Obstructive Sleep Apnea Flashcards

Question

common risk factors for ARDS

Answer 1

-Sepsis (1/3 of pts)** -Severe multiple trauma ** -large Aspiration of gastric contents ** ------- -Shock -Infection -Lung contusion -Nonthoracic trauma -Toxic inhalation -Near-drowning -Multiple blood transfusions -Drugs all of these are the "systemic or pulmonary insults"

Answer 2

1) insult causes release of pro-inflammatory cytokines -> promotes tissue destruction + inflammation Lung Inflammation causes: - ↑ Vascular Permeability = Interstitial & Alveolar Edema + Bilateral Diffuse Infiltrates - ↓ Alveolar Surfactants = Alveolar Collapse + Hypoxemia

Answer 3

RAPID onset of really bad dyspnea: -FROTHY RED OR PINK SPUTUM** -Diffuse crackles everywhere -Marked hypoxemia refractory to tx with supplemental oxygen *** - Many pts demonstrate multiple organ failure ——- -Labored breathing -Tachypnea -accessory inspiratory muscles

Answer 4

HEART FAILURE - diffuse crackles -multiple organ failure - dyspnea -cadiogenic pulmonary edema

Answer 5

Findings: "white out" - May be normal at first -BILATERAL infiltrates usually peripheral - Air BRONCHOGRAMS * (80%) -> alveolar inflitrates Normal: -Heart size normal - spares costophrenic angles: no pleural effusions

Answer 6

-Treatment of underlying precipitating or secondary conditions (ex: sepsis) -Tracheal intubation -PEEP: Positive End Expiratory Pressure = Keeps alveoli open -Supplemental O2 - Fluid Management ------- basically: give PEEP and O2 but not too much for O2 toxicity and give fluids but not too much to cause HF

Answer 7

PEEP: Positive End Expiratory Pressure = Keeps alveoli open - Ideally keep PEEP ↓ and Supplemental O2 ↓ as possible PEEP goal: - PaO2 > 55 mmHg or SaO2 > 88% O2 goal: - Recommended FIO2 < 60% with <40% the safest - avoid oxygen toxicity ------------ Fraction of inspired oxygen (FIO2): percentage of O2 in the gas mixture that is inhaled Oxygen saturation (SaO2): proportion of Hb that are saturation

Answer 8

- want to maintain pulmonary capillary wedge pressure at the LOWEST level compatible with adequate cardiac output - don't want to fluid overload (HF)

Answer 9

-30-40% Mortality Rate -90% Mortality with Sepsis -Median Survival Time ~ 2 weeks - If pts survive: will have SIGNIFICANT respiratory impairments

Answer 10

Definition: Aspiration of material Causes: Impaired deglutition - Secondary to Altered Consciousness - Secondary to Esophageal Dysfunction

Answer 11

-Aspiration of Inert Material -Aspiration of Toxic Material -"Café Coronary" -Retention of Aspirated FB -Chronic Aspiration of Gastric Contents -Acute Aspiration of Gastric contents

Answer 12

Inert Material: non-hazardous = No serious sequelae - Aspiration of particular matter or large volumes of fluid - May present with asphyxia if amount aspirated is MASSIVE -- ex: waterboarding

Answer 13

May cause hydrocarbon pneumonitis**: aspiration of ingested petroleum distillates: -Gasoline, kerosene, furniture polish - occurs in suicide attempt or child accidentally ingesting toxic material -Lung injury: mainly from vomiting and aspiration Symptoms: - vomiting, coughing - respiratory distress - cyanosis - fever Tx: supportive care "toxicpeople go low and hide in the middle, they are initially normal and then get worse at night"

Answer 14

CXR: initially be normal -> significantly progress over the next 12 hours. Patchy airspace consolidation particularly in: - LOWER lobes - medial basal segments Tx: supportive "toxic ppl: - go low and hide in the medial base - initially normal and can get worse at night (12 h)"

Answer 15

Chronic syndrome due to REPEATED aspiration of oily materials - Mineral oil, cod liver oil, and oily nose drops -Can cause pneumonia and fibrosis - MC: Elderly patients with impaired swallowing -Cough is present Dx: lipid laden alveolar macrophages - sputum sample or bronchial washings with + lipid-laden alveolar macrophages "Lipoid = Oily Fat People" - can cause Fibrosis and Pneumonia - chronic ingestion of oily substances - Oily: Old ppl with impaired swallowing -> cough a lot

Answer 16

Definition: ACUTE obstruction of the upper airway by FOOD Associated with: -Difficulty swallowing -Old age -Dental problems that impair chewing -Use of alcohol and sedative drugs Tx: Heimlich procedure

Answer 17

May be acute, chronic, or asymptomatic: these are what it can cause: "foreign Body -> Being HAPA is a foreign body" - Bronchiectasis - Hyperinflation - Abscess (lung) - Pneumonia (recurrent) - Atelectasis" ---- -recurrent pneumonia -Bronchiectasis -Lung abscess -Atelectasis -Postobstructive hyperinflation

Answer 18

CXR: - usually suggests the site of the foreign body Golden Standard = Bronchoscopy - Establishes Dx & Removal of FB "foreign BOdy = BrONchoscopy -> BB"

Answer 19

Result from primary disorder of larynx or esophagus: -Untreated asthma -esophageal stricture -achalasia -scleroderma -chronic reflux it can cause: - Bronchial asthma - pulmonary fibrosis - bronchiectasis

Answer 20

Dx: "swallowing disorders" - EGD - barium swallow Tx: - EGD Dilate - PPI - H2 Blocker - Metoclopramide: increase gastric emptying

Answer 21

Catastrophic event!! -> response depends on how much was aspirated -more acidic + more quantity = WORSE chemical pneumonitis -Aspiration of pure gastric acid (pH < 2.5) -> ARDS What can it cause: "HEbP = HELP!!" -Hemorrhage: bleeding in lungs -Extensive desquamation of the bronchial epithelium -Bronchiolitis -Pulmonary edema

Answer 22

-Patchy alveolar infiltrates in dependent lung zones -Appear within few hours and progresses - If particular food matter = Obstruction may be observed

Answer 23

ABCs: -Maintain the airway -Supplemental oxygen - mechanical ventilation if ARDS Supportive: -Fluids for hypotension -Treatment of superinfection -> prevent secondary infection "ACUTE= ABCs - airway: maintain airway - Breathing: ventilate if respiratory failure (ARDS); O2 - Circulation: fluids for hypotension + treat superinfections"

Obstructive Sleep Apnea Flashcards

(47 cards)