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PAR2012 - Respiratory > Week 10 > Flashcards

Week 10 Flashcards

1
Q

What are the 3 things that keep the lungs dry and not in pulmonary oedema?

A
  • Lymphatic drainage
  • balance between pressures
  • Capillary permeability
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2
Q

What is cardiogenic PO?

A

oedema due to the movement of excess fluid into the alveoli as a result of an alteration in one o more of starling’s forces. Its high pulmonary capillary pressures that responsible for abnormal fluid movement.

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3
Q

What is non-cardiogenic PO?

A

caused by various disorders not related to the heart.

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4
Q

what are two main causes for non-cardiogenic PO?

A

Injury to capillary endothelium

Blockage of lymphatic vessels

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5
Q

What is the pathophysiology for non-cardiogenic PO?

A
  • injury to capillary endothelium
  • increased capillary permeability and disruption of surfactant production by alveoili
  • movement of fluid and plasma proteins from capilary to interstitial space and alveoli
  • Pulmonary oedema
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6
Q

What are the causes of non cardiogenic APO?

A
  • Smoke inhialation
  • drowning
  • negative pressure PO
  • Acute respiratory distress syndrome
  • Sepsis
  • Disseminated intravascular coagulopathy
  • High altitude
  • neurogenic PO
  • Opiod overdose
  • PE
  • Eclampsia
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7
Q

what are the 2 ways that smoke or toxic chemical interferes with alveolar?

A
  • presence of gas other than air means a reduction in o2 available to capillary blood
  • causes a shunt
  • toxic gases likely to irritate lung causing inflammatory response
  • results in fluid moving into alveoli
  • more shunting
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8
Q

what does inhalation injury cause?

A

damage to endothelial cells
produces mucosal oedema of small airways
decreases alveolar surfactant activity
results in bronchospasm/airflow obstruction and atelectasis

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9
Q

what are some clues for smoke inhalation?

A 
- burns to face
singed eyebrows
blistering inside mouth
sooty sputum
hoarseness, stridor, brassy cough
SOB
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10
Q

what are signs and symptoms of inhalation injury?

A 
cough
sore throat
SOB
increased RR
hoarseness or noisy breathing
drooling
headache
red and irritated eyes
acute mental status changes
confusion, fainting, seizures, coma
skin colour
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11
Q

what are some major consequences of smoke inhalation?

A

carbon monoxide poisoning

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12
Q

what is carbon monoxides affinity for haemoglobin?

A

200x more than oxygen

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13
Q

what should all patients with carbon monoxide poisoning recieve?

A

100% oxygen non-rebreather

evaluate for hyperbaric o2 therapy

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14
Q

What are signs and symtoms of cyanide poisoning?

A
  • general weakness
  • confusion
  • bizarre behaviour
  • excessive sleepiness
  • coma
  • sob
  • headache
  • diziness
  • seizures
  • may complain of palpitations
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15
Q

What are signs and symtoms of cyanide poisoning?

A
  • general weakness
  • confusion
  • bizarre behaviour
  • excessive sleepiness
  • coma
  • sob
  • headache
  • diziness
  • seizures
  • may complain of palpitations
  • no signs of cyanosis
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16
Q

What should you do to manage a patient with cyanide poisoning?

A
  • remove pt from source
  • 100% o2 with BVM
  • may need intubation
  • if pt has resp distress of mental status changes need intubation
    may need to suction mucus
    IV fluids as required
    pain mgmt as required
    transport
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17
Q

Define drowning?

A

the process of experiencing respiratory impairment from submersion/immersion in liquid.

18
Q

What are the three reflexes involved in drowning?

A
  1. Airway irritant reflexes - aspiration of water into mouth initially stimulates swallowing, followed by coughing, glottic closure and laryngospasm (if water goes beyond vocal fold it causes bronchospasm
  2. Cold shock - combination of cardio and resp reflexes due to sudden total-body immersion in cold water
  3. Diving reflex - cold water stimulation of face and eyes - produces bradycardia, peripheral vasoconstriction and apnoea
19
Q

what percentage of drownings involve aspirating large amount of water?

A

90%

20
Q

what drowning reflex is more common? cold shock or diving?

A

cold shock.

21
Q

what is ARDS (acute respiratory distress syndrome)

A

severe inflammatory lung injury to the vascular endothelium and the alveolar epithelium.

22
Q

What can cause ARDS?

A

direct or indirect injury to the lung.

23
Q

What is an example of a direct injury to the lung causing ARDS?

A

pneumonia

aspiration of gastric contents

24
Q

What is an example of indirect injury to the lung causing ARDS?

A

sepsis
shock
bacterial pneumonia
multiple trauma

25
Q

How do patients ith ARDS present?

A

severe resp distress

onset within 2 hours of the incident

26
Q

what is the pathological process of ARDS?

A
  • direct / indirect injury
  • initiation of inflammatory-immune response
  • activation of neutrophils, macrophages and platelets release of chemical mediators
  • damage to alveolo-capillary membrane
27
Q

what is the resulting pathophysiological outcome of ARDS?

A
  • atelectasis and decreased lung compliance
  • noncardiogenic pulmonary oedema and intrapulmonary shunting
  • pulmonary hypertension
  • pulmonary fibrosis
28
Q

what is neurogenic pulmonary oedema?

A

acute onset of PO following significant injury to CNS

  • suspected cause is a surge in catecholamines
29
Q

what is cushings triad?

A

Signs of traumatic brain injury

Bradycardia
Hypertension
Adventitious respirations

30
Q

what kinds of events are seen with neurogenic pulmonary oedema?

A
  • spinal cord injury
  • subarachnoid haemmorhage
  • TBI
  • intracranial haemorrhage
  • status epilepticus
  • subdural haemorrhage
31
Q

what is the clinical presentation on neurogenic pulmonary oedema?

A
  • acute hypoxemia
  • tachypnea, frothy sputum or hemoptysis
  • tachycardia
  • persistent cough
  • rapid onset
32
Q

what findings are suggestive of cardiogenic APO?

A

elevated JVP

peripheral oedema

33
Q

what findings are suggestive of non-cardiogenic APO?

A

pulmonary findings may be normal in early stages

34
Q

What differentials would you see in cardiogenic APO in regards to hypoxemia?

A
  • hypoxemia is due to VQ mismatch

- should respond to o2 therapy

35
Q

What differentials would you see in non cardiogenic APO in regards to hypoxemia?

A

hypoxemia due to intrapulmonary shunting

- low o2 persists despite o2 therapy

36
Q

What are the 3 main aspects to treating non-cardiogenic apo?

A
  • improving resp function
  • treating underlying cause
  • avoiding further damage to lungs
37
Q

what are 2 methods of non-invasive ventilation?

A

CPAP

BiPAP

38
Q

What is cystic fibrosis?

A

autosomal recessive inherited disorder

39
Q

what is the pathophys of cystic fibrosis?

A

characterised by abnormal secretions that cause obstructive problems within resp, digestive and reproductive tracts

40
Q

What is pulmonary fibrosis?

A

thickening of lungs and excessive amount of fibrous and connective tissue in lung

-

41
Q

what causes pulmonary fibrosis?

A

inhilation of harmful substance.

fibrosis results from chronic inflammation

42
Q

what are signs and symptoms of CF?

A

perisstent cough or wheeze
sputum production
recurrent or sever pneumonia

may include chronic sinusitis and nasal polyps

may have digital clubbing, barrel chest, persistent crackles

PAR2012 - Respiratory (13 decks)

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