Test Ii, Pathophys Ii, Class Powerpoint Lectures, Respiratory

Front 1

epiglottitis is

Back 1

an inflammation of the airway from the epiglottis up

Front 2

epiglottis is most commonly caused by

Back 2

H.flu (but several other bacteria can cause it too)

Front 3

age group primarily affected by epiglottitis

Back 3

2-7 year olds, but is increasing in adults and decreasing in children due to the H. flu vaccine

Front 4

key symptoms of epiglottitis

Back 4

4 D's - drooling, dyspnea, dysphonia, dysphagia
tripod position
toxic presentation

Front 5

treatment for epiglottitis

Back 5

keep patient calm, secure airway, be prepared for emergency airway, broad spectrum antibiotics and cultures

Front 6

croup is

Back 6

a viral infection of the upper respiratory tract - but is actually the antigen reaction to the infection, not the infection that is causing the problem

Front 7

croup typically affects what age groups

Back 7

6 months to 6 years (most common under 2)

Front 8

croup is aka

Back 8

laryngotracheobronchitits

Front 9

croup is most commonly caused by

Back 9

parainfluenze virus type one (but many other viruses can cause it like RSV)

Front 10

croup affects what part of the airway

Back 10

subglottic

Front 11

signs and symptoms of croup

Back 11

steeple sign on xray
cold like symptoms
harsh, barking cough

Front 12

treatment for croup

Back 12

cool mist?
heliox?
racemic epi
steroids

Front 13

anesthetic implications for croup and epiglottitis

Back 13

possible emergency airway needed,
sevo
use a smaller ETT than normal
extubate only when certain swelling is resolved

Front 14

is cystic fibrosis an obstructive or restrictive lung disease

Back 14

both

Front 15

cystic fibrosis is caused by

Back 15

a gene that causes a defective chloride ion channel leading to decreased sodium and water transport and affects bicarb transport, dehydration, thick viscous secretion, lung scarring

Front 16

symptoms of CF

Back 16

meconium in newborns, clugging, barrel chest, constipation, foul stools, cough, etc

Front 17

CF affects what organ systems

Back 17

reproductive, GI, cardiovascular, endocrine (as well as the obvious respiratory)

Front 18

respiratory complications of CF

Back 18

dyspnea, tachypnea, pneumothorax, nasal polyps, respiratory acidosis, cyanosis, bronchiecstasis, emphysema

Front 19

cardiovascular complications of CF

Back 19

right ventricle hypertrophy, pa dilation

Front 20

GI complications of CF

Back 20

GERD, pancreatitis, ulcers, bowel obstruction, splenomegaly, hepatomegaly, malabsorption, biliary cirrhosis

Front 21

endocrine complication

Back 21

salty skin, electrolyte imbalances, decreased vitamin K, a, d e absorption, Metabolic Alkalosis

Front 22

treatments for CF

Back 22

medications, antibiotics, mucus thinning drugs, chest physiotherapy, bronchodilators, lung transplant

Front 23

anesthetic concerns wih CF

Back 23

continuation of meds, PFTs, coagulopathies, possible pneumothorax, hypoxemia, air trapping, etc.

Front 24

anesthetic management of CF patient

Back 24

small tidal volume, large FRC, preop oxygentation, volatile anesthetics, locals are good, V:Q mismatch - many of the drugs we give are affected by the disease or the other meds they are on, so know that onset or duration may change, hydrate patient, freq suctioning, possible high dose steroid regime

Front 25

one anesthetic NO-NO with CF patient

Back 25

no nitrous because will leak and expand and POP

Front 26

a drug that shows promise in treating CF

Back 26

mannitol

Front 27

drugs to avoid in a patient with CF

Back 27

desflurane, ketamine, nitrous oxide

Front 28

characteristics of sarcoidosis

Back 28

non-caseating epithelial granulomas affecting lung, reticuloendothelial system, skin, eyes, myocardium
ACE is produced in higher quantities

Front 29

is sarcoidosis restrictive or obstructive

Back 29

it is an intrinsic chronic restrictive disease, although sometimes obstructive characteristics can occur at the same time from fibrosis or endobronchial disease

Front 30

sarcoidosis is most common in what population

Back 30

african american

Front 31

pts with sarcoidosis present with

Back 31

no symptoms (most often discovered because chest xray for other purpose - shows bilateral hilar lymphadenopathy)
cough
hypercalcemia
fever, night sweats, fatigue, weight loss, anorexia

Front 32

pt outcomes with sarcoidosis

Back 32

60 - 70% recover after a couple years with no complications
20% have some loss of lung function or visual impairment
10 - 15% die from cardiac, lung, or neurological impairment from disease

Front 33

treatments for sarcoidosis

Back 33

typically high dose, long term steroids (not known if actually improves outcomes and has lots of side effects),
also trying anti-inflammatories, antimalarials, radiation, immunosuppressive agents
time - spontaneous permanent remission in 50% of patients

Front 34

anesthetic implications for sarcoidosis

Back 34

preop lung and system assessment for degree of involvement, PFTs and ABGs
intraop - uptake of gases may be faster
smaller tidal volumes, faster rate
spO2 - 88 - 92% (oxygen is toxic)
decreased FRC, FEV1, FVC
V:Q mismatching
laryngeal sarcoidosis could restrict ETT placement

Front 35

sarcoidosis summary of article

Back 35

although many patients asymptomatic, if undergo all the PFT's and other tests, will show a sign somewhere that it is a restrictive disease (and lots had obstructive components too)

Front 36

NPPE (type I) occurs when

Back 36

spontaneous respiration against an obstructed airway causes increased negative intrathoracic pressure which when released causes influx of fluid into the lungs

Front 37

NPPE (type II) occurs when

Back 37

a chronic partial obstruction of the airway is removed causing patient to suddenly exhale much more effectively leading to more negative intrathoracic pressure and increased venous return and pulmonary flow before heart can compensate causing fluid to move out of pulmonary circulation and into the lungs

Front 38

risk factors for NPPE

Back 38

young health men, or any condition that will predispose someone to developing an obstruction

Front 39

symptoms of NPPE

Back 39

Hypoxemia
Cough
Frothy sputum (sometimes pink)
Tachycardia
Crackles on ausculation
Decreased lung compliance
Pulmonary infiltrates on chest x-ray
Wheezing, Stridor
Increased RR
Decreased SpO2
Agitation

Front 40

treatment of NPPE

Back 40

PPV
maintain airway
steroids?
diuretics?
morphine