Lecture 20: Pulmonary Outcomes and Diagnostics Flashcards
what is a dyspnea scale used for
measures degree of breathlessness in pts with a pulmonary dx or pts who have primary functional limits from shortness of breath
highly responsive to exertion dyspnea but not as useful for dyspnea at rest
0-4 scale
modified MRC dyspnea scale scores
0 = only breathless with strenuous exercise
1= SOB when hurrying on the level or walking uphill
2 = walk slower than other people of the same age on level ground bc of breathlessness or have to stop for breath when walking on my own pace on level ground
3 = stop for breath after walking about 100 meters or after a few min on the level
4 = too breathless to leave the house or breathless when dressing/undressing
describe the BORG dyspnea scale
0-10 scale
less specific on functional limit
pt reported
2nd ventilatory threshold at 5-7 on scale
use of 6MWT with pulmonary pts
most used submit exercise test
easily converted to METs and VO2 max
American Thoracic Society originally developed
Drop in SpO2 during walk tests is associated with worse outcomes and impaired functional activity tolerance
MCID = 54
6MWT average values and values predictive of hospitalization or mortality for COPD pts
average = 380 m
<200m = predictive of hospital/mortality
gait speed use for pulmonary population
almost perfect measure
can be assessed in all settings
MCID in pulm rehab = 0.08-0.11 m/s
only outcome measure that provides data related to potential discharge locations/ambulatory locations/etc
gait speed cut off scores for COPD pts
slow = <0.8 m/s
normal = >/= 0.8 m/s
what is St. George’s Respiratory Questionnaire (SGRQ)
designed to measure impact of overall health, daily life, and perceived well being in pts with obstructive airway disease
combines frequency and severity of symptoms with activities that are limited by breathlessness
scored out of 100
higher scores = more limits
MCID = 4 for minimal improvement, 8 for moderate, 12 for high
what is a chest x-ray and that does it show
static view
shows air, fat, fluid, bone, other tissues
air = black
fat, fluid, bone, and other tissues = variations from gray to white
chest x-ray views
anterior to posterior = frontal plane
lateral = sagittal plane
indications for a chest X-ray
first line of imaging for any respiratory distress
suspicion for pulmonary pathology
post line or device placement
post intubation or extubation
what is the costophrenic angle
junction of the costal diaphragmatic and pleural surfaces
should be a sharp angle ~30 degrees
when is a CT used in pulmonary cases
used to identify structural defects of the lungs or pulmonary vasculature
more detailed than CXR
can be performed with or without IV contrast depending on indication and comorbidities
indications for CT scan with pulmonary pts
lung cancer
ARDS/Covid
any bleeding
structural details
when is a CTA used in pulmonary cases and how does it work
radiopaque IV contrast injected prior to CT scan
shows vascular abnormalities or perfusion deficits (vascular obstruction, filling defects, impairments in flow rate)
first line of imaging used to diagnose PE
CTA indications for pulmonary pts
PE
ARDS
IPF
when is a PET scan used in pulmonary cases
nuclear imaging that can detect glucose uptake, blood flow, and pulmonary metabolism
noninvasive, used to assess for presence of lung tumor metastasis in thoracic cavity
not as accessible as other scans (CT/MRI), expensive, requires equipment
when is a MRI used with pulmonary pts
evaluates pulmonary anatomy, thoracic cavity structures, pulmonary blood flow
similar diagnostic accuracy as PET imaging but less expensive and more available
MRA = magnetic resonance angiogram (MRI with contrast to evaluate vasculature)
MRI indications for pulmonary pts
any conditions involving bone, mm, fat of thoracic cavity
pre-op for sx guidance
lung cancer
what is a ventilation perfusion scan (V/Q scan)
ventilation = air in lungs
perfusion = blood in lungs
measures ventilation
- xenon gas inhaled and pt holds breath
- V scans over lung fields and can see Xenon gas
measures perfusion
- radioactive IV contrast injected
- Q scans over lung fields can see where the blood is perfusing
when is a V/Q scan indicated
PE
IPF/ARDS
how are V/Q scans quantified and what do certain results indicate
scans occur simultaneously and result with a ration of V to Q
both V and Q are greater in lung bases than apex normally
perfusion defect with normal ventilation = suggests PE
ventilation defect with normal perfusion = suggestive of alveolar fibrosis/destruction or airway obstruction
what is a bronchoscopy
fiber optic eval of lower respiratory tract; usually trachea/bronchi/segmental bronchi
flexible optic scope inserted through nose or mouth to show airways
indications for a broncoscopy
visualizing bronchial structures
foreign object removal or biopsy
clearing out of secretions
taking cultures of secretions for infection identification
