT AIRAY
which mediastinum tumors are more likely to be malignant?
anterior then posterior
problem with mediastinum tumors
strutures can be compressed, cardiac tamponade, compression great vessels
SVC syndrome
direct compression SVC, causes backup in venous drainage, results in edema to tiddue whose venous drainage returns to heart via SVC
S/S svc syndrome
dilation collateral veins neck, edema/cyanosis face, edema conjunctiva, evidence increased ICP, dyspnea
asthma char by
airway inflammation, airflow obstruction, bronchial hyperreactivity
s/s asthma
dyspnea, wheezing, chest tighness, cough
atopic asthma
most common, type I ige hypersensitivity reaction, starts in childhood, triggered by allergens
non-atopic
no history allergen, inflammation assoc. hyperirritability
patho atopic astha
intitial exposure allergen stim. secretion inflammatory cytokines, trigger the b cells to produce ige which coat the mast cells.
early phase atopic asthma
bronchoconstriction, increase mucous production, vasodilation with increased vascular permeability
late phase atopic asthma
epithelial damage and additional inflammation and airway constriction
repeated exposure to allergen with atopic results in
goblet cell hyperplasia, subepithelial collagen dep, increased capillary network, smooth muscle hypertrophy
b2 adrenergic agonists
albuterol, terbutaline (short acting) formoterol, salmeterol (long acting
mech action B2 adrenergic
bind to b2 receptors of the lungs directly and relax smooth muscle of the airway by increasing concentration camp
ipratorpium bromide
antimuscarinic vasodilating agent
leukotriene receptor antagonists
montelukast, zafirlukast,zileuton
ga may trigger asthma exacerbation by
alteration diaphragmic function, impaired coughing ability, decreased mucociliary function, stim/irritation airway by ETT
most significant predictors of bronchospasm in asthma
proximity and severity of most recent asthma attack
pt with asthma can
those who are well controlle, have peak flow meter >80% of predicted are at avg risk surgery
intermittent asthma
day: no more then 2x/wk, night: no more than 2x/month
pef>80% predicted
mild persistent asthma
day: more than 2x per week but not daily, night- more than 2x/month
pef > 80% predicted
moderate persistent asthma
daily, night>1 night per week, exacerbation effects adls, fev 60-80% predicted
severe persistent asthma
day/night continuous symptoms with frequent exacerbations, severe limitations adl, fev<60% predicted
what needs to be avoided in asthmatics
nonselective beta blockers, nsaids, histamine releasing drugs, premed with steroids, antihistamines
propofol is a
bronchodilator
ketamine and respiratory
smooth muscle relaxant and decreased airway resistance
manifestations bronchospasm
high inflation pressure with intermittent + pressure vent expiratory upsloping on capno prolonged expiration decreased o2 sat expiratory wheezing decreased breath sounds
tx bronchospasm
100% o2 increase anesthesia beta agonist (albuterol) anticholinergic inhaled (ipratropium) lidocaine IV epi corticosteroids
rigid bronch
trachea/prox/central airways GA straight hollow tube direct intubation with rigid telescope constant diameter vent support ability to analyze expired gas
uses rigid bronch
large endotracheal or endobronchial tumor foreign body removal massive hemoptysis stent placement laser surgery viscous secretions
