Respiratory Diseases Flashcards

Question

**COPD** Risk Factors S/S Diagnosis

Answer 1

**COPD include** (1) cigarette smoking, (2) occupational exposure to dust and chemicals, especially in coal mining, gold mining, and the textile industry, (3) indoor and outdoor pollution, (4) recurrent childhood respiratory infections, and (5) low birth weight. α1-Antitrypsin deiciency is an inherited disorder associated with premature development of COPD.

Answer 2

Smoking cessation and long-term oxygen administration are the two important therapeutic interventions that can alter the natural history of COPD.

Answer 3

* smoking, diffuse wheezing, productive cough

Answer 4

* smoking * diffuse wheezing * productive cough

Answer 5

they are really not predictive of postOp pulmonary function

Answer 6

useful for obtaining baseline functioning and for post Op evaluation

Answer 7

* **Regional Anesthesia** * Spinal and Epidural is OK; but we need to becareful in administering epinephrine to patients with poor perfusion * GA * You want to choose medications with rapid elimination (desflurane, sevoflurane) * Emergence is longer * Be careful with Nitrous * Ventilation of Patients

Answer 8

Patients with COPD are at increased risk of lung injury during mechanical ventilation in the perioperative period. The goals of mechanical ventilation must be to avoid dynamic hyperinlation of the lungs and prevent development of auto- PEEP. * Most studies show **low tidal volumes (6–8 mL/kg), peak airway pressures less than 30 cm H2O**, and **Fio2 titrated to keep Spo2 greater than 90%** result in lower levels of inlammatory markers in bronchoalveolar lavage luid of mechanically ventilated patients. Patients with moderate to severe COPD can have cystic air spaces in the lungs that carry a risk of rupture once positive pressure ventilation is instituted. In patients with COPD who become hemodynamically unstable during mechanical ventilation, the diferential diagnosis must include **tension pneumothorax and bronchopleural fistula.** * **SLOW SMOOTH I TIME AND LONE E TIME**

Answer 9

The phenomenon of air trapping, also called auto PEEP, intrinsic PEEP, or dynamic hyperinlation, **occurs when positive pressure ventilation is applied and insufficient expiratory time is allowed**. * This contributes to increased intrathoracic pressure, impedes venous return, and transmits the elevated intrathoracic pressure to the pulmonary artery. An _increase in pulmonary vascular resistance can lead to right ventricular strain._ Hyperinlated lungs may exert direct pressure on the heart, limiting its ability to expand fully during diastole even with adequate preload. Shift of the ventricular septum and ventricular interdependence due to the shared pericardium may cause a **distended right ventricle to impinge on illing of the let ventricle.**

Answer 10

**Pathophysiology** Bronchiectasis is characterized by l_ocalized irreversible **dilation of bronchi** caused by destructive inlammatory processes involving the bronchial wall_. For example, bacterial or myco bacterial infections can cause inlammation and destruction of medium-sized airways that can eventually lead to airway collapse, airlow obstruction, and an inability to clear secre- tions.

Answer 11

\*\*\* sweat test is a test for CF\*\* \*\*patients tend to have horrible infections.\*\* **TREATMENT** * Clearance of airway secretions * Bronchodilator therapy * Pulmozyme * Antibiotic often long term * Anesthesia Management: * Avoid intubation if possible * Volatiles are good * O2 is good * Humidification is good

Answer 12

* Post- prolonged endotracheal intubation * Tracheal ischemia with circumferential scarring * Symptoms if trachea is **\<5cm** in diameter * Dyspnea at rest * Accesory muscle use * Surgical dilatation or surgical resection

Answer 13

* Pulmonary Edema * Aspiration * Neurogenic Pulmonary Edema * Drug-Induced Pulmonary Edema * High-Altitude Pulmonary Edema * Reexpansion Pulmonary Edema * Negative Pressure Pulmonary Edema

Answer 14

* Pulmonary Fibrosis * Sarcoidosis * Hypersensitivity Pneumonitis * Eosinophilic Granuloma * Alveolar Proteinosis * Lymphangioleiomyomatosis

Answer 15

* Thoracic Extrapulmonary Causes * Extrathoracic Causes

Answer 16

* Restrictive lung diseases are characterized by a decrease in all lung volumes, especially total lung capacity (TLC), a decrease in lung compliance, and **preservation of expiratory flow rate** * Restrictive lung diseases affect both lung expansion and lung compliance (ΔV/ΔP). * The _hallmark of restrictive lung disease is an inability to increase lung volume in proportion to an increase in pressure in the alveoli_ _{These disorders can result from connective tissue diseases, environmental factors and other conditions that lead to pulmonary fibrosis, any conditions that increase alveolar or interstitial fluid, and any conditions that limit appropriate excursion of the chest/ diaphragm during breathing. These conditions lead to a reduction in available surface area for gas difusion, leading to ventilation/perfusion mismatching and hypoxia. Intrinsic or extrinsic pathologies can afect the ability of the lung to expand. As the elasticity of the lungs worsens, patients become symptomatic owing to hypoxia, inability to clear lung secretions, and hypoventilation. This leads to restrictive lung disease manifested by a reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), with a normal or increased FEV1/FVC ratio and a reduced difusing capacity for carbon monoxide (DLco). However, the principal feature of these diseases is a decrease in TLC}

Answer 17

**Pulmonary edema is due to leakage of intravascular fluid** into the interstitium of the lungs and eventually into the alveoli. *Acute pulmonary edema can be caused by increased capillary pressure (hydrostatic or cardiogenic pulmonary edema) or by increased capillary permeability*. * **Cardiogenic pulmonary edema** is characterized by marked dyspnea, tachypnea, and signs of sympathetic nervous system activation (hypertension, tachycardia, diaphoresis) that is often more pronounced than that seen in patients with increased permeability pulmonary edema. * **Pulmonary edema caused by increased capillary permeability** is characterized by a _high concentration of protein and secretory products in the edema fluid_. Diffuse alveolar damage is typically present with the increased permeability pulmonary edema associated with acute respiratory distress syndrome (ARDS).

Answer 18

* Aspiration * Neurogenic problems * CNS injury - vasoconstriction -- blood to pulm circulation -- increased pulmonary capillary pressure * Opiods overdose * High - altidue pulmonary edema * Re-expansion of collapsed lung * Negative pressure pulmonary edema

Answer 19

*Pre-op:* **elective surgery should be delayed** ***Intra-op*** * Careful wil vent settings: consider lower TVs and higher RR * Evaluate ABGs and/ or clinical picture * Extubation after careful consideration ***Post -Op*** * Vented to ICU or not * CXR

Answer 20

\*\* recruitment breaths after intubation

Answer 21

Pulmonary Fibrosis Interstitial lung disease is characterized by **changes in the intrinsic properties of the lungs and is most oten caused by pulmonary fibrosis**. This produces a chronic restrictive form of lung disease. Pulmonary hypertension and cor pulmonale develop as progressive pulmonary fibrosis results in the loss of pulmonary vasculature. Dyspnea is prominent, and breathing is rapid and shallow.

Answer 22

* Often has dyspnea and non-productive cough * Hypoxemia with *normocarbia* * Apneic _periods poorly tolerated [small FRC low O2 stores]_ * POSITIONING: GA supine position and controlled ventilation further decreases FRC * Uptake of VA is faster because of decreased FRC * Lower PIP to prevent barotrauma

Answer 23

* **Acute intrinsic restrictive lung disease** * ARDs, Aspiration, Neurogenic problems * **Chronic Intrinsic Restrictive lung disease (Interstitial)** * Sarcoidosis * Lymphangioleiomyomatosis * Hypersensitivity pneumonitis * Alveolar proteinosis * **Chronic extrinsic restrictive lung disease (chest wall , pleura, or mediastinum)** * Scoliosis * Pneumothorax * Mediastinal mass

Answer 24

* Systemic granulomatosis * Can affect almost any organ system in the body * 90 % of cases affect the the lungs; up to 50% dyspnea and cough * _Unilateral facial palsy --\> most common neurologic involvement._ * Endobronchial sarcoid is common; larygeal sacrcoidosis (5%) * Hypercalcemia - classic manifestation (10%) * More than 50% of cases resolve without treatment * **Tx: Glucocorticoids**

Answer 25

* Apnea is very poorly tolerated * GA, supine position, trendelenberg position, and controlled ventilation further decrease FRC * Smaller ETTs may be indicated * What about uptake of inhaled anesthetics? * Watch peak airway pressures -- ***consider pressure ventilation***

Answer 26

* If surgery is necessary , optimize the patient pre-operatively * Elective surgery should be postponed in acute/severe conditions * Restrictive lung disease contribute to the risk of post-operative complications * If mediastinal mass --\> CT should be perfomed pre-anesthetic * Potential difficult airway * Avoid long acting -resp depressants

Answer 27

* Surgical/ Anesthesia History * Medical History * Previous intubation? Difficulty? how was it done? * Consultation(s) necessary/appropriate? * Respiratory focused assessment: * SOB? * SOB w/ exertion? * Fatigue? * Daytime sleepiness? * O2 at home?

Answer 28

* Smoking history * Recent URIs * Medications * Snoring at night * OSA * STOP- BANG * Type of work? * Exercise tolerance * Airway assessment * Lung Assessment * Heart Assessment

Answer 29

* \>60 years old * ASA physical class II or greater * Functionally dependent

Answer 30

* GA * Procedures \>2.5 hours * Emergency Surgery * Type of Surgery

Answer 31

Adult ARDS is caused by inlammatory injury to the lung and is **manifested clinically as acute hypoxemic respiratory failure.** _{ARDS is now classified as mild (200 mm Hg < Pao2/Fio2 ≤ 300 mm Hg), moderate (100 mm Hg < Pao2/ Fio2 ≤ 200 mm Hg) or severe (Pao2/Fio2 ≤ 100 mm Hg). The calculation of the Pao2/Fio2 ratio must now be calculated with CPAP or PEEP of at least 5 cm H2O.}

Answer 32

* Alveolar damage, capillary damage, edema, inflammatory processes, V/Q mismatch, atelectasis, decrease thoracic compliance, increased dead space, hypoxic vasoconstrictions

Answer 33

1. **Exudative (Frist 7 days)** : High permeability , pulmonary edema 2. **Proliferative (8-21 days):** interstitial inflammation 3. **Fibrotic (After 3-4 weeks):** Fibrosis

Answer 34

different levels of ARDS 28% patients 45% mortality

Answer 35

1. Correct hypoxemia 2. Removal of excess CO2 3. Securing a patent upper airway * Search for underlying cause and treat it * Provide adequate nutrition, prevent GI bleeding and thromboembolism * Systemic inflammatory response syndrome (SIRS) and MODS can result

Answer 36

**intubation** **_Management of ARDS_** * Infections * Alveolar overdistention * Lung- protective ventialtion * Manage atelectasis * Polyneuropathy of critical illness

Answer 37

* **_Pressure control_** ventilation * Pulmonary Toilet * ***_TV 6-8 ml/kg_*** * ***_PEEP_*** * Recruitment maneurvers * Maintain UO \>0.5 ml/kg/hr * Diuretics * Inotropic support * Control infection * Inhaled Beta-adrenergic agonist * Glucocorticoid * Nutritional support

Answer 38

Acute dyspnea Tachypnea Pleuritic chest pain

Answer 39

**Sharp and sudden decrease in ETCO2** represents deadspace ventilation * Unexplained arterial hypoxemia, hypotension, tachycardia, or bronchospasm * Pulmonary HTN * RV dysfunction * Capnography - sharp and sudden deacrease * Spiral CT is diagnostic

Answer 40

* Symptom driven management * Anticoagulation * Vena cava filter * Thrombolytic therapy * Hemodynamic support * **Analgesia** * Surgical Embolectomy \*\*thoracotamy, bypass

Answer 41

Typically ***12- 72 hours post long bone*** fx **Symptoms** * Hypoxia * Mental confusion, sz, coma * Petechiae (over necj, shoulders, chest) **Treatment** * Management of ARDS * Immobilization of long bone fracture * Corticosteroids

Answer 42

Zone 1 : Ventilating not perfusing Zone 2: Perfusing and ventilating (Arterial pressure greater than alveolar pressure. greater than venous presseure) Zone 3: Not ventilating only perfusinf

Answer 43

patient is still spontaneously breathing but injury to C5 -C6 will affect acessory muscles