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29 Cards in this Set

  • Front
  • Back
What are two types of pulmonary edema?
1. Noncardiogenic Pulmonary Edema
2. Cardiogenic -Hemodynamic pulmonary edema
Which end of the capillary is the
Starling Equation +9? (causing net fluid out)
The net fluid is positive (fluid out) at the arterial end of the capillary. (+9)
Which end of the capillary is the Starling Equation -8? (causing net fluid into cap)
the net fluid is negative (fluid out) at the venous end of capillary (-8)
What is the etiology of noncardiogenic pulmonary edema?
Direct assault on pulmonary capillaries
What is the etiology of cardiogenic pulmonary edema?
Occurs with a net increase in Hydrostatic pressure (poor LV fx= Inc PVR)
What are the s/sx of stage 1 Pulm Edema?
Tachypnea with small changes in oxygenation (only interstitial edema present)
What are the s/sx of stage 2 Pulm Edema?
Tachypnea with preserved gas exchange; (fluid fills interstitium into alveoli)
What are the s/sx of stage 3 Pulm edema?
PaCO2 dec. with persistent tachypnea; (Alveoli in dependent areas are flooded, shunting occurs, perfusion without ventilation)
What are the s/sx of stage 4 Pulm Edema?
Hypercapnia and hypoxemia-- PaCO2 increases -PaO2 decreases. (marked alveoli flooding= pink frothy sputum)
Treatment of cardiogenic pulmonary edema(hemodynamic)?
1. Improve LV function 2.Diuretics 3. Vasodilators-dec.pulm.blood flow
4.PEEP-decreases preload and afterload
Describe POPE I?
Negative intrathoracic pressure causes augmented venous return and increases hydrostatic pressure- when pressure is relieved, fluid is forced into alveoli.
An examples of POPE I?
Biting an ETT and attempting to inspire against a closed glottis and post-extubation laryngospasm.
Describe POPE II?
Pulmonary edema that develops acutely after surgical relief of a chronic upper airway obstruction
Examples of POPE II?
Tonsillectomy, Upper airway tumor removal, and removal of PEEP.
Clinical signs of a tension pneumothorax
1.ipsilateral absence of breathsounds
2. hyperresonance to percussion
3.contralateral trachea shift
4. JVD distension
Characteristics of ARDS
Acute Increased Capillary membrane permeability:
1. Acute inflammatory lung injury
2. Influx of protein-rich edema fluid into the alveoli
Causes of ARDS
1. Sepsis
2. Trauma
3. Shock
also... Aspiration, Multi-clood transfusions, burns, DIC, Drug overdose, pulm contusion, etc...
What are the big three response to inflammation with ARDS?
1. Capilllary membrane permeability
2. Pulmonary Vasoconstriction
3. HPV Abolished
What are the s/sx of ARDS?
Arterial hypoxemia resistent to treatment with supp O2.
How is ARDS diagnosed?
PaO2<60 mm/Hg
PaCO2 >50 (absence of resp compensation to met alkalosis)
Dec pHa
Dec FRC & lung compliance
Inc. PVR
What are the goals of treatment of ARDS?
1. Correction of hypoxemia
2. removal of excess Carbon dioxide
3. providing a patent upper airway
What is the consequence of abolished HPV in ARDS ?
1. Alveolar Cells destroyed
2. Inc. surfactant Production
3. Airway Collapse
*** Fibrosis and permanent scarring
Suggested MV settings with ARDS?
FiO2 to maintain PaO2 60-80
TV: 5-8ml/kg
keep PIP< 34-40
(small TV, higher RR)
PEEP: to improve V/Q match
Inverse-Ratio Ventilation: 2:1 ratio
Volume control ventilation description?
TV is set
IP is variable
Inspir Flow is set
Inspir Time is set (by flow and vol settings)
RR -set minimum
Pressure control ventilation description?
TV is variable
IP limited by pressure
Inspir Flow is variable
Inspir Time is set directly
RR -set minimum
Advantages and disadvantages of Vol Control Vent?
ADV: Gives a guaranteed min ventilation
DisADV: Dangerous High alv pressures (bad for ARDS)
ADV and DisADV of Presure Control Ventilation?
ADV: Gives high and variable insp flow rates (esp with stiff lungs) and avoids barotrauma
DisADv: Insp flow may not match the pt's demands= fatigue and dysynchrony
What is the current treatments of ARDS?
Support Ventilation
Treat underlying cause (sepsis)
Steroids
iNO
ECMO, HFJV
What are some of the direct physical injuries to the lung, that can cause ARDS?
Aspiration
Inhalation of Toxins
Embolic Injury