Pathophys Flashcards
(20 cards)
What are the criteria for sepsis?
- Temp > 38 C or 90 bpm
- Tachypnea, RR >22
- WBC > 12000 or >4000
* two or more = sepsis
What is severe sepsis?
sepsis + organ dysfunction
What is septic shock?
sepsis induced hypotension even though fluids were pushed. Requires vasopressors and fluids.
What are the mediators of sepsis?
IL-1, IL-4, IL-8, TNF-alpha
What is goal directed resuscitation?
- central venous pressure: 8-12 mmHg
- MAP >65mmHg
- urine output > 0.5 mL/kg/hr
- Central venous O2 sat >70%
- achieve within 6hrs
Who gets pneumococcal vaccine?
->65 years, asplenia,
What are the symptoms of COPD?
- shortness of breath
- chronic cough
- sputum
Physical exam on COPD pt.
- wheezing during auscultation on slow or forced breathing
- prolongation of FEV1
- Barrel chest deformity
- low diaphragm position
- decreased distant heart sounds and breath sounds
- pursed lip breathing
- use of accessory muscles
DLCO in patients with COPD
reduced in COPD patients with predominant emphysema. Helps exclude asthma.
Blue Bloaters
- characterized by acute exacerbations of respiratory and ventilatory failure
- Hypoxemia and hypercapnia are due to V/Q imbalance
- There are alterations in CNS centers that control minute ventilation that allow for a lower WOB at the cost of higher PCO2
What is the long term effect of being a blue bloater?
- chronic hypoxemia causes polycythemia, pulmonary hyertension, and cor pulmonale.
- blue from hypoxia, bloated from edema
Characteristics of a pink puffer?
- dyspnea, tachypnea, and a high minute ventilation
- hypoxemia due to V/Q imblance
- low DLCO
- high WOB
What is the long term effect of being a pink puffer?
- High WOB- thin cachetic pts
- once hypercapnia and sever hypoxemia develops the pt usually dies quickly
What are the mediators of COPD?
- COPD airway inflammation
- CD8+ lymphocytes
- Macrophages
- Neutrophils
- CD 68+
How do we diagnosis chronic bronchitis?
-chronic or recurrent cough present on most days for a minimum of three months in a year and for not less than 2 consecutive years.
Pathology of Central airways in chronic bronchitis (cartilage airways)?
- bronchial gland hypertrophy and goblet cell metaplasia leads to excessive mucous production
- squamous metaplasia of airway epithelium, loss of cilia and cillary function, and increased smooth muscle and connective tissue.
- CD8 lymphocytes and neutrophils
Where is the major site of airflow limitation in chronic bronchitis?
-small conducting airways <2mm in diameter
What is the definition of emphysema?
-abnormal enlargement of air spaces distal to the terminal bronchioles, occurs in lung parenchyma in COPD
Centrolobular emphysema
- involves dilation and destruction of the respiratory bronchioles
- Predominantly and upper lobe process associated with smoking
Panlobular emphysema
- involves destruction of the entire acinus
- predominantly a lower lobe process associated with alpha-1-antitrypsin deficiency
