Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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 |