Sleep Apnea & Resp. Failure Secondary to Covid 19

Question 1

What is an important predictor of how sick a patient is prior to covid-19 infection?

Answer 1

ESRD, dialysis dependant, or decubitus ulcer

Question 2

What is decubitus ulcer?

Answer 2

Pressure on a sore which is signs that a patient has been immobilized for a while, it is a bad predictor of the patient’s prognosis.

Question 3

Low albumin is another poor patient outcome predicator. What are three things low albumin can indicate?

Answer 3

1. Malnutrition problems, lack of protein
2. Liver disease (or liver cirrhosis): liver creates albumin to help fluids from leaking out from the blood vessels into other tissues.
   3.Inflammation (could be due to sepsis)- this is due to albumin being largely consumed by inflammation within the body

Question 4

Where are hemoglobin levels values more accurate based on laboratory testing?

Answer 4

CBC are more accurate than on an ABG

Question 5

What is the reason for distinction in anion gap?

Answer 5

Caused by a shortage of bicarbonate and non-anion acidosis caused by acid accumulation in the circulation.

Question 6

If someone is acidotic on their ABG describe the two steps you would take.

Answer 6

1) check the anion gap and 2) if high, figure out where the waste of bicarb is going.

Question 7

What is renal tubular acidosis?

Answer 7

Where the kidneys are damaged and cannot remove acid waste from the blood and instead will dump the bicarbonate into the urine.

Question 8

What can lead to kidney failure?

Answer 8

Clogging of blood vessels in the kidney (blood clots)

Question 9

Why does metabolic acidosis occur?

Answer 9

Due to low bicarbonate levels & the part of the blood gas that affects that is the anion gap.

Question 10

What is the meaning of a high anion gap?

Answer 10

Means the acid is building up in the bloodstream.

Question 11

How do you treat metabolic acidosis?

Answer 11

Have the patient urinate and the organ that helps get rid of the acid in the bloodstream are the kidneys.

Question 12

Can you always depend on your ABG for intubation? If not, what is your basis?

Answer 12

Mainly based on our assessment and how patients look in order to determine.

The decision to intubate is not from objective blood gas results but subjective visual inspection of the patient’s appearance. (labored breathing, accessory muscle usage then consider intubation not just strictly blood gas results)

Question 13

What is acinetobacter?

Answer 13

It is a bacteria that cause infection in the blood, urinary tract, lungs, or wounds in other parts of the body.

Question 14

What is sleep apnea?

Answer 14

A condition where the airway is relaxed during sleep which results in snoring. Body structures affected are nostrils flaring, muscles such as the soft palate, tonsils, and pharyngeal distor constriction.

Question 15

What is a normal breathing mechanism while sleeping breakdown?

Answer 15

nostrils flare, the soft palate elevates, pharyngeal muscles contract, the glottis opens, the diaphragm drops and air moves down.

Question 16

What are the 3’s in OSA symptoms?

Answer 16

1. SNORING
2. SLEEPINESS or SOMNOLENT
3. SPOUSAL REPORT TO APNEA

Question 17

What are some causes for OSA?

Answer 17

-Obesity
-COPD
-neuromuscular disease
Obesity and OSA are also very strongly associated with hypertension.

Question 18

What is leptin and what is its effect on OSA patients?

Answer 18

Leptin is a protein product of adipocytes that suppresses appetite and increases energy expenditure, hence inducing weight loss. Obese people have high leptin levels which persist due to presumed resistance to appetite suppressant along with the metabolic effects of leptin.

Question 19

What is the best way to diagnose OSA?

Answer 19

Polysomnography

Question 20

Which is the typical treatment for OSA and what does it achieve?

Answer 20

-CPAP: which provides continuous positive airway pressure is the typical treatment for OSA.
-Goal is to push the airway walls aside in order to allow the patient to breathe & maintain a patent airway. Preferred to put them on an air titrating machine to end arenas or actually measure in the lab.

Question 21

What are the lowest and highest settings for CPAP in OSA patients?

Answer 21

Lowest - 8
Highest - 18

Question 22

What is a tongue stabilizer achieve in OSA patients?

Answer 22

It is placed in order for people with OSA to sleep without the tongue obstructing the flow of air in and out of the lungs.

Question 23

What is the Inspire Machine and how does it work?

Answer 23

This device is surgically implanted under the skin hypoglossal nerve in the neck and diaphragm & works by sending a signal to the hypoglossal nerve to tighten the tongue during sleep so that it does not fall back& obstruct the airways but instead pushes forward. Only some people qualify to use this type of device though, not all people with sleep apnea can use the Inspire Device.