Y2S1B1 - Cs - Vent/ards & Tuberculosis

Front 1

What is the most common type of pressure ventilation - negative or positive?

Back 1

Positive

An example of negative pressure ventilation is the iron lung.

Front 2

What are some clinical indications for mechanical ventilation?

Back 2

-when pt's breathing is inadequate to support life
-imminent collapse of other physio functions and subsequent clinical instability (multi-organ failure)
-acute lung injury (ARDS, severe pneumonia) resulting in hypoxemia
-acute respiratory acidosis w/ pCO2 >50 and pH <7.3 (drugs, alcohol, spinal cord injury, diaphragmatic paralysis in Guillain-Barre syndrome, brain injury)
-increased work of breathing that may lead to fatigue (COPD/asthma exacerbation)
-low perfusion states such as cardiogenic shock or large pulmonary emboli (big MI, dec CO, etc.)
-any condition requiring intubation (impending upper airway obstruction, high risk of aspiration, need for aggressive pulmonary toilet)

Front 3

What's the difference between pressure-controlled and volume-cycled ventilation?

Back 3

Volume-cyled delivers a preset VOLUME of gas with each breath

Pressure-controlled delivers a volume of gas until a preset PRESSURE is reached

*some newer models combine both

Front 4

What are the possible modes of volume-cycled ventilation?

Back 4

Assist Control (A/C) - controlled mandatory ventilation

Synchronized Intermittent Mandatory Ventilation (SIMV)What

Front 5

What are the possible modes of pressure-cycled ventilation?

Back 5

Continuous Positive Airway Pressure (CPAP)

Pressure Control Ventilation (PCV)

Pressure Support Ventilation (PSV)

Front 6

What type of ventilation can be used in an outpatient setting for sleep apnea?

Back 6

Noninvasive Positive Pressure Ventilation (NIPPV)
-> CPAP or BIPAP

sleep apnea - nasal CPAP

Front 7

What is the greatest risk of using a ventilator in the elderly?

Back 7

Whether or not we will be able to get them back off of it

Front 8

Name the type of ventilation.

It is sensitized to the inspiratory effort of the patient - so with each attempted breath, the machine will give the preset tidal volume or pressure (IPPV). There is a minimal "set rate" where breaths will be delivered with same preset volume or pressure.

When is this indicated/contraindicated?

Back 8

Assist-Control Ventilation "AC"

This may not be a good idea in someone who is tachypneic, because it may cause overbreathing.

Front 9

Name the ventilation type.

It provides a mechanical breath on a preset timing, ignoring patient effort. Prolonged use can lead to respiratory muscle atrophy.

When is this indicated/contraindicated?

Back 9

Controlled Mandatory Ventilation

This is useful with patients with no spontaneous effort (sedated), and is uncomfortable in conscious patients. If someone keeps fighting it, it may actually paralyze the patient! Can cause inc in BP and HR

Front 10

Name the ventilation type.

It provides a preset volume or pressure according to set respiratory rate, but if a patient breathes more than the set rate, no assist is given.

Back 10

Synchronized Intermittent Mandatory Ventilation (SIMV)

Can be used to wean a patient off the ventilator by gradually lowering the set rate and adding PSV. (better choice than controlled mandatory ventilation for awake patients with spontaneous effort)

Front 11

What positive pressure mode is used to augment spontaneous respiratory modes?

Back 11

Pressure Support Ventilation

Front 12

Name the ventilation mode.

The minimum rate is not set, because all breaths are initiated by the patient and are assisted by preset levels of positive pressure.

When is this indicated/contraindicated?

Back 12

Pressure Support Ventilation

Can be used alone or in conjunction with other ventilator modes (such as SIMV). It decreases the work of breathing, increases patient's comfort, and aids in weaning.

Front 13

Name the ventilation mode.

It is a continuous level of elevated pressure provided through patient circuit, where patient initiates all breaths. It may be used via ETT or face mask.

When is it indicated/contraindicated?

Back 13

Continuous Positive Airway Pressure (CPAP)

It decreases work of breathing and helps maintain adequate oxygenation. It helps hold alveoli open, preventing atelectasis, and therefore preventing shunting.

Front 14

The most severe form of ALI is what?

Back 14

ARDS! d/t dysregulated immune response in lung, absence of cardiogenic pulmonary edema

Front 15

What is PAO2/FiO2?

Back 15

ratio of the partial pressure of arterial O2 to the fraction of O2 in expired air

ARDS: <200
ALI: <300

ie: 250 = ALI, not ARDS

Front 16

#1 cause of ALI/ARDS?

Back 16

Acid aspiration (injury of alveolar epithelium)

Front 17

#1 cause of indirect lung injury?

Back 17

Sepsis (60%) - injury is at vascular endothelium

Front 18

Hallmark of ARDS?

Back 18

Increased vascular permeability to proteins

Front 19

Mortality from ARDS increases significantly in those over 65, and is mostly a/w what 2 things?

Back 19

Sepsis and/or multi-organ failure

Front 20

Most deaths from ARDS are caused by what?

Back 20

Multiple organ failure

Front 21

TB skin test positive if ≥ 15 mm in what patients?

Back 21

No risk factors for TB

Front 22

TB skin test positive if ≥ 10 mm in what patients?

Back 22

Recent immigrants from high prevalence countries
HIV neg IV drug users
Residents/Employees of long term care facilities
Health care workers
Chronic diseases
Children exposed to high risk person or < 4 years old
Mycobacteriology laboratory worker

Front 23

TB skin test positive if ≥ 5 mm in what patients?

Back 23

HIV positive person
Recent contact with active TB
Fibrotic changes on CXR
Organ transplant patient or other on predisone > 1 month or more

Front 24

False positives in PPD skin test can be caused by what?

Back 24

Bacillus Calmette-Guerin (BCG) vaccine
Non tuberculous mycobacteria

Front 25

False negatives in PPD skin test can be caused by what?

Back 25

Improper technique
Less than 12 weeks since infection
Malnutrition
Advanced age
Lymphoreticular malignancies
Corticosteroid therapy
Chronic Renal Failure
HIV infection

Front 26

A 29 year old teacher needs her yearly tuberculosis screening. She is G1P0 at 28 weeks. She has previously had a positive PPD skin test. What is the proper way to screen her?

Back 26

Quantiferon Gold

Front 27

T/F

3 consecutive morning sputums is helpful in diagnosing active TB.

Back 27

True!

More accurate than pneumonia testing, because if m. tb is in the sputum, it's from the lungs! small amount can show up

Front 28

What is the key to not developing resistance to TB?

Back 28

Adherence to treatment!

Front 29

Why does rifampin have a lot of drug interactions?

Back 29

It increases the cytp450 system

Front 30

What is the treatment for latent TB?

Back 30

9 months isoniazid and 4 months rifampin

Front 31

What are some indications for TB prophylaxis with isoniazid?

Back 31

New TST conversion over past 2 years
PPD+ contacts of patient with active TB
PPD- contacts of patient with active TB
PPD+ with HIV
PPD+ unkown duration in patient<35 yrs
Patient w/X-ray evidence of inactive TB, who were not adequately treated

Front 32

Treatment for TB?

Back 32

RIPE for 2 months
4 months of rifampin and isoniazid

(vary based on initial and subsequent cultures and smears)

Front 33

When monitoring AST levels during treatment of TB, when must you stop treating?

Back 33

when >5x normal range (>3x if symptomatic)

Front 34

What is MDR-TB resistant to?

Back 34

isoniazid and rifampin

Front 35

What is XDR-TB resistant to?

Back 35

isoniazid, rifampin, fluoroquinoline and any of the 2nd-line injectable drugs (amikacin, kanamycin, or capreomycin)