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1a. 675 - Coexisting Diseases > Week 3 - Restrictive Respiratory Disease/Lung Transplant/P. HTN > Flashcards

Week 3 - Restrictive Respiratory Disease/Lung Transplant/P. HTN Flashcards

1
Q

What is the hallmark of Restrictive Lung disease?

A

Inability to ↑ lung volume relative to ↑ in alveolar pressure

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2
Q

In Restrictive lung disease:

A

Lungs are restricted from fully expanding

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3
Q

Principle feature of RLD?

A

↓ in TLC

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4
Q

What measures of RLD result in Mild, Moderate, or Severe disease?

A
  • Mild: 65-80% of predicted TLC
  • Moderate: 50-65% of p. TLC
  • Severe: < 50% of p. TLC
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5
Q

Difference between Restrictive Vs. Obstructive LD?

A
  • Restrictive: Cannot fill their lungs
  • Obstructive: Cannot exhale all air out
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6
Q

Two characteristics of RLD?

A
  • ↓ in TLC(Lung volume)
  • ↑ or normal FEV1/FVC
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7
Q

Two characteristics of OLD?

A
  • ↑ in TLC
  • ↓ in FEV1/FVC
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8
Q

What lung volume changes are there in RLD?

A

↓ in ALL volumes, especially TLC

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9
Q

What are examples of acute intrinsic disease in RLD?

A
  • Alveolar/Interstitial pulmonary Edema
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10
Q

What are examples of extrinsic RLD?

4 + 1

A

Disorders of the chest wall, pleura, mediastinum
* Mediastinal Mass
* Pneumothorax
* Ankylosing spondylitis
* Muscular Dystrophy

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11
Q

What are some Other examples of RLD?

A
  • OBCT
  • Ass-kites
  • Pregnancy

Obesity, ascites

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12
Q

What is the acronym and definition for causes of RLD?

A
  • P: pleural
  • A: alveolar
  • I: interstitial
  • N: neuromuscular
  • T: thoracic cage abnormalities
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13
Q

Pt population(s) @ risk for RLD?

5

A
  • > 75 years
  • African-American
  • Females due to sarcoidosis
  • Obese
  • Smokers
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14
Q

Volume and defnition of FVC?

A

Forced Vital Capacity (~4,500mL)
* Amount of air forcefully exhaled in one breath

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15
Q

Volume & definition of FEV1

A

Forced Expiratory Volume over 1 second (3-4L)

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16
Q

What does a FEV1/FVC represent and how is it measured?

A

Amount of FVC able to expire in 1 second (75-80%)

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17
Q

What kind of disease is present if the FEV1/FVC is normal/↑
FVC & TLC is ↓
DLCO is ↓

A

Interstitial RLD (inside the lungs)

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18
Q

What kind of disease (& 3 examples) is present if the:

  • FEV1/FVC is normal/↑
  • FVC & TLC is ↓
  • DLCO is normal
A

Extrinsic RLD
* Neuromuscular disease
* Kyphosis
* Obesity

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19
Q

Anesthetic management of RLD

4

A
  • Avoid drugs w/ respiratory effects in PACU
  • Monitor for Pneumothorax
  • Cautious use of regional above T10
  • Mechanical ventilation improves O2 & ventilation
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20
Q

What factors ↓ FRC?

A
  • General Anesthesia
  • Supine Position
  • Controlled Ventilation
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21
Q

Anesthetic considerations for pts w/ Chronic ILD?

3

A
  • Caution w/ factors that ↓ FRC
  • ↑ uptake of volatiles 2/2 ↓ FRC
  • Keep Ppeak/Pplat < 30cmH20 to avoid barotrauma
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22
Q

What are some diseases that qualify as acute intrinsic RLD?

7 +1

A

The Edemas
* Pulm. edema
* Neurogenic PE
* Cardiogenic PE
* Drug-induced PE
* High-Altitude PE
* Re-expansion PE
* Negative Pressure PE

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23
Q

Two causes of Pulm. edema?

A
  • ↑ capillary pressure (Hydrostatic)
  • ↑ capillary permeability
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24
Q

S/s of Aspiration PNA?

5

A
  • Arterial Hypoxemia
  • Tachypnea
  • Broncospasm
  • Acute P. HTN
  • ↑ airway pressure
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25
Q

Tx of Aspiration PNA?

4

A
  • O2
  • PEEP
  • Bronchodilators
  • +/- ABX, Steroids
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26
Q

How does neurogenic pulmonary edema occur?

4

A

Acute brain injury -> inflammatory reaction -> ↑ SNS release -> ↑ pulmonary hydrostatic pressure

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27
Q

What factors ↑ risk for re-expansion pulm. edema?

3

A
  • > 1L of fluid/air in pleural space
  • > 24 hrs of collapse
  • Rapid re-expansion
28
Q

What risk factors ↑ occurance of Negative pressure pulm. edema?

4

A
  • Spontaneously breathing (need negative pressure)
  • Young, Healthy, Male athletes
  • Acute upper airway obstruction
  • Head/Neck Surgery
29
Q

Causes of negative pressure pulm. edema?

6

A
  • Laryngospasm
  • Epiglottitis
  • Tumor
  • Obesity
  • Hiccups
  • OSA
30
Q

Your patient is experiencing a prolonged laryngospasm resistant to non-pharmacologic measures, what drug, dose, and intervention should be considered

A
  • Succinylcholine: 1mg/kg
  • Reintubation/Mechanical ventilation
31
Q

S/s of negative pressure pulm. edema?

3

A
  • Tachypnea
  • Cough
  • Failure to remain >95% O2
32
Q

Onset of Negative pressure pulm. edema?

A

Few minutes -> 2-3 hrs after relief of airway obstruction

33
Q

Definition of Acute Respiratory failure

A

Inability to:
* Oxygenate
* Eliminate CO2

34
Q

Objective indications of ARF?

A
  • PaO2 < 60mmHg despite O2 supplementation
  • PaCO2 >50mmHg w/o respiratory compensation
35
Q

Management of ARF?

3

A
  • Maintain patent airway
  • Correct hypoxemia
  • Remove excess CO2
36
Q

Interventions in increasingly invasive order to Maintain PaO2 > 60mmHg?

A
  1. Supplementary O2 to spontaneous breathing pts
  2. CPAP
  3. Intubation & Ventilation
  4. Intubation w/ PPV & sedation/NMB
37
Q

What objective sign will be present in chronic hypoxemia?

A

↑ RBCs

38
Q

What is the definition of ARDS used to measure severity?

A

↓ PaO2/FiO2 ratio

39
Q

P/F ratios used to determine ARDS Severity?

A
  • Mild: 201-300
  • Moderate: 101-200
  • Severe: < 101
40
Q

You’re trying to determine if your pt has mild/moderate/severe ARDS, what MUST be applied in order to determine the P/F ratio?

A

P/F ratio must be calculated with a CPAP/PEEP of 5 cmH2O

41
Q

Ventilator parameters for pts w/ ARDS?

6

A
  • Any mode
  • I:E ratio: 1:1-1:3
  • PEEP: > 5 cmH2O ( >12cmH2O for mod/severe ARDS)
  • RR: < 35 bpm
  • TV: 4-8 mL/kg PBW
  • Pplat: < 30cmH2O
42
Q

Definition of plateu pressure

A

Pressure required to keep lungs inflated in absence of airflow

43
Q

Definition of P. HTN?

A

MPAP > 25 mmHg

44
Q

Some causes of P. HTN?

3

A
  • COPD
  • L heart disease
  • Connective tissue disorders
45
Q

Definition of Precapillary P.HTN?

A

↑ PVR w/o ↑ in LA pressure
* (PCWP < 15 mmHg)

46
Q

Defintion of Postcapillary P. HTN?

A

↑ in LA pressure (PCWP >15mmHg)

47
Q

Definition of Mixed P.HTN and what does it reflect?

A

↑ in PVR & ↑ in LA pressure
* Chronic P.HTN

48
Q

Mixed P.HTN is also known as what, and reflects what?

A

Reactive P.HTN
* L Heart Failure

49
Q

High-flow P. HTN occurs due to what occurrance? How are PVR and PAWP reflected?

A

Systemic->pulmonary shunt
* PVR/PAWP = normal

50
Q

How do you prevent ↑ in P.HTN / PVR?

9

A

Avoid:
* Hypoxia
* Hypercarbia/Acidosis
* Hypothermia
* Atelectasis
* PEEP
* Pain
* N2O
* Desflurane
* Ketamine

51
Q

Induction agent of choice in P.HTN?

A

Etomidate

52
Q

RV + ERV = What two things? (Name & value?)

Risidual volume + Expiratory reserve volume

A

1.5L + 1.5L = 3L or FRC

Functional residual capacity

53
Q

What kind of flow loop does this represent?

A

Restrictive LD

54
Q

What kind of flow loop does this represent?

A

Normal

55
Q

What kind of flow loop does this represent?

A

Obstructive LD

56
Q

What specific RLD doesn’t respond to O2 therapy?

A

ARDS

57
Q

What are some distinct differences between ARDS and Cardiogenic pulm. edema?

A

ARDS:
* Normal Heart size
* Refractory to O2 therapy
* PCWP < 18 mmHg

Cardiogenic edema:
* Cardiomegaly
* Hypoxemia improved w/ O2 therapy
* PCWP > 18mmHg

58
Q

What side of the heart has dysfunction in Cardiogenic Pulm. edema?

A

L side dysfunction

59
Q

Maintenance drug of choice in P. HTN?

A

Sevoflurane

60
Q

A patient with RLD develops hypoxia rapidly during an apneic event, what lung volume is responsible for keeping their oxygenation?

A

FRC = ERV + RV

61
Q

A PFT shows RLD, but DLCO is increased, what kind of RLD?

A

Obesity (chronic extrinsic)

62
Q

A PFT shows RLD, but DLCO is decreased, what kind of RLD?

A

Chronic instrinsic RLD

63
Q

What’s another name for Aspiration Pneumonitis?

A

Mendelson’s Syndrome

64
Q

What kind of drugs increase gastric pH?

A
  • Bicitra (Sodium Citrate)
  • Pepcid (Famotidine)
65
Q

What population regularly requires an increase in gastric pH?

A

Obstetrics

1a. 675 - Coexisting Diseases (12 decks)

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