Restrictive Lung Disease

Question 1

Restrictive disease characterized by what

Answer 1

Proportional decrease in all volumes and preservation of expiratory flow

Question 2

PFTs in restrictive lung disease

Answer 2

Reduced: TLC, FRC, RV, VC <70ml/kg, FEV1, FVC, TV exhaled, lung compliance. VQ mismatch. No change in FEV1/FRC

Question 3

Classifications of restrictive lung disease

Answer 3

Acute intrinsic (pulm edema and ARDS), chronic intrinsic (sarcoidosis), chronic extrinsic (chest wall/abd/NM disease), disorders of pleura and mediastinum

Question 4

Pulmonary edema signs

Answer 4

Bilateral opacity cxray. If cardiogenic: tachypnea/dyspnea, SNS activation (htn, tachycardia, sweaty)

Question 5

Aspiration pneumonitis signs

Answer 5

Pulmonary edema and atelectasis. Arterial hypoxia, tachypnea, bronchospasm, pulm htn, cxr changes 6-12 h later in RLL

Question 6

TX aspiration pneumonitis

Answer 6

Inc Fio2, PEEP, B2 agonist for bronchospasm. Maybe steroids

Question 7

Negative pressure pulmonary edema. Causes

Answer 7

2-3 h after upper a/w obstruction in spontaneously breathing pt. Post extub laryngospasm, OSA, hiccups, epiglottitis, tumors

Question 8

What negative intrapleural pressures cause

Answer 8

Dec hydrostatic pressure, inc venous return/afterload on LV/SNS outflow

Question 9

Negative pressure pulmonary edema: presentation, duration, tx

Answer 9

Tachypnea, cough, sa02 <95%. 12-24hrs. 02, patent a/w, mechanical vent maybe

Question 10

Sarcoidosis: what it leads to, types

Answer 10

Pulmonary fibrosis. Pulm htn and cor pulmonale. Laryngeal (hard to pass normal sized ett), myocardial (conduction defects)

Question 11

Sarcoidosis: presentation, common procedure, tx

Answer 11

Dyspnea/cough/rapid shallow breathing. Mediastinoscopy to dx lymph node tissue. Steroids, consider stress dose intraop

Question 12

Chronic extrinsic: what happens to anatomy

Answer 12

Inc WOB from compressed lungs. Inc a/w resistance. Abn chest wall mechanics. RV dysfunction, compression of pulm vasculature. Cough preserved.

Question 13

NM disorders that prevent normal resp pressures results in 6

Answer 13

Impaired secretion clearance, impaired cough leads to infection/COPD, aspiration from inability to swallow, pna, RF, sensitive to CNS depressants

Question 14

Mediastinal tumor considerations

Answer 14

Compresses PA/myocardium/or SVC. May occlude in supine position or if given muscle relaxant. See scans for tracheobronchial compression/degree

Question 15

Factors that signal increased risk

Answer 15

VC <15 ml/kg, resting hypercarbia

Question 16

Anesthesia management of vent. Settings. Caution w use of what. VA consid.

Answer 16

PEEP to expand stiff lungs, lower TV/higher rates. N2O- risk of barotrauma/ptx. Accelerated uptake from decreased FRC/increased RR

Question 17

Anesthesia management: pre induction, maintenance, regional

Answer 17

Pre: avoid vent depression, little reserve. Shorter acting agents preferred to avoid post op resp depression. >T10 will lose accessory muscles which help w spontaneous vent

Question 18

Ventilation: what is super important. Expect what, specific vent setting numbers

Answer 18

Pre oxygenation, dec FRC. Sa02 drops quickly w apnea. Dec vol 4-8 ml/kg, inc rate 14-18, keep end insp p <30, consider barotrauma risk

Question 19

Extubation criteria

Answer 19

PaO2 >60, PaCo2 <50, rr <30, tv >300, VC >10-15. Adequate LOC, full reversal NMB

Question 20

Post anesthesia management

Answer 20

Supplemental 02 for transport, tx pain but avoid depression.

Question 21

Critically ill pts: if emergency sx do what

Answer 21

Diuretic for fluid overload. Vaso dilators/inotropes for HF, drain pleural effusions/ascites pre op. May require ICU vent. Aggressive hemodynamic monitoring