Respiratory pathophysiology 5

Question 1

Examples of antacids used for aspiration prophylaxis include

Answer 1

sodium citrate
sodium bicarbonate
magnesium trisilicate

Question 2

Examples of H2 antagonists used for aspiration prophylaxis include

Answer 2

ranitidine
cimetidine
famotidine

Question 3

Examples of GI stimulants used for aspiration prophylaxis include

Answer 3

metoclopramide

Question 4

Examples of proton pump inhibitors used for aspiration prophylaxis include

Answer 4

omeprazole
lansoprazole
pantoprazole

Question 5

Examples of antiemetics used for aspiration prophylaxis include

Answer 5

droperidol
ondansetron

Question 6

Treatment for aspiration includes

Answer 6

tilt the head downward or to the side (first action)
upper airway suction to remove particulate matter
lower airway suction is only useful for removing particulate matter
secure the airway to support oxygenation
PEEP to reduce shunt
bronchodilators to reduce wheezing
IV lidocaine to reduce the neutrophil response
steroids probably don’t help
Abx only if the patient develops a fever or an increased WBC count >48 hrs.

Question 7

Early signs of vAP include

Answer 7

presence of leukocytosis (high white blood cell count)
fever
increased secretions
increasing O2 requirements

Question 8

Methods to reduce the incidence of VAP include

Answer 8

hand washing
HOB >30 degrees
daily spontaneous breathing trials
limit sedation
oropharyngeal decontamination
subglottic suctioning

Question 9

What are the 3 types of pneumothorax?

Answer 9

closed
communicating
tension

Question 10

The hallmark characteristics of tension pneumothorax include

Answer 10

hypoxemia
increased airway pressures
tachycardia
hypotension
elevated CVP

Question 11

How does pneumothorax appear on POCUS?

Answer 11

will reveal a lung sliding and the absence of comet tails

Question 12

If you suspect a pneumothorax, you must discontinue

Answer 12

nitrous oxide immediately

Question 13

Emergency treatment of a tension pneumothorax includes

Answer 13

insertion of a 14 g angiocath into the 2nd intercostal space at the mid-clavicular line or the 4th or 5th intercostal space at the anterior axillary line

Question 14

Flail chest is a consequence of

Answer 14

blunt chest trauma with multiple rib fractures

Question 15

The key characteristic of flail chest is

Answer 15

a paradoxical movement of the chest wall at the site of the fractures

Question 16

Consequences of flail chest include

Answer 16

alveolar collapse
hypoventilation
hypercarbia
hypoxia

Question 17

Treatment of flail chest includes

Answer 17

reducing pain (epidural or intercostal nerve blocks)
some patients may require mechanical ventilation and surgical fixation

Question 18

Closed pneumothorax is a defect in the

Answer 18

pulmonary tree or lung tissue and air enters and exits the pleural space through the defect
no communication between the pleural cavity and atm

Question 19

Treatment of a closed pneumothorax includes

Answer 19

observation
catheter aspiration
chest tube insertion

Question 20

With an open pneumothorax the defect is in the

Answer 20

chest wall and air passes between the pleural space and the atmosphere

Question 21

With an open pneumothorax the lung ____________ on inspiration and ____________ on expiration

Answer 21

collapses; partially re-expands

Question 22

Treatment of open pneumothorax includes

Answer 22

an occlusive dressing that does not let air in but allows air to escape
supplemental O2
chest tube insertion
possibly tracheal intubation

Question 23

A tension pneumothorax can occur with

Answer 23

a closed or open defect

Question 24

Pneumothorax can occur after

Answer 24

central line insertion
supraclavicular, interscalene, and intercostal nerve blocks
barotrauma, high peep, or high peak inspiratory pressures
lung cysts and bullae can expand and rupture when nitrous oxide is used
surgical procedures
chest trauma

Question 25

_______________ following chest trauma should raise suspicion about a pneumothorax

Answer 25

Increasing peak inspiratory pressures

Question 26

Surgical procedures that can cause pneumothorax include

Answer 26

radical neck dissection shoulder arthroscopy mastectomy axillary lymph node dissection mediastinoscopy laparoscopy nephrectomy

Question 27

What are other substances that don't belong in the chest?

Answer 27

chylothorax hemothorax fibrothorax pyothorax (empyema) pleural effusion

Question 28

A chylothorax is

Answer 28

lymph

Question 29

A hemothorax is

Answer 29

blood

Question 30

A fibrothorax is

Answer 30

organized blood clot

Question 31

A pyothorax is

Answer 31

pus

Question 32

Hemothorax is most commonly caused by

Answer 32

bleeding intercostal vessels

Question 33

Indications for thoracotomy in the setting of a hemothorax include

Answer 33

initial drainage >1000 mL continued bleeding >200 mL/hr. white lung on CXR large air leak

Question 34

Hemodynamically stable patients wit a hemothorax and bleeding <150 mL/hr may be managed with

Answer 34

VATS

Question 35

______________ can cause chylothorax

Answer 35

injury to the thoracic duct during CVL insertion (subclavian> internal jugular insertion)

Question 36

Injury to the thoracic duct is more likely on

Answer 36

the left side

Question 37

When a gas embolism of significant size travels to the right heart, it can lodge in the

Answer 37

pulmonary outflow tract or pulmonary artery where it can produce an airlock that converts distal alveolar units to dead space

Question 38

The incidence of VAE varies with

Answer 38

patient position

Question 39

Patient positions that are highest to lowest risk for VAE include

Answer 39

sitting> supine> prone> lateral

Question 40

__________ the most sensitive diagnostic tool of venous air embolism

Answer 40

TEE

Question 41

Signs and symptoms of VAE include

Answer 41

air observed on TEE "mill wheel" murmur on precordial doppler decreased EtCO2 increased EtN2 hypotension dysrhythmias hypoxia cyanosis CV collapse

Question 42

Treatment of VAE includes

Answer 42

100% O2 flooding the surgical field discontinuing insufflation employing the Durant maneuver (left lateral decubitus position)

Question 43

Consequences of air trapped in the pulmonary circulation icnlude

Answer 43

increased pulmonary artery pressure increased RV stroke work index right ventricular failure decreased pulmonary venous return decreased left ventricular preload decreased CO asystole and CV collapse

Question 44

Most sensitive indicators of VAE from most to least include

Answer 44

TEE, precordial doppler, EtCO2, CVP, EKG/BP