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Pulmonology > Respiratory Failure + ARDS > Flashcards

Respiratory Failure + ARDS Flashcards

1
Q

Acute respiratory failure

A
  • hypoxic failure
  • hypercarbic failure (elimination failure)
  • cardiogenic pulmonary edema
  • non-cardiogenic pulmonary edema (ARDS)
  • pneumonia
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2
Q

Hypoxemia

90%

A

Decrease in night vision

High altitude pulm edema

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3
Q

Hypoxemia 80-89%

A

Drowsiness
Poor judgement
Impaired: coordination + efficiency

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4
Q

Hypoxemia

79-70%

A

Impaired:

  • handwriting
  • Speech
  • vision
  • memory
  • judgement
  • intellect
  • sensation to pain
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5
Q

Hypoxemia

<69%

A
  • circulatory failure
  • CNS failure
  • convulsions
  • cardio collapse
  • death
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6
Q

When do we need supplemental O2?

A

<88% or lower sitting (medicare)

Do 6 minute walk test

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7
Q

Alveolar air equation

A

PO2=FiO2 x (Pb-Pwater)-PaCO2/0.8

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8
Q

Alveolar-Arterial O2 gradient

A

Alveolar PO2 - arterial PO2

Normal = 1/2-1/3 age

Abnormal>30mmHg

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9
Q

PO2 =

A

IN AIR = Percentage of air x 760mmHg

IN VOCAL CORDS = percentage of air x (760-47)mmHg

in ALVEOLI = PO2 - PaCO2/0.8

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10
Q

What regulatory mechanism happens in high altitude =

A

Hyperventilation

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11
Q

CHF = cardiogenic pulm edema

ARDS = non-cardiogenic pulm edema

Path

A

Not understood how endothelial membrane damaged

  • neutro/macro enters
  • plasma gets in
  • exudate
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12
Q

Acute phase

Path

A

Intra-alveolar red cells + neutrophils

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13
Q

Fibrosing-Alveolitis Phase

A
  • granulation tissue in the distal air spaces w/ a chronic inflammatory-cell infiltrate
  • collagen deposition
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14
Q

ARDS. Risk factors

A

Pneumonia
Extrapulmonary sepsis
Aspiration

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15
Q

ARDS

Ventilate with High or Low tidal volume?

A

LOW tidal volume (<6ml/kg) = higher survival

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16
Q

High PEEP or low PEEP

A

No difference, just keep low tidal volume

17
Q

ARDS

Tx

A

Positive pressure mechanical ventilation

  • low volume (6mL/kg)
  • mode ventilation = doesn’t matter
  • use PEEP
18
Q

Lung protective strategy

ventilation (peep vs. volume)

A

Under inflection point = Peep keeps higher

Over inflection point = lower tidal volume

19
Q

PEEP purpose

A

Makes sure that alveoli doesn’t close when expire

Recruitment?

20
Q

ARDS tx

A

Positive pressure

CONSERVATIVE fluid management

NO Rx helps (methypredisolone can increase death risk)

Prone positioning (fluid is gravity dependent, opening new areas)

Extra Corporeal Membrane Oxygenation (ECMO)

21
Q

ARDS

Path

A

Proinflammatory cytokines –>diffuse alveolar damage –> alveolar-capillary permeability –> pulmonary edema/alveolar fluid –> hypoxemia

22
Q
  • MC critically ill patients
  • acute hypoxemia
  • Hours to days after inciting event (ex. sepsis)
  • CXR : BILAT INFILTRATES, WHITE-OUT, NO in costophrenic angles
  • NO CHF pulm edema
  • ABG: PaO2/FIO2 <200mmHg OR <5cmH2O = PEEP!
  • PCWP<18mmHG = pulm artery catheterization (opposite CHF!!)
A

Acute Respiratory Distress Syndrome ARDS

23
Q
  • hypocapnea
  • Central neurogenic
  • sustained, rapid, deep breaths
  • acute: paresthesias, tetany, anxiety
  • chronic: fatigue, anxiety, palpitations (s/s reproduced if voluntary action)
A

Hyperventilation Syndrome

24
Q

Hyperventilation Syndrome

Tx

A

breathing through pursed lips/1 nostril/paper bag

*Rx: anti-anxiety

25
Q

Respiratory failure

  • PaO2 <60mmHg
  • PaCO2 = normal/down
A

HYPOXEMIC
Type 1 RF

*Alveoli block, Poor alveoli gas transfer, obstructed blood flow

26
Q

Respiratory failure

*PaCO2 >45mmHg

A

HYPERCAPNIC
Type 2 RF

*decreased alveolar minute ventilation
Tx: O2

27
Q

Respiratory failure

  • abnormal chest wall mechanics - surgery/trauma
  • splinting
A

PERIOPERATIVE
Type 3 RF

  • regional atelectasis
  • hypoventilation
28
Q

Respiratory failure

  • normal lungs
  • increased ventilatory demands from hypermetabolism (sepsis)
A

HIGH-DEMAND
Type 4 RF

*muscle fatigue? –>ventilation

29
Q

CXR - cardiogenic Pulm Eedema or not?

  • Heart size: enlarged
  • Edema : central
  • Pleural effusions, peribronchial cuffing, septal lines
  • NO air bronchiograms
A

Cardiogenic

30
Q

CXR - Cardiogenic Pulm Edema or Not?

  • heart size: normal
  • edema: patchy/peripheral
  • NO pleural effusions, peribronchial cuffing, septal lines
  • YES air bronchograms
A

Non-cardiogenic pulm edema

31
Q

PO2/FIO2 ratios

  • normal
  • ARDS mild
  • ARDS Moderate
  • ARDS Severe
A
  • Normal = 429 mmHg
  • ARDS mild = 300 mmHg
  • ARDS moderate = 150 mmHg
  • ARDS severe = 90 mmHg

Pulmonology (12 decks)

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