Week2 Lectures Flashcards
Path and Micro
Name this tx for mechanical ventilation:
- P applied during all phases of respiratory cycle
CPAP (continuous pos pressure)
hint: tight mask; spont breathing
max P measured by ventilator during inspiration
PIP (Peak Inspatory Pressure)
P in the airways at end of expiration
PEEP (Peak End Expiratory Pressure)
Name the dvice/tx:
- pt breathes spont in bwn ventilator breaths
- support some/all breaths
SIMV (synchronized intermittent mechanical vent)
hint: pt-ventilator synchrony for comfort + help weaning
the following are conditions for ______ (controlled/normal) ventilation
- RR 8-10
- Tv 3-5cc/kg
- PIP < 35
controlled
Barotrauma can occur as a result of (3 dx)
- Pneumodmediastinum
- Pneumothorax
- Alveolar overdistension
the following are conditions for ______ (controlled/normal) ventilation
- RR = 12
- TV = 7cc/kg
normal
Explain how pH, PaCO2, and HCO3 change with the following dx’s (see pic)
answer below
What are pulmonary (4) and cardiac (2) complications for ventilation
see pic below
what should be added to the ventilation regimen when sedated pts can possibly still sense pain (2)?
- sedation: benzos/propafol
- pain: opiates/ketamine
Contraindications for ______ ventilation (NIV) -
- Coma
- ø airway protection (lethary, emesis, angioedma, mass, bleeding)
- Resp arrest
- Precipitous/Acute Instability
- pH < 7.20 rel to failure
non-invasive
explain the pathophysio behind failed CPAP tx
- = extrinsic PEEP + EPAP –> ↑alv recruitment + intrathoracic P
explain the pathophysio behind failed NIV/bilevel tx?
- P support from IPAP
- resting during inspiration (breaths should be triggered by pt?)
what are the 2 forms of Aorta Coarctation
- infantile: with PDA + tubal hypoplasia –> narrowing prox to arch
- adult: narrowing/infoldings distal to arch + branches
Name the dz
- males:females = 2:1
- 2 forms
- 50% involves bicuspid aortic valve
- assc w Turner’s Syndrome
- ± assc ASD+ VSD, aortic stenosis, mitral regurg, berry aneurysms
Coarctation of the Aorta
Name the congenital malf
- parallel pulmonary and systemic circ
- 50% VSD*
- ∆truncal/aortal septa formn
- pulm trunk + artery arises from LV, post and to the left of aorta, which arises from RV
*explain why?
Transporition of the great arteries
*bonus: required intra/extra-cardial communication, otw NCWL
15% of TOF cases occur with what 3 dx?
- Down syndrome
- Alagille syndrome
- Digeorge syndrome
what’s the syndrome?
- RV hypertrophy
- polycythemia*
- cyanosis
Eisenmenger Syndrome
* bonus: hypoxemia –> inc EPO from kidney –> inc RBCs
Which congenital defect?
- most common
- assc with fetal alcohol syndrome
- small defects → asympto; large defects → Eisenmenger
- surgical or spont closure
VSD
Which congenital defect?
- 90% involve ostium secondum
- Ostium Primum type assc w Down Syndrome
- split S2*
- complication –> paradoxical emboli**
explain * and **
ASD
*bonus: inc blood in R heart –> delayed pulm valveclosure
**bonus: R-> L shunt, thf emboli can lodge in L circuit (brain/periphery)
Which Cong Defect:
- assc with cong rubella
- cont. machine~ murmur
- L –> R shunt →bypasses Lungs –> LE cyanosis + Eis Synd
- tw indomethacin → ↓PGe → closure
PDA (patent ductus arteriosus)
Which cong defect
- R →L shunt –> early cyanosis
- boot shaped heart
- squating → cyanotic spell relief*
* explain why?
Tetralogy of Fallot (TOF)
*bonus: squatting ↑TPR → back pressure ↓shunting → more blood to lungs
The 4 chr’s of TOF
- Pulmonic Stenosis (RV outflow tract)
- RV hypertrophy
- Overriding aorta (over VSD)
- VSD
hint: PROV
Obstruction from the narrowing of pulmonic outflow tract in TOF is a results of narrowing of the ______
infidibulum (where?)
how do you treat TOF?
- PGE keeps PDA open until surgery
- surgical repair
- 10% live to adulthood w/o surgery
Which cong defect?
- PFO/ASD allows pulm blood to enter LA failed connxn of pulm vein + LA
- ± cyanosis
- LA hypoplasia w/ normal LV
- Dilation of R heart + pulm trunk
Total Anomalous Pulmonary Venous Connection
Which COng Defect
- failed tri valve formn →hypoplastic RV
- ↑mitral valve size
- ASD/PFO allows for R→L shunt; but also systemic cyanosis
- high mortality in first few wks/months
Triscupid Atresia
Which cong defect:
- failed separation of truncus → single large vessel from both ventricles
- early systemic cyanosis
- deoxy blood mixture before pulm and aortic branching
truncus arteriosus
Which defect:
- htn in UEs; ↓pulses in LEs
- collateral circ to intercostal arteries → engroged arteries + ↑rib knotching
- bicuspid aortic valve
adult coarctation of the aorta
describe a partial AV septal defect? -2
- Primum ASD
- cleaft mitral leaflet → mitral insuffc
Describe a complete AV septal defect? - 3
- combined AV septal defect + large common AV valve
- all 4 chambers freely communicate
- down syndrom in 1/3 pts
