RESPIRATORY LABS Flashcards

1
Q

major causes of respiratory distress

A

tumors, infections, airway disease (asthma, COPD), pulmonary vasculature ds (PE, Pulm HTN), or intersitial lung ds (sarcoidosis, pneumoconiosis)

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2
Q

how do issues with ventilation occur?
perfusion?
gas exchange?

A

ventilation- obstructed airway
perfusion- pulmonary embolus in blood vessel
gas exchange- thickened alveolar-capillary barrier (in ILDs)

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3
Q

allen test

A

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

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4
Q

at which sites can you obtain an ABG

A

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)

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5
Q

blood gas
- what is it composed of
- what can it show

A

partial pressure of O2, CO2, and pH

can show hypoxemia, hypercapnia, resp/metabolic acidosis/alkalosis

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6
Q

ABG analysis
ranges for bicarb, CO2, pH

A

bicarb: 22-28
CO2: 35-45
pH: 7.35-7.45

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7
Q

causes of resp acidosis

A

HYPOventilation
- airway obstruction
- acute lung ds
- chronic lung ds
- opioids, sedatives
- weakening of resp muscle

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8
Q

causes of resp alkalosis

A

HYPERventilation

hysteria, hypoxemia (high altitudes), salicyclate (early), tumor, PE

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9
Q

causes of metabolic alkalosis

A

H+ loss, excess HCO3 loss

loop diuretics, vomiting, antacid use, hyperaldosteronism

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10
Q

electrolytes?
anion gap is? used for?

A

sodium, potassium, chloride, bicarb

anion gap: difference between major free cations and free anions
- use to eval acidosis

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11
Q

how to calc anion gap

normal range not including K+
normal range including K+

A

Na - (Cl + HCO3)
normal: 8-12

(Na+K)-(Cl+HCO3)
normal: 16

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12
Q

anion gap >12 - causes

A

MUDPILES:
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic Acidosis
Ethylene glycol
Salicylates (late)

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13
Q

normal anion gap causes (8-12)

A

HARDASS
Hyperalimentation
Addison ds
Renal tubular acidosis
Diarrhea
Acetazolamide
Spirinolactone
Saline infusion

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14
Q

transudate vs exudate

A

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

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15
Q

lights criteria for pleural effusions
- transudate

A

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

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16
Q

lights criteria for pleural effusions
- exudate

A

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

17
Q

bronchalveolar lavage fluid analysis
diagnostic uses

A

diagnostic- pulm infx, acquired pna, ILDs, lung ca, lung transplant monitoring

18
Q

bronchalveolar lavage fluid analysis
- what is tested w the fluid
- results?

A

culture, WBC count, gram stain

bloody- alveolar hemorrhage
cloudy- pulm alveolar proteinosis
microscopy/biomarkers

19
Q

community acquired pna- pathogens

A

s.pneumoniae, mycoplasma pneumoniae, F.influenza, legionella, bordetella pertussis

20
Q

viral pna- pathogens

A

influenza, covid 19

21
Q

PNA- ventilator infx
- drug resistant

A

k.pneumonia, p.aeruginosa, a.baumanii, MRSA

22
Q

PNA- travel pathogens

A

tb, fungal

23
Q

PNA- depressed immunity pathogens
- hiv pt, neutropenic pt

A

HIV
- pneumocysitis jirovecci
- CMV

neutropenic
- aspergillus

24
Q

PNA testing

A
  • 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
25
asthma Dx
spirometry, PFT, CXR, allergy testing
26
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 ## Footnote copd presentation but never smoked-- might be AAT1 def
27
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
28
ARDS Dx and Tx
Hx, CXR, CT, ABG, Echo, cardiac biomarkers tx: o2, IV fluids, underlying ds
29
neonatal resp distress syndrome - clin features
incomplete development, preterm infants - deficiency in surfactant, prevents alveolar collpase during exhalation - HAVE perfusion, lack ventilation
30
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)
31
sepsis- clin features
severe physiological and biochemical response to a global infection - response to infection is no longer localized
32
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
33
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
34
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 ## Footnote cancer is the answer, tissue is the issue