Respiratory

Question 1

pneumotaxic center

Answer 1

• located in midbrain
• control transition between inspiration and expiration
• recieves

Question 2

Apneustic center

Answer 2

• located in pons
• trigger inspiration
• recieves input from peripheral stretch receptors

Question 3

Centreal cheomrecptors

Answer 3

• located in medulla

- sense changes in partial pressure of PCO2 of CSF

Question 4

definition of continuous hemothorax

Answer 4

• Evacuation of more than 1000 mL of blood immediately after tube thoracostomy; this is considered a massive hemothorax
• 150-200 mL/hr for 2-4 hours
• Repeated blood transfusion is required to maintain hemodynamic stability

Question 5

what to communicate about a chest tube

Answer 5

• location R or L (IC shape if known)
• size of chest tube
• how is it sucured (sutures/tape)
• whats it draining and amount (sent for analysis or not)
• is there an air leak
• connected to suction or not

Question 6

Virchow’s Triad

Answer 6

• vascular injury
• hypercoagulability
• venous stasis

Question 7

when are the ventricles perfused

Answer 7

RV- systole and diastole

LV- diastole

Question 8

RV death spiral from PE

Answer 8

RV dilation (from clot burden not pulmonary vascular resistance) -TV insufficiency- RV wall tension- neurohormonal activation- MI-RV ischemia-decreased RV contractility- decreased LV preload- systemic hypotension- decreased RV coronary perfusion- decreased RV o2 delivery - CARDIOGENIC SHOCK- DEATH

Question 9

how does ketamine cause tachycardia

Answer 9

norepinephrine release

Question 10

signs of RV dysfunction

Answer 10

• new RBB
• ST depression
• elevated BNP, troponin

Question 11

treatment of high risk PE

Answer 11

• optimize fluid volume (250-500ml) (risk volume can over-load ventricles, worsening CO)… this is to optimize decreased LV preload
• norepi: increases RV inotropy and systemic BP, restores coronary perfusion gradient
• Dobutamine: increases RV isotropy, lowers filling pressure (may aggravate arterial htn if used without vasopressor)

Question 12

submassive PE

Answer 12

• RV strain without shock

- may not require thrombolysis

Question 13

what does D-dimer tell you

Answer 13

• released upon cleavage of cross-linked fibrin by plasmin
• tells you there’s a clot somewhere
• if pre test probability is high, and D-dimer is elevated, dx of PE is likely
• Normal plasma levels of D-dimer by ELISA testing are <500 ng/mL

Question 14

what causes hemoptysis associated with PE

Answer 14

pulmonary infarct

Question 15

which artery normally associated with hemoptysis

Answer 15

bronchial artery rupture

Question 16

MAP goal in RV failure

Answer 16

consider maintaining a higher MAP in pt’s with high RV pressures

Question 17

what is pneumonia

Answer 17

lower respiratory tract infection. community and hospital acquired ( > 48hrs since admission). Viral, bacteria and fungal

Question 18

what is empyema

Answer 18

collection of pus in pleural space

Question 19

purpose of PEEP in COPD management

Answer 19

• PEEP matching= applying external PEEP to oppose the transpulmonary PEEP with is opposing ventilation. Even if PEEP isn’t completely matched, it should reduce the sensitivity required to trigger a breath reduce WOB
• Improves oxygenation/ventilation- thinning the alveolar membrane, opening derecruited lungs

Question 20

Asthma

Answer 20

Hallmarks of asthma

• airway inflammation
• thickening of basement mamba
• inflammatory exudate with eosinophils and edema

Question 21

Vent strategy for Asthsma

Answer 21

• volume control
• Vt 7-8 ml/kg
• peak < 50
• plat < 35
• mimimal PEEP
• short Ti
• PH > 7.10
• permissive hypercapnia