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Apex Review > Respiratory pathophysiology 5 > Flashcards

Respiratory pathophysiology 5 Flashcards

1
Q

Examples of antacids used for aspiration prophylaxis include

A

sodium citrate
sodium bicarbonate
magnesium trisilicate

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2
Q

Examples of H2 antagonists used for aspiration prophylaxis include

A

ranitidine
cimetidine
famotidine

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3
Q

Examples of GI stimulants used for aspiration prophylaxis include

A

metoclopramide

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4
Q

Examples of proton pump inhibitors used for aspiration prophylaxis include

A

omeprazole
lansoprazole
pantoprazole

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5
Q

Examples of antiemetics used for aspiration prophylaxis include

A

droperidol
ondansetron

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6
Q

Treatment for aspiration includes

A

tilt the head downward or to the side (first action)
upper airway suction to remove particulate matter
lower airway suction is only useful for removing particulate matter
secure the airway to support oxygenation
PEEP to reduce shunt
bronchodilators to reduce wheezing
IV lidocaine to reduce the neutrophil response
steroids probably don’t help
Abx only if the patient develops a fever or an increased WBC count >48 hrs.

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7
Q

Early signs of vAP include

A

presence of leukocytosis (high white blood cell count)
fever
increased secretions
increasing O2 requirements

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8
Q

Methods to reduce the incidence of VAP include

A

hand washing
HOB >30 degrees
daily spontaneous breathing trials
limit sedation
oropharyngeal decontamination
subglottic suctioning

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9
Q

What are the 3 types of pneumothorax?

A

closed
communicating
tension

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10
Q

The hallmark characteristics of tension pneumothorax include

A

hypoxemia
increased airway pressures
tachycardia
hypotension
elevated CVP

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11
Q

How does pneumothorax appear on POCUS?

A

will reveal a lung sliding and the absence of comet tails

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12
Q

If you suspect a pneumothorax, you must discontinue

A

nitrous oxide immediately

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13
Q

Emergency treatment of a tension pneumothorax includes

A

insertion of a 14 g angiocath into the 2nd intercostal space at the mid-clavicular line or the 4th or 5th intercostal space at the anterior axillary line

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14
Q

Flail chest is a consequence of

A

blunt chest trauma with multiple rib fractures

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15
Q

The key characteristic of flail chest is

A

a paradoxical movement of the chest wall at the site of the fractures

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16
Q

Consequences of flail chest include

A

alveolar collapse
hypoventilation
hypercarbia
hypoxia

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17
Q

Treatment of flail chest includes

A

reducing pain (epidural or intercostal nerve blocks)
some patients may require mechanical ventilation and surgical fixation

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18
Q

Closed pneumothorax is a defect in the

A

pulmonary tree or lung tissue and air enters and exits the pleural space through the defect
no communication between the pleural cavity and atm

19
Q

Treatment of a closed pneumothorax includes

A

observation
catheter aspiration
chest tube insertion

20
Q

With an open pneumothorax the defect is in the

A

chest wall and air passes between the pleural space and the atmosphere

21
Q

With an open pneumothorax the lung ____________ on inspiration and ____________ on expiration

A

collapses; partially re-expands

22
Q

Treatment of open pneumothorax includes

A

an occlusive dressing that does not let air in but allows air to escape
supplemental O2
chest tube insertion
possibly tracheal intubation

23
Q

A tension pneumothorax can occur with

A

a closed or open defect

24
Q

Pneumothorax can occur after

A

central line insertion
supraclavicular, interscalene, and intercostal nerve blocks
barotrauma, high peep, or high peak inspiratory pressures
lung cysts and bullae can expand and rupture when nitrous oxide is used
surgical procedures
chest trauma

25
Q

_______________ following chest trauma should raise suspicion about a pneumothorax

A

Increasing peak inspiratory pressures

26
Q

Surgical procedures that can cause pneumothorax include

A

radical neck dissection
shoulder arthroscopy
mastectomy
axillary lymph node dissection
mediastinoscopy
laparoscopy
nephrectomy

27
Q

What are other substances that don’t belong in the chest?

A

chylothorax
hemothorax
fibrothorax
pyothorax (empyema)
pleural effusion

28
Q

A chylothorax is

A

lymph

29
Q

A hemothorax is

A

blood

30
Q

A fibrothorax is

A

organized blood clot

31
Q

A pyothorax is

A

pus

32
Q

Hemothorax is most commonly caused by

A

bleeding intercostal vessels

33
Q

Indications for thoracotomy in the setting of a hemothorax include

A

initial drainage >1000 mL
continued bleeding >200 mL/hr.
white lung on CXR
large air leak

34
Q

Hemodynamically stable patients wit a hemothorax and bleeding <150 mL/hr may be managed with

A

VATS

35
Q

______________ can cause chylothorax

A

injury to the thoracic duct during CVL insertion (subclavian> internal jugular insertion)

36
Q

Injury to the thoracic duct is more likely on

A

the left side

37
Q

When a gas embolism of significant size travels to the right heart, it can lodge in the

A

pulmonary outflow tract or pulmonary artery where it can produce an airlock that converts distal alveolar units to dead space

38
Q

The incidence of VAE varies with

A

patient position

39
Q

Patient positions that are highest to lowest risk for VAE include

A

sitting> supine> prone> lateral

40
Q

__________ the most sensitive diagnostic tool of venous air embolism

A

TEE

41
Q

Signs and symptoms of VAE include

A

air observed on TEE
“mill wheel” murmur on precordial doppler
decreased EtCO2
increased EtN2
hypotension
dysrhythmias
hypoxia
cyanosis
CV collapse

42
Q

Treatment of VAE includes

A

100% O2
flooding the surgical field
discontinuing insufflation
employing the Durant maneuver (left lateral decubitus position)

43
Q

Consequences of air trapped in the pulmonary circulation icnlude

A

increased pulmonary artery pressure
increased RV stroke work index
right ventricular failure
decreased pulmonary venous return
decreased left ventricular preload
decreased CO
asystole and CV collapse

44
Q

Most sensitive indicators of VAE from most to least include

A

TEE, precordial doppler, EtCO2, CVP, EKG/BP

Apex Review (224 decks)

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