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73 Cards in this Set
- Front
- Back
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Cardiogenic Pulmonary Edema occurs when:
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left ventricle unable to pump out all the blood it receives from the lungs
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The Pulmonary blood pressure as a result of cardiogenic pulmonary edema is:
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increased
as a result of backed up blood in veins & capillaries due to the l. ventricle inability to keep up w/the lungs |
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The increased Pulmonary blood pressure results in:
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fluid being pushed through the capillary walls and into the alveoli
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Normal pulmonary capillary hydrostatic pressure
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10 to 15 mmHg
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Normal oncotic (colloid) pressure
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25 to 30 mmHg
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The stability of the fluid within the pulmonary capillaries is determined by:
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the balance between the hydrostatic and oncotic pressure
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What is the hydrostatic pressure that the pulmonary vascular system much reach to lose its holding force over the fluid within the caqppillaries?
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>25 to 30 mmHg
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What are some common causes of cardiogenic pulmonary edema?
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systemic hypertension (Most common)
arrhythmias producing low CO (PVC, bradycardia) congential heart defects excessive fluid admin. left vent. failure (CHF) pulmonary embolus renal failure |
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Noncardiogenic pulmonary edema
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fluid from pulmonary capillaries enters alveoli in the abscence of an abnormal heart
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pulmonary edema can develop as a result of what processes?
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infection
inflammation |
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some causes of increased capillary permeability
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alveolar hypoxia
ARDS inhalation of toxic agents pulmonary infections Tx radiation of lungs head injury (a.k.a. cephalogenic pulmonary edema) |
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Causes of noncardiogenic pulmonary edema
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increased capillary permeability
lymphatic insufficiency decreased intrapleural pressure decreased oncotic pressure |
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lymphatic insufficiency can arise from:
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decreased drainage due to obliteration or distortion of lymphatic vessels.
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decreased intrapleural pressure can result from:
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Severe airway obstruction
the neg. pressure created on inspiration can cause suction effect |
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decreased oncotic pressure (rare) can result from:
(from normal 25 to 30 mmHg to < 10 to 15 mmHg) |
overtransfusion and/or rapid transfussion of IV fluids
uremia (blood in urine) severe malnutrition acute nephritis |
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Other causes of noncarcinogenic pulmonary edema
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allergic reaction to drugs
excessive Na+ consumpiton OD Metal poisoning chronic alcohol ingestion aspiration (near drowning) cardiac tamponade high altitudes >> 8 or 10,000 ft |
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Priority of critical life functions
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Ventilation
Oxygenation Circulation Perfusion |
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How is the pressure determined within the pulmonary vacular system
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PCWP obtained by a Swan Ganz a.k.a pulmonary artery catheter
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what is frank pulmonary edema?
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fluid in the air sacs
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Tx of cardiogenic pulmonary edema
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positive ionotropic drugs - make the heart pump stronger
dieuretic - relieve fluids oxygen w/CPAP - shunting ms/morphine sulfate - powerful vasodilator will pull blood into peripheral circulation which lessens workload on heart |
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What is the most common cause of cardiogenic pulmonary edema?
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Long standing hypertension
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What is the PCWP in noncardiogenic pulmonary edema?
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PCWP is normal or low
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Common structural changes associated with pulmonary edema
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increased alveolar-capillary membrane thickness, excessive bronchial secretions
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What type of respiration pattern is associated with CHF
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cheyne-stokes respiration
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what are the characteristics of the sputum in pulmonary edema?
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frothy and pink
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What chest assesment findings should be expected w/pulmonary edema?
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increased tactile & vocal fremitus; crackles, rhonchi and wheezing
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Lung volumes and capacities in pulmonary edema
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All decreased!
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What is the diffusion capacity findings in pulmonary edema
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decreased Dlco
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The potassium and sodium levels in pulmonary edema are often:
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low! hypokalemia and hyponatremia are often seen
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CXR findings
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fluffy opacities
left ventricular hypertrophy (only in cardiogenic) kerley A and B lines Pleural effusion |
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What does the CPAP mask improve?
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CPAP improves decreased lung compliance, decreases WOB, enhances gas exchange, and decreases vascular congestion
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Common direct acting Vasodilator drugs
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nitroglycerin, nitroprusside, hydralazine, and minoxidil
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Angiotensin-converting enzyme inhibitors (ACE inhibitors)
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direct acting vasodilators (afterload reducers) used in the more chronic cases of CHF
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Angiotensin-converting enzyme inhibitors (ACE inhibitors) drug examples
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lisinopril, captopril
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Morphine sulfate works by inducing:
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venodilation and venous pooling; also used for sedation and relief of anxiety
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What is a saddle embous
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when a lg. emoblus detaches from a thrombus, passes through r. heart & lodges in the bifucation of the pulmonary artery
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structural changes of lungs associated with pulmonary embolism
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blockage of pulmonary vascular system, pulmonary infarction, alveolar atelectasis and consolidation, bronchospams
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what is a pulmonary embolism?
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a thrombus dislodges from veins elsewhere in body & moves (embolizes) in the pulmonary arterial circulation
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What is the classic triad of symptoms with a pulmonary embolism?
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dyspnea
hemoptysis pleuritic chest pain (Occurs in < 20% of patients) |
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Risk factors of pulmonary embolism
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venous stasis
trauma hypercoagulation disorders |
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What does the CXR show in a patient with a pulmonary embolism?
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CXR is often normal
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What is the gold standard for diagnosing a pulmonary embolism?
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Pulmonary angiogram
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What other tests can be done to determine the likely hood of a pulmonary embolism?
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ECG, V/Q scan, CT scan
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What is a blood clot in the vein called?
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venous thromboembolism (VTE)
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what tests can be done to detect a VTE?
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fibrinogen test, extremity venography, duples ultrasonography (DUS) or MRI
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What is the V/Q ratio distal to the pulmonary embolism?
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high
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When significant pulmonary hypertension occurs, what is the systemic BP like?
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normally systemic hypotension occurs due to decreased cardiac return resulting in decreased L. vent. output
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Sharp chest pain, low oxygen, low SPO2, High HR and RR, sudden hemoptysis are indicative of:
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pulmonary embolism
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Abnormal ECG patterns found in pulmonary embolism
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sinus tachycardia
atrial arrhythmias |
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CXR findings
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right ventricular cardiomegaly (cor pulmonale)
increased density pulmonary edema |
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Fast acting Anticoagulants
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heparin (calciparine, liquaemin)
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Slow acting anticoagulants
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warfarin (coumadin, panwarfin)
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Thrombolytic agents (Clot busters) which dissolve clots
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streptokinase (Kabikinase or Streptase)
urokinase (abbokinase) activase |
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the aortic & carotid baroreceptors initiate what in respone to decreased systemic BP?
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Increased HR and RR
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What is the upperlimit of the normal mean pulmonary artery pressure?
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15 mmHg
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Pulmonary hypertension devolps in pulmonary embolis due to:
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vasoconstriction caused by humoral agent release
vasoconstriction induced by a decreased alveolar oxygen pressure |
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when humoral agents are released into the pulmonary circulation what occurs
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v/Q ration decreases
bronchial smooth muscle constricts |
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Thrmobolytic agents
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urokinase, streptokinase
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what is pleurodesis
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chemical or medication is injected into the chest cavity causing intense inflammatory reaction. causes surface of lung to stick to chest cavity
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Forms of pneumothorax
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traumatic
spontaneous iatrogenic tension |
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transudate pleural effusion
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fluid from pulmonary capillaries moves into pleural space (thin watery containing a few blood cells & little protein)
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Exdudate pleural effusion
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develops when pleural surfaces are diseased. fluid has high protein content & alot of cellular debris.
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Exudate is usually caused by:
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inflammation, infection or malignancy
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major causes of transudative pleural effusion
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CHF, Hepatic hydrothorax, peritoneal dialysis, nephrotic syndrome, pulmonary embolus
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Major causes of an exudative pleural effusion
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malignant pleural effusions, malignant mesotheliomas, pneumonias, TB, fungal diseases
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Empyema
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accumulation of pus in the pleural cavity
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Chylothorax
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milk white pleural effusion; chyle in pleural space; chyle produced from food in sm. intestine during digestion
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Hemothorax
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presence of blood in pleural space
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A hemothorax is said to be present only when:
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the hematocrit of the pleural fluid is at least 50% that of the peripheral blood. (42-45% is normal hematocrit level)
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chest assement findings of pleural effusion
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tracheal shift, decreased tactile & vocal fremitus, dull percussion note, diminished breath sounds, displaced heart sounds
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CXR findings in pleural effusion
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blunting of the costophrenic angle
fluid level on affected side depressed diaphragm |
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where is a chest tube placed
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4th or 5th midaxillary line
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where is thoracentesis performed
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4th or 5th midclavicular line
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