Ventilator Flashcards
Rise time
Time to reach the target inspiratory pressure and the adjustable inspiratory time.
Muscle fatigue can be expected if pressure time index is
More than 0.15
VILI can be seen at Transpulmonary pressures more than
30 to 35 CM h2o
Safe fio2 values
40% safe for prolonged periods
Arterial po2 more than 120-130mm hg may produce systemic toxicity
Two new modes of ventilation
Proportional assist ventilation - PAV
Neurally adjusted ventilator assistance - NAVA
4 Pulmonary infectious complications in mech ventilator patients
1- compromised natural Glottic closure
2- ET tube impairs cough reflex portal for pathogens to enter lungs
3- Airways and parenchymal injury
4- ICU environment and use of antibiotics and many sick patients in close proximity
Care bundles
Hand washing, elevated head end of bed, oral care with chlorhexidine, appropriate antibiotics
3goals for ventilation setting
Enough PEEP to recruit alveoli
Avoidance of peep -TV combination that causes over distension
Limiting TV to physiological range
Most common etiology of SVC syndrome
bronchogenic carcinoma and lymphoma
Agents used for pleurodesis
Talc most common
Tetracycline, bleomycin, iodine povidone, nitrogen mustard, corynebacterium parvum, silver nitrate
Young’s syndrome
Bronchiectasis, sinusitis, infertility(azoospermia)
Kartagener syndrome
Primary culinary dyskinesia, situs inversus totalis
Primary ciliary dyskinesia
HrCt shows lower lobe involvement more and sparing of upper lobe
Lady windermere syndrome
Women suppress cough voluntarily causing retention of secretions. M/C a/w MAC infections.
Thoracoscopy was introduced by
Hans-Christian Jacobaeus
Semirigid pleuroscope dimensions
Proximal 22 cm is stiff, distal 5 cm bendable, angulation of 160 and 130 degrees, outer diameter of shaft is 7mm and working channel diameter of 2.8 mm
Schramel and co workers pneumothorax grade
1-normal lung
2-pleuropulmonary adhesions
3-bullae and blebs <2cm in diameter
4-numerous large bullae >2cm in diameter
Will Rogers Phenomenon
Seen in PET CT, patients that move from one stage to another can improve survival rates in both the stages
RPGN identified D/D
Anca associated vasculitis, idiopathic Pauci immune glomerulonephritis, SLE, good pasture syndrome, post infectious glomerulonephritis, IgA nephropathy, Henoch -schonlein purpura, essential cryoglobulinemia, MPGN
Deoxyspergualin
Antitumour and Immunosupressant used in refractory ANCA associated vasculitis
Clinical antisynthetase syndrome
AB to aminoacyl transferase RNA synthetases
Co existence of myositis, diffuse lung disease and arthritis.
M/c is jo 1
Csf ZN stain
4-40%
CSF L/J C/S
25-70%
CSF gene xpert sensitivity specificity
80.5%, 97.8% respectively
Ortners syndrome
Hoarseness of voice due to compression of left recurrent laryngeal nerve due to enlarged left atrium seen in mitral stenosis
Differentials of aspergilloma on CT
Organised hematoma, pus in cavity, neoplasm, abscess, wegener granulomatosis, ruptured hydatid cyst.
Modified Ravitch procedure
Thoracic surgery - resection of Costal cartilage, sternal osteotomy, with or without fixation of the sternum with internal/external supports
Nuss procedure
Thoracic surgery- placing a curve metal rod under the sternum through small incision on each side of the rib cage
Blau syndrome
Granulomatous iritis, arthritis, skin rash
Sarcoidosis
Dry skin common problem with
Cfz
Order if reintroduction for skin rash for mdr tb
H ,R ,Z, ETO, CS, E, PAS, FQ ,KM
Pancreatitis
Lzd, BDQ
Antacids
Decrease absorption of FQ
Ondensetron
Prolongs QT interval
Pseudomembranous colitis
FQ
When to stop all hepatotoxic drugs
Enzymes 5 times ULN
Short MDR Tb hepatotoxicity drugs to with hold
H, ETO, Z
Short mdr tb drugs to re introduce order
ETO, H, Z
Monitor AST ALT for every
3 days after reintroduction
Longer MDR TB hepatotoxicity drugs to with hold
ETO, Z, BDQ
Longer MDR TB hepatotoxicity drugs to reintroduce order
BDQ, ETO, Z
Shorter MDR TB regimen
Mfx, Kn/Am, ETO, Cfz, H, Z, E
Giddiness in MDR TB
Aminoglycosides, ETO, FQ, Z
Hypothyroidism
Eto/pto, pas
Arthralgia
Z, FQ , BDQ
Peripheral neuropathy
Lzd, CS, H, S, Km, Cm, Am, FQ, rarely pto /eto, E
Depression
Cs, FQ, H, ETO /PTO
Psychosis
Cs, FQ, H
Seizures
Cs, H, FQ
Superficial fungal infection and thrush
FQ
Dysglycemia and hyperglycemia
Gtx, ETO /PTO
DR TB follow up after treatment completion
6,12,18,24 months after treatment completion
Non lactose fermenting gram negative bacilli
Acinetobacter, pseudomonas, burkholderia
Important cause of health care associated pneumonia
Discharge of CAP patient
Hemodynamically stable, afebrile, accepting oral feeds for at least 48 hrs
Bradycardia with fever
Legionella, C. Psitassi, Mycoplasma , F. Tularensis
Ecthyma gangrenosum
Pseudomonas. aeruginosa
Nitinol coils
Sx management of copd
Interventional therapy in stable COPD
LVRS, bullectomy, transplantation, bronchoscopic interventions - endobronchial valves, lung coils, vapour ablation.
Copd anxiety questionnaires
The hospital anxiety and depression scale(HADS) and primary care evaluation of mental disorders. (PRIME - MD)
Lung transplant criteria for referral COPD
Bode index 5-6, pco2 >50 mm hg,
Pao2 <60 and fev1 <25%
Recommended criteria for listing for lung transplant
Bode index >7,
fev1 15-20%,
Three or more severe exacerbation in 1 year,
One severe exacerbation with acute hypercapnic failure or moderate to severe pulmonary hypertension
COPD EXACERBATION
1) No respiratory failure
2) Acute respiratory failure non life threatening
3) Acute respiratory failure life threatening
1) RR 25-30, no accessory muscles use, good mental status, Hypoxic improved with supplemental oxygen via venturi mask 28-35%, no increase in paco2
2) RR >30 ,use if accessory muscles,good mental status, Hypoxic improved with venturi mask 28-35%,paco2 50-60 or elevated from baseline.
3) RR > 30, use of accessory muscle, MENTAL STATUS ALTERED, Hypoxic not improved with venturi or fio2 >40%, paco2 > 60 or elevated from baseline and PH <7.25.
Crazy paving on CT
HP, pcp, minimally invasive adeno CA, lymphangitic carcinomatosis, cardiogenic pulm edema, lipiod pneumonia.
