RESPIRATORY LABS Flashcards
major causes of respiratory distress
tumors, infections, airway disease (asthma, COPD), pulmonary vasculature ds (PE, Pulm HTN), or intersitial lung ds (sarcoidosis, pneumoconiosis)
how do issues with ventilation occur?
perfusion?
gas exchange?
ventilation- obstructed airway
perfusion- pulmonary embolus in blood vessel
gas exchange- thickened alveolar-capillary barrier (in ILDs)
allen test
hand upright, compress radial and ulnar arteries, allow blood to drain from hand
then lower hand and open fist, release pressure over ulnar artery
color should return to hand within 6 seconds
if the hand does not turn pink—> pt does not have collateral circulation
if it does–>access ulnar artery to take an ABG
at which sites can you obtain an ABG
radial artery (cannulation between distal radius and tendon of flexor carpi radialis)
femoral artery- if pt is intubated or has line in upper ext (do not have to worry abt collateral circ)
blood gas
- what is it composed of
- what can it show
partial pressure of O2, CO2, and pH
can show hypoxemia, hypercapnia, resp/metabolic acidosis/alkalosis
ABG analysis
ranges for bicarb, CO2, pH
bicarb: 22-28
CO2: 35-45
pH: 7.35-7.45
causes of resp acidosis
HYPOventilation
- airway obstruction
- acute lung ds
- chronic lung ds
- opioids, sedatives
- weakening of resp muscle
causes of resp alkalosis
HYPERventilation
hysteria, hypoxemia (high altitudes), salicyclate (early), tumor, PE
causes of metabolic alkalosis
H+ loss, excess HCO3 loss
loop diuretics, vomiting, antacid use, hyperaldosteronism
electrolytes?
anion gap is? used for?
sodium, potassium, chloride, bicarb
anion gap: difference between major free cations and free anions
- use to eval acidosis
how to calc anion gap
normal range not including K+
normal range including K+
Na - (Cl + HCO3)
normal: 8-12
(Na+K)-(Cl+HCO3)
normal: 16
anion gap >12 - causes
MUDPILES:
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic Acidosis
Ethylene glycol
Salicylates (late)
normal anion gap causes (8-12)
HARDASS
Hyperalimentation
Addison ds
Renal tubular acidosis
Diarrhea
Acetazolamide
Spirinolactone
Saline infusion
transudate vs exudate
transudate- occurs due to inc in hydrostatic or dec oncotic pressure
- HF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia
exudate- occurs due to inflamm and infection, inc capillary permability
- trauma, malignancy, lupus, pnuemonia, infection, TB, cancer
lights criteria for pleural effusions
- transudate
protein- pleural:serum <=0.5
LDH- pleural:serum <=0.6 or pleural LDH <= 2/3 upper limit of normal serum LDH
common causes
- hypoalbuminemia
- CHF
- constrictive pericarditis
lights criteria for pleural effusions
- exudate
protein- pleural:serum >0.5
LDH- pleural:serum >0.6 or pleural LDH>2/3 upper limit of normal serum LDH
common cause
- autoimmune, esoph rupture, infection, malignancy, pancreatitis, post CABG, PE
bronchalveolar lavage fluid analysis
diagnostic uses
diagnostic- pulm infx, acquired pna, ILDs, lung ca, lung transplant monitoring
bronchalveolar lavage fluid analysis
- what is tested w the fluid
- results?
culture, WBC count, gram stain
bloody- alveolar hemorrhage
cloudy- pulm alveolar proteinosis
microscopy/biomarkers
community acquired pna- pathogens
s.pneumoniae, mycoplasma pneumoniae, F.influenza, legionella, bordetella pertussis
viral pna- pathogens
influenza, covid 19
PNA- ventilator infx
- drug resistant
k.pneumonia, p.aeruginosa, a.baumanii, MRSA
PNA- travel pathogens
tb, fungal
PNA- depressed immunity pathogens
- hiv pt, neutropenic pt
HIV
- pneumocysitis jirovecci
- CMV
neutropenic
- aspergillus
PNA testing
- gram stain
- sputum culture
- acid fast stain (TB)–also do culture/nucelic acid amplification test
- PCR assays
- KOH preps for fungal
- NAAT for viral infections
- rapid antigen test for flu
asthma Dx
spirometry, PFT, CXR, allergy testing
COPD Dx and clinical features
blue bloater (bronchitis) v. pink puffer (emphysema)
- PFT
- CBC (compensatory rise in HgB)
- rule out infections
- r/o AAT-1 Deficiency, elastin degradation
copd presentation but never smoked– might be AAT1 def
ARDS clinical features
rapid onset of resp failure
- systemic inflamm, trauma, severe infection
significant morbidity and mortality
SS- hypoxia, bilat infiltrates, resp failiure withOUT CV insult or pulm HTN
ARDS Dx and Tx
Hx, CXR, CT, ABG, Echo, cardiac biomarkers
tx: o2, IV fluids, underlying ds
neonatal resp distress syndrome
- clin features
incomplete development, preterm infants
- deficiency in surfactant, prevents alveolar collpase during exhalation
- HAVE perfusion, lack ventilation
neonatal resp distress syndrome- SS, tx, dx
- hypoxia and resp acidosis
- steroids 48 hrs before birth (to try and mature lungs)
- lamellar body count test for fetal lung maturity in amniotic fluid (done with a amniocentesis)
sepsis- clin features
severe physiological and biochemical response to a global infection
- response to infection is no longer localized
SIRS
proinflamm cytokines cause fever, leukocytosis, activation of endothelial cell function and coagulation
temp >38 (100.4) or <36 (96.8)
WBC >12,000 or <4,000
RR>20/min
HR >90
PCO2 <30
sepsis, severe sepsis, and septic shock
sepsis- 2 SIRS + confirmed or suspected infection
severe sepsis- sepsis + signs of end organ damage + hypotension SBP<90 + lactate >4
septic shock- severe sepsis with persistent signs of end organ damage, hypotension, lactate >4
lung cancer Dx
- labs
- what test can be used for prognosis
CXR, CT, MRI
tissue histology analysis
molecular testing, mutations direct therapy
gene protein mutations, amplifications
cytokeratin 19 fragments in serum may be used in prognosis
cancer is the answer, tissue is the issue
