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Coexisting Disease 1 > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

URI def
cases/yr
% infectious

A

Upper Respiratory Tract Infection
25,000,000
95% infectious, 5% allergy

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2
Q

Delay surgery? Why?
How long?
Unless…

A 
Yes, potential reactive airway.
6 weeks (peds) 2 weeks (adults), unless pt is in stable/improving condition.
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3
Q

URI Intraop Management (3 things, +/- 1 thing)

A
  1. Adequate Hydration
  2. Limit secretions
  3. Decrease airway manipulation (Use LMA)
    +/- bronchodilators to prevent bronchospasm
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4
Q

Asthma: Restrictive or Obstructive?
Prevalence worldwide:
Women vs Men:

A

Obstructive
300 million
Women 23% higher than men

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5
Q

Asthma vs Status Asthmaticus

A

Asthma is episodic: acute periods of obstruction then periods of no symptoms.
Status Asthmaticus: Life threatening bronchospasm despite treatment.

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6
Q

Clinical Manifestations of Asthma (5)

A
  1. Wheezing
  2. Productive/Non-productive cough
  3. Dyspnea
  4. Chest tightness
  5. Eosinophilia (Certain WBC, too many of them)
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7
Q

Single greatest risk factor for asthma?

A

Atopy - genetic predisposition to developing allergic hypersensitivity reactions.

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8
Q

Describe the positive feedback (feed forward) mechanism for sustained inflammation/bronchoconstriction.

A
  1. Chemical release from Mast cells interact with parasympathetic ANS releasing ACh. Those chemicals also enhance ACh receptors. Stimulating muscarinic receptors facilitate more chemicals from mast cells.
    All this leads to Bronchoconstriction.
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9
Q

Stimuli provoking symptoms of asthma (5 types)

A
  1. Allergens
  2. Drugs: Aspirin, some NSAIDs, Beta antagonists, Sulfites. Also Muscle relaxants, Morphine, Desflurane
  3. Infections: Respiratory Viruses
  4. Exercise: Especially After exertion
  5. Emotional Stress: Endorphins/Vagal mediation
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10
Q

2 most common findings in arterial blood gas in presence of mild asthma?

A

Hypocarbia and respiratory alkalosis

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11
Q

How to determine Acute R heart failure from the ECG?

A

S1Q3T3

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12
Q

GOLD (Global Initiative for Chronic Obstructive Lung Disease) spirometric post bronchodilator classification of severity. At Risk, Mild, Moderate, Severe, Very Severe

A

0: At risk
I: fev1/fvc <70%, fev1 > 80% predicted
II: fev1/fvc < 70%, fev1 50-80% predicted
III: “” ‘’ “ fev1 30-50% predicted
IV: “ “ “ fev1 <30% or <50% w/PaO2 <60mmHG and/or PaCO2>50

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13
Q

Short Term benefit of smoking cessation

- Carbon monoxide half life
- P50 
- Carboxyhemoglobin
A
  • 4-6 hrs CO half life
  • P50 increases from 22.9 to 26.4mmHg
  • Carboxyhemoglobin decreases 6.5% down to 1%
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14
Q

Intermediate effects (actually negative effects)

A

Actually negative which is why they should quit for 6 weeks prior to surgery.
- increased sputum expulsion, ciliary dyskinesia, closure of small airways.

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15
Q

Powerful predictor of post-op pulmonary complications

A

Poor nutrition status and serum albumin < 3.5mg/dL

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16
Q

Pre-op COPD prep summary (6)

A 
Encourage cessation of smoking
Treat evidence of airflow obstruction
Treat respiratory infections
Educate on lung expansion maneuvers
Consider post-op pain management
Counsel on prolonged intubation
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17
Q

Control (mechanical) ventilation settings:

A
  • tidal volumes of 6-8 ml/kg
  • Slow RR : 6-10/min allows for complete exhilation and preload.
  • DO NOT use positive pressure ventilation
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18
Q

Hypoxic Pulmonary Vasoconstriction take effect over ____ minutes, and peaks at around _____ hours

A

30 min

2 hours

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19
Q

HPV depends upon PAO2, PaO2, and PvO2. Which is the most important?

A

PAO2. Vasoconstriction occurs around alveoli that are not properly perfused and blood redirected to alveoli that have good O2 perfusion (PAO2 100mmHg) This limits V/Q mismatch.

20
Q

Inhibition of HPV comes about through vasodilation of the pulmonary vasculature. Which volatile agents inhibit HPV?
Which IV drugs inhibit HPV?

A

Vol. Agents: All of them.

IV drugs: None of them.

21
Q

Preferred Regional technique?

Avoid this type of regional technique.

A

Epidural works well.

Avoid Interscalene Block.

22
Q

Cystic fibrosis sweat chloride level for diagnosis

A

> 80 mEq/L, plus cough/purulent sputum, pan sinusitis

23
Q

Bronchiectasis

A

Similar to COPD. Infection causing bronchial dilation. Use antibiotics, postural drainage, and no nasal ,instrumentation

24
Q

Anticholiergics:

A

MoA: Block M1 & M3 receptors, cause bronchodilation
DoA: 8hrs
Routes of Administration: IV
Side Effects: inhibition of vagal tone

25
Q

Corticosteroids

A

MoA: Inhibition of production of cytokines. Increase Beta adrenergic receptors.
DoA:
Routes:
Side Effects:

26
Q

Butterfly pattern on CXR

A

Acute Pulmonary edema

27
Q

If aspiration occurs while supine, fluid most likely in which lobe?

A

Right Lower

28
Q

Treatment for aspiration

A

Crank up the O2
PEEP
Bronchodilators
(Streroids not used nowadays as much)

29
Q

Head injury (high ICP) causes Vasoconstriction. This shunts blood from periphery to pulmonary raising capillary pressure. What happens then?

A

Fluid forced out of pulm capillaries into lung interstitium then into alveoli. EDEMA

30
Q

Opioids can cause what type of edema? Would Naloxone help?

A

permeability edema

NO naloxone can make it worse.

31
Q

Heroin Overdose Symptoms and Treatments

A

Symptoms: RR=16-44 Breaths/min, O2=47-89% room air.
Treatment: 33% Intubated / mech. vent, 66% placed on O2 NRB mask and observed.

32
Q

High Altitude Pulmonary Edema:
What does it cause?
Time of onset?
Treatment?

A

Hypoxic Pulmonary Vasoconstriction
48-72 hours at altitude of 2500-5000 meters
Supplemental O2 and descent. Nitric Oxide (Vasodilation)
Only for neonates at this time in the US

33
Q

Risks of edema with collapsed lung reexpansion (3)

A

> 1L liquid surrounding lung in plural space
Duration of collapse (>24 hrs)
Rexpansion too rapidly: more than a breath or two.

34
Q

Edema following Upper Airway obstruction

Negative Pressure Pulmonary Edema (NPPE)

A 
Laryngospasm (after extubation)
Epiglottitis
Tumors
Obesity
Hiccups
OSA (in patients that are spontaneously ventilating)
35
Q 
1 Onset of NPPE following obstruction:
2 Symptoms (4)
3 Treatment (3)
4 Resolution time
A

Minutes to 3 hours following obstruction
Symptoms include: Pink Froth, Tachypnea, cough, failure to maintain O2 sat >95%
Treatment: Maintain patent airway, Supp O2, Mechanical Ventilation +/-
Resolution 12-24 hours

36
Q

Acute Intrinsic Respiration PreOp:

IntraOp:

A

Pre-Op: delay elective cases, optimize cardiac/pulm function, and Use Mech Vent and PEEP if O2<90%
Intra-Op: IV & V-agent, TV 4-8 mL/kg, RR 14-18/min, PIP < 30 cmH2O because of restrictive airway.

37
Q

Chronic Intrinsic Restrictive Pulmonary Disorders (Interstitial Lung Disease)

A

Decreased TLC, VC, FRC

38
Q

Normal Vital Capacity

Severe Dysfunction

A

70 mL/kg

< 15 mL/kg

39
Q

Respiratory failure with kyphoscoliosis

A

Vital Capacity < 45% predicted, scoliotic angle >110 Deg

40
Q

Pleurisy

A

Inflammation of the pleura that causes pain w/breathing

41
Q

Pleural effusion

A

Excess fluid buildup in the pleural space.

42
Q

Pneumothorax

A

Build up of air/gas in pleural space

43
Q

Pleural Fibrosis

A

Visceral pleura becomes fibrous. Decortication cuts pleura away.

44
Q

Restrictive Lung Characteristics

Mechanical

A

Lower lung volume, increased work, increased resistance

45
Q

Restrictive Lung Anesthesia Management
Pre
Intra
Post

A

Pre: Regional anesthesia no higher than T10 pleural issues
Intra: Minimize use of respiratory depressants, watch for Pneumo.
Post: Leave these people intubated longer.

46
Q

Vertebral level where trachea bifurcates:
Angle of Right Bronchus
Angle of Left Bronchus

A

T-5
Right 25 degrees
Left 45 degrees

47
Q

One Lung Ventilation

  • TV
  • MV
  • PeeP?
A
  • 8-10 mL/kg
  • increase to maintain MV equal to 2 lung ventilation.
  • Hell No PEEP!! Causes decreased venous return raising pressure in the lungs and backing up into the R-heart.

Coexisting Disease 1 (1 decks)

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