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486 Cards in this Set
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Asthma: Does normal spirometry rule out asthma... |
1. hyperresponsiveness
2. airway obstruction 3. inflammation normal spirometry does not rule out asthma |
|
Asthma Airway remodeling |
ASTHMA patient lungs with subepithelial fibrosis, increased smooth muscle mass, angiogenesis and hyperplasia of mucous gland and goblet cells |
|
Asthma Severity: Mild Intermitt
a. Symptoms (3) b. Night Symptoms c. Lung Function |
a. less than or equal 2x a wk |
|
Asthma Severity: Mild Persistent
a. Symptoms (2) b. Night Symptoms c. Lung Function |
a. Sx greater than 2x a wk, but less than once a day
flares may affect activity b. greater than twice a month c. FEV1 or PEF equal or greater than 80%, predicted PEF variability 20-30% |
|
Asthma Severity: Mod Persistent
a. Symptoms (4) b. Night symptoms c. Lung Function |
a. daily symptoms
daily use of albuterol flares affect activity flares equal or greater twice a wk, may last days b. greater than once a wk c. FEV1 or PEF greater than 60% less than or equal PEF variability greater than 30% |
|
Asthma Severity: Severe Persist
a. Symptoms (3) b. Night symptoms c. Lung Function |
a. continual symptoms
limited physical activity freq flares b. frequent c. FEV1 or PEF less than or equal 60% predicted PEF variability greater than 30% |
|
Peak Expiratory Flow - Asthma
1. change of 20% 2. 20-50% change 3. >50% |
1. stable disease |
|
Bronchial challenge test |
bronchoconstrictor which reduces FEV1. like methacholine or histamine normal test rules out asthma while positive test does NOT rule in |
|
Asthma
Type that does not respond to therapy |
ABPA - acute bronchopulmonary aspergillosis
|
|
Asthma |
RADS - reactive airway dysfunction syndrome
|
|
Asthma
ABPA is______ asthma with imaging (3) and (1) sign |
persistent |
|
Asthma
ABPA treatment |
oral steroids for several weeks
|
|
Asthma
worsening condition taking leukotriene receptor blocker with development of pulm infiltrates and eosinophilia during steroid taper |
Churg strauss vasculitis
|
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Asthma
exercise induced asthma trigger |
exercise in cold dry air
|
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Asthma
exercise induced asthma treatment |
beta agonist inhaler
|
|
Asthma
Symptoms of Aspirin sensitive asthma (2) |
rhinorrhea and nasal congestion
|
|
Asthma |
see specialist for desensitization
|
|
Asthma
mild aspirin intolerance and asthma |
leukotriene modifying agent
|
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Asthma
3 big symptoms |
cough
wheeze chest tightness |
|
Asthma
1. breakthrough symptoms 2. exercise induced asthma prophylaxis |
short acting beta2 agonist
|
|
Asthma |
inhaled steroids |
|
Asthma
Side effect of inhaled steroids(2) |
thrush and dysphonia related to laryngeal muscle myopathy
|
|
Asthma
alternate to inhaled steroids(2) |
Cromolyn and Nedocromil
|
|
Asthma If failing albuterol and inhaled steroids... |
Leukotriene modifier add long acting beta 2 |
|
Asthma FEV1/FVC ratio less than 70% on spirometry… Why avoid this treatment with FQ or macrolide... |
theophylline indicates airway obstruction theophylline toxicity |
|
Asthma |
Omalizumab (Anti- IgE antbody)
|
|
Asthma measures lung ability to transfer gas across alveolar-capillary membrane… normal arterial PCO2 with severe symptomatic asthma indicates... |
1. overweight DLCO impending resp failure |
|
COPD
4 major disorders.. is clubbing seen in COPD... |
emphysema No, clubbing is not feature of COPD |
|
COPD
chronic bronchitis clinic definition |
productive cough on most days for 3mo in each of 2 straight years
|
|
How is COPD different from asthma?
|
asthmatics have greater reversibility of obstruction |
|
COPD
#1 risk factor |
smoking |
|
Spirometry TLC less than 80% predicted... Low TLC, but increased residual volume... |
obstructive lung process restrictive lung process resp muscle weakness from neuromusc disease |
|
Emphysema |
1. centrilobular |
|
Centrilobular emphysema
- lung pathology - risk factor |
- dilation and destruction of resp bronchioles
- tobacco |
|
Panlobular emphysema
- lung pathology - risk factor |
- destruction of whole acinus
- alpha 1 anti trypsin |
|
COPD
blue bloater (ankle edema, enlarged liver, engorged neck veins) |
alveolar hypoxia remodel pulm arteries causing RVH and secondary pulm HTN
|
|
COPD
key to diagnosis |
expiratory airflow limitation
|
|
COPD
spirometer 2 values... which confirm |
post bronchodialtor FEV1 <80% |
|
COPD |
BMI, airflow Obstuction, Dyspnea, 6min walk Exertion |
|
COPD |
diffusing capacity of carbon monoxide. single breath uptake of CO over 10sec breath hold. measures gas transfer
|
|
COPD |
low in emphysema |
|
COPD |
elevated carboxyhgb can cause false normal oxygen saturation via pulse ox. need ABG to eval CO2 retention. arterial hypoxemia and alveolar hypoventilation |
|
COPD
ABG values for resp failure on RA (2) |
PaO2 less than 60
PaCO2 greater than 55 |
|
COPD
differential (6) |
asthma, CHF, bronchiectasis, Tb, obliterative bronchiolitis, diffuse panbronchiolitis
|
|
COPD |
alpha1 anti trypsin def |
|
COPD When to initiate treatment with serevent or spiriva ... |
COPD treatment when FEV1 less than 60% predicted |
|
COPD
Do not combine spiriva with... |
atrovent. do not combine long acting with short acting anticholinergic |
|
COPD
oral anticholinergic. |
theophylline |
|
COPD
theophylline level need to be monitored because in can potentiate |
steroids |
|
COPD Do not use alone or for maintenance or rescue in COPD.... |
oral steroids inhaled steroids |
|
COPD young patient with COPD.... |
annual flu shot and pneumovax. alpha 1 anti trypsin df |
|
COPD |
IV infusion of purified protein weekly |
|
COPD Consider this for all symptomatic COPD with FEV1 less than 50% predicted |
antitussives because cough is protective pulm rehab |
|
COPD SEVERE COPD treatment if chronic bronchitis and frequent exacerbations... |
leukotriene modifier Roflumilast - daliresp |
|
COPD If FEV1<=20% of predicted... |
bullectomy DO NOT CONSIDER SURGERY |
|
COPD |
SOB with ph <7.35 |
|
ILD |
Acute interstitial pneumonia |
|
ILD - physical findings
crackles common in.... less common... |
common in fibrosing ILD
less common sarcoid |
|
ILD - physical findings
mid inspiratory squeaks |
bronchiolitis
|
|
ILD - physical findings
increased P2, RV lift, TR murmur |
severe restrictive disease like pulm HTN seen in ILD, scleroderma, PLCH |
|
ILD - physical findings Most common idiopathic interstitial pneumonia |
IPF |
|
ILD - physical findings
erythema nodosum (3) |
sarcoid
IBD behcet |
|
ILD - physical findings
maculopapular exantham (3) |
sarcoid
amyloid Behcet |
|
ILD - physical findings
uveitis/conjunctivits(4) |
sarcoid
behcet IBS AS |
|
ILD - physical findings
Lacrimal/salivary gland enlargement(2) |
sarcoid
Sjogren |
|
ILD - physical findings
adenopathy, hepatosplenomegaly (2) |
sarcoid
amyloid |
|
ILD - physical findings
arthritis (5) |
collagen vascular disease
IBD sarcoid behcet AS |
|
ILD - physical findings
muscle weakness or tenderness |
polymyositis
|
|
ILD - physical findings
1. cranial nerve deficit 2. mental retard |
1. sarcoid
2. tuberous sclerosis |
|
ILD - lab findings
eosinophilia (4) |
eosinophilic pneumonia
sarcoid systemic vasculitis drug induced |
|
ILD - lab findings
hemolytic anemia (4) |
connective tissue disease
sarcoid lymphoma drug induced |
|
ILD - lab findings
normocytic anemia carcinomatosis (3) |
diffuse alveolar hemorrhage syndromes
connective tissue lymphangitic |
|
ILD - lab findings
urinary sediment abnormalities (3) |
connective tissue
systemic vasculitis drug induced |
|
ILD - lab findings
hypogammaglobulinemia |
lymphocytic interstitial pneumonia
|
|
ILD - lab findings
serum ACE (4) |
sarcoid
hypersensitivity pneumonitis silicosis Gaucher |
|
ILD - lab findings
anti basement membrane antibody |
goodpasture
|
|
ILD - lab findings
ANCA (3) |
wegener
churg strauss microscopic polyangiitis |
|
ILD - lab findings
serum precipitating antibodies |
hypersensitivity pneumonitis
|
|
ILD |
IPF - idiopathic pulm fibrosis |
|
ILD
IPF histopathology |
fibroblast foci
|
|
ILD |
sx: worsening SOB and nonproductive cough |
|
ILD |
restrictive lung process
linked to degree of restriction less than 3yrs |
|
ILD |
lung transplant
|
|
ILD |
acute interstitial pneumonia or idiopathic diffuse alveolar damage or Hamman-rich syndrome |
|
ILD
resembles IPF, but younger and less rales on exam |
NSIP - nonspecific interstitial pneumonitis
|
|
ILD
NSIP chest xray and chest CT |
CXR - bilat lower zone opacities
Chest CT - bilat lower lung opacities. |
|
ILD
NSIP on chest CT lacks |
honeycombing
|
|
ILD
NSIP lung biopsy |
homogenous lymphoplasmacytic inflammation +- fibrosis
|
|
ILD
NSIP prognosis |
level of fibrosis on biopsy
|
|
ILD
NSIP treatment |
steroids |
|
ILD |
COP - cryptogenic organizing pneumonia
|
|
ILD |
crackles, not clubbing |
|
ILD |
CXR - consolidation |
|
ILD |
restrictive with low DLCO
|
|
ILD |
organizing pneumonia with preserved lung architecture
|
|
ILD |
24wk taper of steroids
|
|
ILD
smoking related disorders (2) |
(DIP)- desquamative interstitial pneumonitis
(RB-ILD) - resp bronchiolitis associated interstitial lung disease |
|
ILD
DIP chest xray |
ground glass pattern
|
|
ILD
DIP chest CT |
fibrosis with traction bronchiectasis and honeycombing
|
|
ILD
DIP PFT (2) |
restrictive lung, low DLCO
|
|
ILD
DIP path |
pigmented macrophages in alveolar spaces
|
|
ILD
DIP treatment (2) |
stop smoking and steroids
|
|
ILD
RB-ILD vs DIP age |
RB-ILD younger
|
|
ILD
RB-ILD Chest xray |
basilar reticular or reticulonodular in centrilobular distribution
|
|
ILD
RB-ILD chest CT |
ground glass
|
|
ILD
RB-ILD PFT |
normal vs mixed rest/obst
low DLCO |
|
ILD
RB-ILD path |
similar to DIP
|
|
ILD
RB-ILD treatment |
stop smoking
steroids |
|
ILD
DIP vs RB-ILD prognosis |
RB-ILD can still have significant disease
|
|
ILD
acute disease |
AIP - acute interstitial pneumonia
|
|
ILD
other name for AIP |
Hamman-Rich syndrome
|
|
ILD
AIP progress |
hypoxemic resp failure
|
|
ILD
AIP chest xray |
diffuse bilat airspace disease
|
|
ILD
AIP similar to |
ARDS
|
|
ILD
AIP path |
diffuse alveolar samage
|
|
ILD
AIP treatment |
IV steroids
|
|
ILD
AIP prognosis |
poor, die in 2mo
|
|
ILD
rarest ILD and seen more in women |
LIP-lymphoid interstitial pneumonia
|
|
ILD
LIP chest xray chest CT(2) - one is not seen in other conditions |
honeycombing
ground glass opacity and pervascular cysts |
|
ILD
LIP BAL |
lymphocytosis
|
|
ILD
LIP path |
interstitial pneumonia with dense lymphoid infiltrate
|
|
ILD
LIP path seen in (2) |
Sjogren and HIV
|
|
ILD
LIP differential |
lymphoma
|
|
Eosinophilic pneumonia
classic chest xray |
no pulm edema
|
|
Eosinophilic pneumonia
simple eosinophilic pneumonia |
Loffler syndrome
|
|
Eosinophilic pneumonia
acute vs chronic lab value |
acute eosinophilia may not be seen in periph smear. Check BAL.
|
|
Eosinophilic pneumonia
treatment |
steroids
|
|
LAM |
lymphangioleiomyomatosis
cystic lung disease affecting child bearing age women |
|
LAM
a. effusion b. complication c. PFT |
a. chylous |
|
LAM |
a. no help
b. reduced |
|
LAM |
LAM smooth muscle cells and cysts |
|
LAM |
pleurodesis
|
|
LAM |
may lead to ESLD requiring transplant |
|
PLCH
what is it and 2 other names |
pulmonary langerhans cell histiocytosis
Histiocytosis X eosinophilic granuloma of lung |
|
PLCH
who? |
young smokers (less than 40yo)
|
|
PLCH
25% develop complication |
PTX
|
|
PLCH
CXR |
cysts and nodules
|
|
PLCH
path (2) |
1. bronchiolocentric cellular infiltration with langerhans cells
2. Birbeck granules - rod shaped structures in cells |
|
PLCH
treatment |
stop smoking
|
|
Sarcoid imaging finding: |
smoking upper lobe infiltrates on lateral chest xray pg.126 |
|
Sarcoid |
Heerfordt syndrome |
|
Sarcoid
90% have this involvement |
lung
|
|
Sarcoid
chest CT |
widespread nodules
|
|
Sarcoid
Treatment a. mainstay b. cutaneous and pulm |
a. steroids
b. hydroxychloroquine |
|
Rheumatoid lung disease
physical finding PFT |
clubbing
restrictive defect |
|
Rheumatoid lung disease
who |
men with advanced joint disease
|
|
Scleroderma
Lung finding Heart finding PFT |
pulm HTN
R heart failure restrictive lung |
|
Scleroderma
Chest CT |
ILD
|
|
Scleroderma
GI finding (2) |
esophageal dilation and dysmotility
|
|
Scleroderma
path |
fibrotic form on nospecific interstitial pneumonitis
|
|
Scleroderma
Treatment |
cyclophosphamide
|
|
polymyositis/dermatomyositis
lung Sx(2) similar presentation |
DOE and nonproductive cough
ARDS |
|
polymyositis/dermatomyositis
Lab (2) PFT (2) |
elevated muscle enzymes
anti Jo-1 Ab restrictive defect reduce DLCO |
|
polymyositis/dermatomyositis
imaging |
honeycombing
|
|
polymyositis/dermatomyositis
therapy(2) |
steroids
cytotoxic agens |
|
polymyositis/dermatomyositis
who responds best? |
pathologic organizing pneumonia
|
|
SLE
at risk for |
venous thromboembolism
|
|
Sjogren
chest CT expiratory |
focal air trapping
|
|
Sjogren
treatment(2) |
steroids
cytotoxic agents |
|
Diffuse alveolar hemorrhage
linked to... |
goodpasture or small vessel vasculitis
|
|
Pulm vasculitis
necrotizing granulomatous vasculitis affecting small and medium vessels in lungs and kidney |
wegener's granulomatosis
|
|
Pulm vasculitis
+ C-ANCA |
Wegener's granulomatosis
|
|
Pulm vasculitis
Wegener's perform this type of lab |
culture to RO infection
|
|
Pulm vasculitis
Wegener's UA (3) |
red cell casts, RBC, WBC
|
|
Pulm vasculitis
Chest CT with nodules, focal consolidation, cavitary and airspace disease |
Wegeners
|
|
Pulm vasculitis
Wegener's treatment (2) |
steroids and cyclophosphamide
|
|
Pulm vasculitis
Wegener's treatment after 3-6mo |
azathioprine
|
|
Pulm vasc
triad of asthma, hypereosin, necrotizing vasculitis |
churg-straus
|
|
Pulm vasc
Churg straus associated withdrawal of this drug |
corticosteroids
|
|
Pulm vasc
Churg straus PFT |
reversible airflow
|
|
Pulm vasc
Churg strauss complication |
GI bleed or ischemia
|
|
Pulm vasc
Churg straus dx |
periph blood eosinophilia
|
|
Pulm vasc
Churg straus chest CT |
ground glass opacity
|
|
Pulm vasc
Churg straus bx |
necrotizing vasculitis and granuloma
|
|
Pulm vasc
Churg straus treatment |
steroids
|
|
Pulm vasc
Churg straus treatment refactory to steroids |
cyclophosphamide
|
|
Pulm vasc
small vessel affecting lung and kidney |
microscopic polyangiitis
|
|
Pulm vasc
microscopic polyangiitis presents with (2) |
glomerulonephritis
hemoptysis |
|
Pulm vasc
microscopic polyangiitis Labs 1 serum, 2 UA |
elevated Cr
proteinuria active sediment on UA |
|
Pulm vasc
microscopic polyangiitis + test |
P-ANCA
|
|
Pulm vasc
microscopic polyangiitis bx |
focal segmental necrotizing glomerulonephritis
|
|
Pulm vasc
microscopic polyangiitis treatment (2) |
steroids and cyclophosphamide
|
|
Sarcoid
presenting manifestations 2 systems 2 body parts |
lymph and pulm systems as well as eyes and skin
|
|
Drug Induced Lung Disease
Lab results |
eosinophilia
|
|
Drug Induced Lung Disease
Chest CT |
reticular and ground glass opacities with or without consolidation
|
|
Drug Induced Lung Disease
Treatment |
steroids
|
|
Drug Induced Lung Disease
Hypersensitivity drug rxn symptom |
fever
|
|
Drug Induced Lung Disease
Drug induced lupus(3) |
procainamide
hydralazine isoniazid |
|
Drug Induced Lung Disease |
amiodarone
|
|
Drug Induced Lung Disease
chemo drug that causes acute or delayed lung toxicity |
nitrosurea carmustine
|
|
XRT Lung Disease
Treatment |
steroids
|
|
XRT Lung Disease
Y shaped CXR |
mediastinal lymphoma and Hodgkin due to paramediastinal fibrosis
|
|
Hypersensitivity Pneumonitis
other name |
extrinsic allergic alveolitis
|
|
Hypersensitivity Pneumonitis
pathogensis |
cell mediated immunity
|
|
Hypersensitivity Pneumonitis
Immunomodulatory role... modulate severity... |
Interferon gamma
IL-10 |
|
Hypersensitivity Pneumonitis
farmer's lung cause |
thermophilic bacteria in decaying hay and grain
|
|
Hypersensitivity Pneumonitis
CBC |
leukocytosis
|
|
Hypersensitivity Pneumonitis
end stage clinical |
cyanosis and R heart failure
|
|
Hypersensitivity Pneumonitis
chest xray in early disease |
normal
|
|
Hypersensitivity Pneumonitis
chest xray in acute disease |
diffuse ground glass opacification and fine reticulonodular disease
|
|
Hypersensitivity Pneumonitis
chest xray in chronic disease |
honeycombing
|
|
Hypersensitivity Pneumonitis
Chest CT high res |
centrilobular nodules
*more sensitive than chest xray |
|
Hypersensitivity Pneumonitis
biopsy triad |
cellular bronchiolitis
lymphoplasmacytic interstitial infiltrate non-necrotizing granuloma |
|
Hypersensitivity Pneumonitis
Treatment |
avoid antigen
oral steroids |
|
Hypersensitivity Pneumonitis
Refractory cases |
cytotoxic agents such as cyclophosphamide and azathioprine |
|
Mesothelioma asbestos is linked to 3 cancers... |
pleura mostly and peritoneum small cell non small cell mesothelioma |
|
Mesothelioma |
asbestos exposure
|
|
Mesothelioma
Not a RF |
smoking
|
|
Mesothelioma
other Risk factor |
erionite - turkish fiber used in home building
|
|
Mesothelioma
clinical |
chest pain with pleural effusion
|
|
Mesothelioma
confirm dx |
surgical lung biopsy
|
|
Mesothelioma
prognosis |
10% survival in 2 yrs
|
|
Mesothelioma
treatment |
pemetrexed
|
|
Asyphyxiant
most common chemical |
carbon monoxide
|
|
Asyphyxiant
carbon monoxide path |
hgb binds CO rather than o2
|
|
Asyphyxiant
CO labwork |
carboxyhgb
|
|
Asyphyxiant
CO treatment |
nonrebreather oxygen and hyperbaric oxygen
|
|
Asyphyxiant
odor of rotten eggs |
HS - hydrogen sulfide
|
|
Asyphyxiant
HS treatment |
nitrites
|
|
Asyphyxiant
HS path |
severe metabolic acidosis
|
|
Asyphyxiant
hypoxia with AG lactic acidosis but no cyanosis |
HCN
|
|
Asyphyxiant
cyanide path |
inhibit MTCH cytochrome oxidase
|
|
Asyphyxiant
Cyanide treatment (3) |
100% oxygen, nitrite and thiosulfate
|
|
RADS
cause |
exposure to chlorine gas and other irritants
|
|
RADS
histology |
epithelial desquamation, submucosal inflammation and basement membrane thinkening
|
|
RADS
similar to... |
asthma
|
|
RADS
PFT |
obstructive pattern
|
|
RADS
after exposure, what happens to symptoms away from exposure |
little relief
|
|
memory loss, impaired judgement and poor concentration can begin 2-28 days after...
|
CO2 toxicity especially with LOC
|
|
Pleural Effusion |
when hydrostatic pressure greater than clearance |
|
Pleural Effusion |
increased vasc permeability |
|
Pleural Effusion |
exudate if (any of 3)
- fluid protein/eff protein > 0.5 - fluid LDH/serum LDH >0.6 - pleural LDH > 2/3 serum LDH |
|
Pleural Effusion |
CHF |
|
Pleural Effusion |
pulm embolism |
|
Pleural Effusion |
exudative |
|
Pleural Effusion |
parapneumonic (lots of lymphocytes) |
|
Pleural Effusion
Parapneumonic effusion thoracentesis |
>10mm of pleural fluid on lat decub or US
|
|
Pleural Effusion |
Tb |
|
Pleural Effusion
most common cause of eosinophil effusion |
PTX |
|
PTX
Spont. is primary when |
lung is overtly normal
|
|
PTX
Primary spont PTX seen in.. CT scan shows... |
tall men who smokes
subpleural blebs and bullae |
|
PTX
Secondary PTX most common linked to.. |
COPD
|
|
PTX
women who don't smoke |
LAM
|
|
PTX
treatment for primary spont PTX: aspirate (2) |
if >2cm or if SOB present
|
|
PTX
treatment for primary spont PTX if aspiration failed |
intercostal tube
|
|
PTX
treatment for primary spont PTX if drainage failed |
chest surgery
|
|
PTX
treatment for secondary spont PTX +/- SOB. >2cm |
aspiration
|
|
PTX
treatment for secondary spont PTX that fails aspiration |
intercostal tube drainage
|
|
PTX
tension PTX defined |
intrapleural pressure exceeds atmospheric pressure throughout resp cycle
|
|
PTX
tension PTX treatment (3) |
1. high oxygen
2. cannula in pleural space in 2nd intercostal space to remove air and stabilize patient 3. chest tube in pleural space |
|
PE
dangerous phsyio |
increase pulm vasc resistance, increase R heart work, reduce cardiac output, infarction and death
|
|
PE
virchow triad… T/F: Normal pulse ox or arterial PO2 RULES out pulm embolus |
hypercoag
venous stasis vascular damage FALSE: does not rule out. |
|
PE
CT scans miss |
sub segmental pulm arteries
|
|
PE
Lung VQ, chest CT and leg doppler neg, but patient unstable and PE concern is strong |
gold standard test pulm angiography.
|
|
PE intermediate to high probability of pulm embolus then (even if D-dimer normal)…. If high probability for PE/DVT... |
Anti-Xa activity CHEST CTA if no contraindications start therapy first, then imaging. |
|
PE
unstable PE treatment to decrease risk of short term embolization… IF lung VQ and chest CT indeterminate with intermediate probability then… if that test negative... |
IVC filter
indeterminate - check doppler of legs negative - no further evaluation or therapy |
|
PE Duration of anticoagulation typically... refractory hypotension and pulm embolus in acute setting... |
at least 3mo thrombolytic therapy followed by anticoag |
|
CTEPH 3. DIAGNOSTIC TEST |
chronic thromboembolic pulm HTN
fatal if untreated VQ scan is better than chest CT |
|
CTEPH
Treatment (combo) |
resect chronic thrombus and start warfarin if no contraindications
|
|
CTEPH
physio |
increased resistance of pulm arteries.
|
|
CTEPH
monitor |
2decho after initial acute PE treatment
|
|
CTEPH if inconclusive... |
lung VQ scan > chest CT. if still inconclusive pulm angiography |
|
CTEPH
Treatment combo |
pulm thromboendarectomy and warfarin
|
|
CTEPH
who get it |
acute PE patients who do not recover completely
|
|
PAH mean pulm art pressure... pulm capillary wedge pressure.... pulm vasc resistance |
narrow lumen of small pulm arteries and arterioles. elevated mean pulm art pressure normal wedge increased resistance |
|
PAH |
AD with variable penetrance
BMPR2 |
|
PAH
lung VQ |
moth eaten perfusion pattern
|
|
PAH |
connective tissue disorder
HIV |
|
PAH What happens medication does not decrease pulm artery pressure with vasoreactivity test... |
R heart cath to diagnose and assess acute vasodilator response before long term vasodilator is attempted. if drug does not reduce pressure with vasoreactivity test then do not order that drug. |
|
PAH
Treatment (BP med) |
Ca channel blocker to reduce art pressure in acute setting |
|
PAH
IV treatment (3) and the best... physio of treatment (2) helps with |
prostacyclin (EPOPROSTENOL, treprostinil, and iloprost)
vasodilator and remodeling cor pulmonale |
|
PAH |
bosentan- endothelin-1 receptor antogonist. endothelin 1 is potent vasoconstrictor
mortality |
|
PAH |
sildenafil. inhibits cGMP phosphodiesterase. cGMP induced by nitric oxide to regulate vascular smooth muscle tone
|
|
PAH
Non drug treatment (2) |
oxygen because alveolar hypoxemia causes vasoconstriction.
transplant |
|
Pulm nodule no follow up is needed for nodule… if nodule is >3cm... |
less than 3cm in diameter (surrounded by normal tissue with no LN) less than 4mm if never smoked or no cancer risk factors. if smoked or still smoking follow up 12mo if no change LUNG mass for >3cm |
|
Pulm nodule
malignant findings(3) approx 35% of solitary nodules are... |
spiculated margin Bronchogenic ca |
|
Pulm nodule Ground glass nodule followup: |
smooth margin yearly followup greater than 2 yrs due to possibility of transforming to slow growing adenoca |
|
Lung ca #1 overall cancer killer |
non small cell such as adeno lung ca kills more than any other |
|
Lung ca chest xray and lung cancer screening |
small cell not effective |
|
Lung ca |
bronchoscopy |
|
Lung ca
peripheral lesion workup |
transthoracic needle aspiration
|
|
Lung ca
T - primary tumor |
primary lesion size and invasion of contiguous structures
|
|
Lung ca
N |
thoracic nodules
|
|
Lung ca
M |
distant mets
|
|
Lung ca
stage 4 lung ca |
M1
|
|
Lung ca
3 cancers that often go to lungs |
kidney
colon breast |
|
Mets to Lung
present as.. |
asymptomatic single or multiple lung nodule
|
|
Mets to lung Exception... |
poor and inoperable mets from colorectal ca can be resected and good prognosis |
|
Lung tumor
benign |
hamartoma
|
|
Lung tumor
Benign on chest xray or CT |
eccentric popcorn calcification
|
|
Terminal Care
COPD survival scale |
BMI
airflow Obstruction Dyspnea Exercise capacity |
|
Terminal Care
Medicare criteria (3) |
1. medicare part A coverage
2. less than 6mo left 3. revocable agreement that hospice benefits replace medicare benefits |
|
Terminal Care
Medicare criteria for terminal phase of lung disease (3) |
1. disabling SOB @ rest
2. frequent ER visits 3. PaO2 <=55 O2 sat<=88 |
|
OSA
define |
absence of airflow for at least 10 sec despite resp effort |
|
OSA |
AHI |
|
OSA
AHI mild AHI moderate AHI severe |
mild 5-15 |
|
OSA
hallmark symptom |
excess daytime sleepiness. |
|
OSA
common physical findings |
obesity
large neck large tongue/tonsils |
|
OSA
diagnosis |
nocturnal polysomnography
|
|
OSA
treatment if conservative treatment FAILS (like wt loss, reduce eton, avoid supine)… Is oxygen primary therapy for OSA... |
CPAP
No, oxygen is not primary therapy |
|
OSA
still sleepy after CPAP |
CPAP ineffective or another sleep disorder
|
|
OSA
still sleepy after effective CPAP |
modafinil
|
|
OSA
obstructive hypoapnea |
reduction of airflow or aplitude of thoraco-abdominal movement by at least 30% at least 10sec in duration, and oxygen desat of 4% or more
|
|
OSA
treatment for anatomical abnormalities |
surgery
|
|
OSA
treatment for mild to moderate OSA did not tolerate CPAP or surgery… Is obesity-hypoventilation syndrome (Pickwickian) the same as OSA…. |
oral device
No, o-h syndrome is associated with COPD with CO2 retention while awake. It may co-exist with OSA. |
|
CSA
|
sleep unmasks sensitive apnea threshold for CO2. |
|
CSA
who? |
CHF with EF<40%
|
|
CSA
diagnosis |
nocturnal polysomnography
|
|
CSA |
treat underlying disease such as treat heart failure to improve cardiac function. |
|
Sleep and COPD
desats occur mostly in.. |
REM sleep
|
|
Sleep and COPD
If on home oxygen, then with sleep |
increase by 1L/min at night
|
|
Sleep and asthma
asthma worsened by (2) |
gerd
OSA |
|
Sleep and asthma
OSA and asthma treatment |
CPAP improves asthma control
|
|
Sleep and asthma
nadir in peak flow rate when |
early morning hours
|
|
Sleep
restrictive lung disease as well as pregnancy associate |
sleep related oxygen desat
|
|
High Altitude Condition with cyclic central apneas and hyperpneas associated with repetitive arousals from sleep, often with paroxysms of dyspnea |
High altitude periodic breathing (HAPB) |
|
HAPB |
1. acetazolamide
2. low dose hypnotics |
|
High Altitude
when does acute mountain sickness occur? |
4-36hr after ascent of above 2000m or 6500ft
|
|
Acute Mountain Sickness
resolves |
after 2-5 days
|
|
Acute Mountain Sickness
concern for acute mountain sickness.. |
transition to HACE, high altitude cerebral edema
|
|
Acute Mountain Sickness
less at risk |
older people
|
|
Acute Mountain Sickness 2. to treat acute mountain sickness or cerebral edema |
1. acetazolamide before and after ascent; great for prevention |
|
HAPE
(High Altitude Pulm Edema) |
very rare
|
|
HAPE
symptoms occur |
2-4 days of ascent
|
|
HAPE
Symptoms... |
SOB, cough with blood, AMS, and death
|
|
HAPE
physio... |
blunted vent response to hypoxia, which increase pulm art pressure, leak protein into alveoli
|
|
HAPE
prevention |
give time to acclimatize |
|
HAPE/HACE
immediate management for both… 3 meds for HAPE... 1 med for HACE... |
immediate travel to lower altitude with supplemental oxygen and/or hyperbaric oxygen.
HAPE - lasix or nifedipine or viagra HACE - dexamethasone |
|
Air Travel
cabin pressure |
altitude less than 8000ft
|
|
Air Travel COPD with long flight... |
check pulse ox @ sea level. oxyhgb saturation less than 92% should get in flight supplemental oxygen hypoxia altitude stimulation test |
|
High Altitude |
cresendo-decrescendo ventilation followed by hypopnea or apnea |
|
Resp failure
acute hypoxemic resp failure includes |
caridiogenic
|
|
Resp failure
what shifts oxyhgb dissociation curve to Right, lowering oxygen content ?(2) |
high temp and acidity
|
|
Pulm edema
cardiogenic cause vs noncardiogenic |
hydrostatic pressure vs permeability related issue
|
|
ARDS imaging... |
PaO2/FIO2 <= 200 alveolar opacities |
|
2 mechanisms of resp failure
|
1. hypoxic
2. ventilatory |
|
COPD |
1. airway obstruction |
|
Acute Vent failure
lab test |
PaCO2
|
|
Acute vent failure
Lab test if chronic lung disease and why |
check pH on ABG. baseline elevated CO2. "hypercapnic"
|
|
Acute vent failure
#1 cause |
drugs
|
|
Acute vent failure
neuromuscular syndrome affects 3 muscle groups |
1. inspiratory - diaphragm, intercostal
2. exipratory - abd 3. bulbar - protect airway If all 3 systems affected, BAD |
|
Acute vent failure
Spinal cord injury. if lesion below C4 |
C3-C5 phrenic nerve
|
|
Phrenic nerve injury
ALS or myasthenic crisis |
orthopnea with abdominal paradox in supine
|
|
Acute vent failure
Most common cause in acute care setting |
acute inflammatory demyelinating polyneuropathy (Guillain BArre)
|
|
Acute vent failure
surgical... How to avoid |
neuromuscular blocking agents combined with high dose steroids
check train of 4 stimulation |
|
Acute vent failure
SIRS- how to avoid |
tight glycemic control
|
|
Acute vent failure
Airway obstruction causers (2) |
COPD,
asthma |
|
Acute vent failure
Acute severe asthma signs |
tachycardia
tachypnea accesory muscle use pulsus paradoxus - pulse and BP drops more than 10 with inspiration |
|
Acute Vent Failure When to worry about asthma exacerbation.... |
Mag sulfate with beta agonist slightly elevated or normal PCO2 may indicate impending resp arrest |
|
Acute Vent failure
obesity hypoventilation rule out |
hypothyroid |
|
Mechanical ventilation in moderate to severe COPD exacerbation... |
counterbalance auto PEEP Noninvasive positive pressure ventilation is standard of care. |
|
Mechanical ventilation |
1. acute hypercapnic failure in COPD |
|
NPPV When is it bad? |
improvement in pH, PaCO2, Level of consc., RR delays intubation in high risk patients |
|
VENTS
asthma and vents |
avoid intubation due to PTX and pneumomediastinum |
|
Vents
when to wean? (3) SaO2 FIO2 |
SaO2 >89%
FIO2 <= 40% hemodynamic stable |
|
Vents
wean with (2) |
T piece or low level CPAP
|
|
Vents
Failure to wean over 3 wks |
trach
|
|
Vents
Settings for acute lung injury and ARDS (2) |
lung protective strategy
low tidal volume 6mL/kg limited plateau pressure <30cm H20 |
|
VENTS
intubated COPD: settings need to minimize adverse effects of… 3 ways to avoid this condition... |
auto PEEP
remove airway obstruction lower tidal volume lower resp rate |
|
CPR outcomes
best survival (3) |
1. witnessed arrest
2. vfib 3. vtach |
|
severe sepsis After IVF bolus and MAP less than 65 or central venous pressure less than 8... poor prognosis if... |
start pressors. MAP= (2xDP +SBP)/3 refractory septic shock. poor prognosis if still need IVF and pressors to maintain pressure |
|
sepsis
key component of sepsis physiology |
endothelial damage
|
|
Sepsis
3 things important to surviving sepsis |
a. spont breathing trial
b. ulcer prophylaxis c. DVT prophylaxis |
|
sepsis
give to high risk of death or 2 organ dysfunction |
activated protein C or Drotrecogin alfa
|
|
sepsis
|
IV hydrocortisone |
|
severe sepsis
6 criteria of organ dysfunction |
hypoxemia, shock, delerium, thrombocytopenia, high Cr, high bili |
|
shock Defn.... |
bedside echo decreased tissue perfusion that results in inadequate oxygen delivery for cellular needs (tissue ischemia) |
|
shock - echo findings
1. PE 2. acute MI 3. hypovolemia 4. sepsis |
R vent dilatation |
|
warfare
most potent |
nerve agent
|
|
warfare |
1. atropine
2. pralidoxime |
|
Anaphylaxis IV steroids are helpful in... |
anyphylactic - IgE mediated ANAPHYLAXIS, not angioedema from ACE inhibitor. angioedema may be part of anaphylaxis, it can occur alone without urticaria or other features of anaphylaxis |
|
Anyphalactic shock
due to...(2) anaphylaxis treatment… if BP is low... |
hypovolemia and vasodilation
epinephrine pressors if low BP |
|
anyphlactic shock
death from... |
refractory bronchospasm, resp failure with airway obstruction, and CV collapse
|
|
anyphalaxis
refractory anaphylaxis with low BP and bradycardia due to bblocker, then give... |
glucagon
|
|
HTN emergency
goals of treatment (2) |
MAP by 20-25%
or diastolic BP <120 |
|
HTN urgency
captopril side effect and avoid |
1. reflex tachycardia
2. ARF with high grade bilat renal stenosis |
|
HTN urgency
Clonidine side effect |
sedation
|
|
HTN urgency
Labetalol side effect (2) |
bradycardia
bronchospasm |
|
HTN urgency
pheochromocytoma treatment |
prazosin
|
|
HTN emergency
avoid enalapril in... |
pregnant women
|
|
HTN emergency
med used when there is renal involvement |
fenoldopam - dopamine 1 receptor agonist. decreased both preload and afterload
|
|
HTN emergency
decreases cerebral and cardiac ischemia |
nicardipine
|
|
HTN emergency
pheochromocytoma IV med and side effect |
phentolamine. tachycardia causing ischemia
|
|
HTN emergency
Sodium nitroprusside monitor |
thiocyanate
|
|
HTN emergency
acute aortic dissection |
trimethaphan - ganglionic blocker
|
|
HTN emergency
overall treatment and goal |
ICU with IV agents. goal is not normal BP, but lower BP to avoid further organ damage
|
|
Hyperthermia
104 or 40C 106 or 41 |
life threatening
brain death |
|
Hyperthermia
1st sign of heat stroke |
no sweat
warm, dry skin |
|
Hyperthermia
increased intracellular calcium causing mucle contraction |
malignant hyperthermia
|
|
Hyperthermia
2 causes of malignant hyperthermia |
expose muscle to halothane or caffeine
|
|
Hyperthermia |
stop drug, hydration, oxygen, cooling measures
Dantrolene |
|
Hyperthermia |
pretreat with dantrolene
|
|
Hyperthermia |
neuroleptic malignant syndrome
|
|
Hyperthermia
|
can occur when quickly stop levodopa or anticholinergic meds
|
|
Hyperthermia
neuroleptic malignant syndrome and parkinson treatment… |
restart parkinson meds |
|
Hypothermia
EKG finding |
J wave or osborn wave
|
|
Hypothermia
treatment and complications |
re-warming
compartment syndrome, rhabdo, DIC |
|
ICU nutrition
lab for severe protein and calorie malnutrition |
prealbumin less than 5
|
|
ICU nutrition
avoid aspiration |
TF into small intestine
|
|
ICU nutrition
TPN risks |
gastric mucosa atrophy and bacteremia from translocation of bacteria from gut to bloodstream
|
|
OD
visual complaints -1 Ca oxalate crystals urine -1 no osmolar gap due to ketones - 1 |
methanol toxicity
ethylene glycol isopropyl alcohol |
|
OD
alcohol toxicity treatment (2) |
IV ethanol and fomepizole
|
|
OD
bruxism and jaw clenching |
ecstasy
bruxism - teeth grinding |
|
OD
amphetamine treatment (2) |
supportive and benzo for agitation
|
|
OD
CO poisoning pathophys... |
shifts L on curve. impairs oxygen offload @ tissue
|
|
OD
CO poisoning rare finding... |
cherry red lips
|
|
OD
CO poisoning diagnosis… What about pulse ox... |
venous or arterial carboxyHgb. CARBOXYHGB >25% is diagnostic of acute poisoning
pulse ox is unreliable, cannot separate carboxyhgb from oxyhgb |
|
OD
CO poisoning and normal lab... |
carboxyHgb may be normal due to oxygen already given
|
|
OD |
oxygen or hyperbaric oxygen |
|
OD |
benzo for agitation and dilt for chest pain/HTN |
|
OD
cocaine and cardiac |
ASA and NTG |
|
OD
salicylate |
alkalinization of urine to pH 7-8 for renal clearance |
|
OD |
IV Sodium bicarb (blood alkalinaztion) |
|
Rhabdo
pathophys |
skeletal muscle damage with myoglobin and CK release into circulation.
|
|
Rhabdo
#1 risk factor |
etoh abuse
|
|
Rhabdo
classic triad |
muscle pain, weakness, dark urine
|
|
Rhabdo
Urine - 1 blood - 2 |
myoglobinuria
CK and potassium |
|
Rhabdo
complication |
hypovolemia from fluid shifts to muscle
ARF from ATN |
|
Rhabdo
treatment and goal stop treatment |
aggressive IVF for goal of UOP 300cc/hr
No myoglobin in urine |
|
Pulm diagnostic tests
FEV1/FVC less than 70% on spirometry bronchial challenge test and asthma DlCO |
airway obstruction
sensitive but not specific lung ability to transfer gas across alv-cap membrane |
|
Pulm diagnostic tests |
fire or smoke inhalation due to carboxyhgb which looks like oxyhgb to pulse ox
|
|
Pulm HTN defn... 2 main causes |
elevation of mean pulm art pressure of 25mm Hg or greater at rest L side heart dysFN underlying chronic lung disease |
|
Pulm HTN if patient with suspected pulm art HTN or uncertain cause of pulm HTN |
R heart cath |
|
Pulm HTN follow up after diagnosis |
2decho and 6min walk test |
|
Lung ca how to stage preoperative NSCL ca or suspected NSCL ca.... |
PET scan |
|
Lung ca staging lung ca: endoscopic guided needle aspiration vs mediastinoscopy |
endoscopic guided aspiration is better |
|
Lung ca treatment for stage 1 or 2 NSCL ca.... stage 3 or 4 lung ca treatment... |
surgical resection chemo or chemo +XRT |
|
Lung ca prognosis of lung ca depends on 2... |
stage @ presentation and performance status |
|
Lung tumor typical carcinoid treatment... |
resection low grade neuroendocrine tumor |
|
Sleep therapy of excessive daytime sleepiness regardless of cause... |
at least 7-8hrs sleep a night |
|
ARDS physio... corrected by 3 things... |
hypoxemia mechanical ventilation with supplemental oxygen and PEEP |
|
ARDS How to avoid ventilator associated lung injury in ARDS? (4) |
limit tidal volumes 6ml/kg of ideal BW lower plateau pressure optimize PEEP reduce FIO2 to less than 0.6 |
|
Intubation obstructive lung disease and intubation strategy |
allow adequate time for exhalation before next delivered breath and minimize airway resistance through PEEP |
|
Intubation readiness to wean intubation |
rapid shallow breathing index |
|
Intubation daily interruption of sedation and spont breathing trial... |
lead to earlier extubation |
|
Critical Care after stabilized in ICU, sugar goal if severe sepsis and hyperglycemia |
less than 180 |
|
COPD symptomatic COPD with FEV1 less than 50% predicted should receive... |
pulm rehab |
|
OD ethylene glycol (antifreeze) poisoning or methanol (wood alcohol) or isopropyl (rubbing) alcohol poisoning treatment...(3) |
fomepizole, ethanol, dialysis |
|
PTX Primary Secondary If less than 2cm between chest wall and lung... |
primary - no previous lung disease secondary - previous lung disease, usually COPD manage inpatient with serial chest xrays, no tube.
|
|
Sleep First step of evaluation for daytime sleepiness. |
sleep diary for 1-2wks |
|
Spirometry evaluate fixed airway obstruction |
Flow volume loops, not lung volume measurments |
|
Vents How to avoid autoPEEP in intubated status asthmaticus or severe airflow obstruction? |
allow adequate time for exhalation to avoid stacking breaths and autoPEEP |
|
Asthma pregnant and not controlled by albuterol and inhaled steroids... avoid this oral drug... avoid this asthma test... |
add long acting beta agonist theophylline methacholine challenge |
|
OSA nasal congestion and CPAP... avoid this drug... |
humidify CPAP circuit to improve compliance oxymetazoline nasal spray due to rebound congestion when med is stopped. |
|
Silicosis If history of silicosis, puts you at risk for... |
Tb |
|
PE unprovoked PE/DVT with completed course of AC and still high DDimer |
restart anticoag because of risk of recurrence. should test DDimer 3-4 wks after stopping warfarin |
|
Resp Failure hypoxemia from atelectasis after abdominal surgery or lung resection |
CPAP helps avoid intubation and pneumonia |
|
Resp failure ARDS with normal BP and kidney function |
aggressive diuresis may reduce time on ventilation |
|
Critical Care Illness best means of nutritional support in critically ill if can tolerate |
NG tube with enteral tube feeds |
|
Work Exposure Coal workers with breathing symptoms: PFT or chest CT |
PFT first to eval obstructive disease |
|
ICU common cause of AMS in ICU |
delerium |
|
Lung mass from posterior mediastinum... from anterior mediastinum... from middle mediastinum... |
neural tissue origin like schwannoma anterior: thymus or thyroid middle: LN |
|
Resp Failure 2 bedside test for resp failure and neuromuscular disorder |
vital capacity and maximum inspiratory pressure. VC less than 20 are poor prognosis |
|
COPD CPAP vs NPPV |
use NPPV for moderate to severe COPD. do not use NPPV if high risk COPD, just go to intubation. CPAP is for OSA. |
|
Lung Ca If abnormal PET scan, next step of workup and why? |
mediastinal LN sampling is better than CT guided biopsy for STAGING. During US can see all area LN |
|
Lung Ca Stage 1 or 2 non-small cell lung ca treatment... Stage 3 or 4 lung ca treatment... |
surgical resection chemo +/- XRT |
|
Hyperthermia Neuroleptic malignant hyperthermia is caused by: treatment: Not helpful.... |
antipsychotic agents stop agent, start IVF, start IV ativan not helpful dantrolene |
|
Sleep obese with daytime CO2>45 (hypercapnia) and DOE... Treatment... |
Obesity Hypoventilation syndrome or Pickwickian CPAP |
|
Lung Ca if nonsmall cell lung ca is suspicious, and thoracentesis is negative, next step... |
repeat thoracentesis and cytology |
|
Interstitial pneumonia Nonspecific idiopathic interstitial pneumonia with initial negative workup, then in 1 yr.... |
repeat autoimmune testing (may test negative initially, but will test positive in the future) |
|
ARDS mechanical ventilation goal for PEEP... (which ensures).. |
PEEP that acheives FIO2 less than 0.6 that does not reduce BP |
|
ARDS reduce mortality by decreasing (2) |
tidal volume 6 and plateau pressure <30 |
|
Asthma symptomatic with PCO2 greater than or equal to 42 or persistent FEV1 or peak expiratory flow less than 40% despite aggressive bronchodilator treatment.... |
ICU admission |
|
Effusion complicated parapneumonic effusions that are large in size, glucose less than 60, fluid pH less than 7.2 |
Give Abx and pleural drainage (thoracostomy tube) |
|
Hypoventilation hypercapnic resp failure related to neuromuscular weakness (daytime sleepiness with PCO2 >45 |
bipap because cpap will not reduce hypercapnia |
|
Lung ca endobronchial (within bronchus) obstructing neoplasm in young non-smoker and treatment... |
carcinoid with resection, good prognosis |
|
PFT if patient with low lung volumes and normal DLCO2... |
extrapulm cause of low lung volume |
|
PFT Who has normal pulse ox, when VERY SOB (2)… if tissue is underperfused, then... |
cyanide and CO poisoning pulse ox may be false low. |
|
CF CF with acute abdominal pain... |
intestinal intussusception |
|
PTX if SOB, pleurisy or both with normal exam, then… if suspected tension PTX, do this before CXR results... |
check upright chest X-ray needle decompression |
|
PTX primary spont PTX that resolve with aspiration who are stable… secondary PTX, need this... |
can DC home hospitalization |
|
Insomnia when to treat insomnia with antidepressant… when to prescribe antihistamine for insomnia... |
when depressed NEVER |
|
Pulm nodule PET scans in alveolar ca or lesions less than 1cm in diameter… PET scans in various inflammatory lesions... |
False Negative False positive in inflamm lesions |
|
Pulm nodule bronch biopsy or Transthoracic needle aspiration biopsy with nonspecific negative result... |
DOES not rule out presence of malignant growth |
|
Hemoptysis rule out these 2 common conditions… check 2 labs... |
epistaxis and GI bleed PLT and coags |
|
Sarcoid rule out these 2 conditions… What lab is NOT helpful in diagnosis or treatment... |
Tb and fungal infection ACE level |
|
Sarcoid sarcoidosis like condition in light bulb factory worker or semiconductor factory… Treatment for asymptomatic sarcoidosis... |
beryllium exposure NOTHING |
|
Chronic Hypercapnic Resp Failure obtain these measurements to diagnose neuromuscular disease (ALS, MS, MG)... |
maximal inspiratory and expiratory pressures |
|
ARDS avoid this drug for acute treatment… high or low PEEP… tidal volume goal... |
avoid corticosteroids. low PEEP 6ml/kg of ideal body weight |
|
Pulm preop T/F: preop spirometry SHOULD be used to predict risk for post op pulm complications…. |
F: should not be used |
|
Ventilator if resp acidosis… if resp alkalosis… if low tissue oxygenation... |
acidosis - reduce PaCO2 by increase RR and tidal volume alkalosis - increase PaCO2 by reducing RR and tidal volume oxygenation - increase Fio2 and increase PEEP |
|
Ventilator avoid this weaning mode, because it increases time to wean... |
synchronized intermittent mandatory ventilation |
|
DVT after diagnosis, then apply… T/F: IV thrombolytics therapy for PE improves overall survival... |
TEDs to reduce risk of postthrombotic syndrome. False: does NOT improve survival |
|
Poisoning organophosphate poisoning labwork… Treatment and management… if fever and delirium... |
lab: acetylcholineesterase level treatment: atropine management - check serum Acetylcholineesterase levels atropine toxicity |
|
Hyperthermia shivering, hyperreflexia, myoclonus and ataxia (with high fever and cognitive change)... |
serotonin syndrome |
|
ICU EMG with axonal sensorimotor peripheral neuropathy in patient with generalized weakness or difficult to wean ventilator…. treatment... |
critical illness neuropathy stop corticosteroids or neuromuscular blocking agents |