Presentations mixture of highlights!!!!!!!! Flashcards

Question

treatment for bronchospasm

Answer 1

``` 100% O2 Increase anesthestic beta agonist (terbutaline 0.25mg SQ; albuterol) anticholinergic ( ipratropium bromide) Lido IV Epi- corticosteroids ```

Answer 2

Great job on the last section!!!!!!!!!

Answer 3

``` Emphysema Chronic bronchitis Asthma Bronchiectasis OSA ```

Answer 4

emphysema | chronic bronchitis

Answer 5

cigarette smoking

Answer 6

PFTs via spirometry

Answer 7

Low FEV1/FVC= 70%

Answer 8

mild- >80% moderate- 50-79% severe- 30-49% very severe- <30%

Answer 9

abnormal permanent enlargement of airspace distal to the terminal bronchiole,

Answer 10

centiacinar | panacinar

Answer 11

Centiacinar

Answer 12

``` dyspnea @ rest dry cough pursed lip breathing wheezes with auscultation long expiratory pause barrel shaped chest ```

Answer 13

mild chronic inflamation throughout the airways, parenchyma, and pulmonary vasculature

Answer 14

Impressive cough productive sputum wheezes or crackles dyspnea (late) cor pulmonale/ right sided heart failure (late)

Answer 15

disease characterized by permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastoc tissue, resulting from or associated with chronic necrotizing infections

Answer 16

``` ADLs presence of infections sputum triggering agents meds and effectiveness time of symptoms (day night) previous anesthesia hx OSA ```

Answer 17

alpha1-antitrypsin

Answer 18

``` supress neural reflexes Inhibit increased intracellular Ca++ Control airway inflammation eliminate secretions maintain VQ ```

Answer 19

VAAs- iso or sevo (greater broncho=dilators) IV agents- propofol (direct vagal mediated relaxation of airway smooth muscle) -Ketamine- bronchodilatory effects avoid what- barbiturates (histamine release)

Answer 20

``` Increase expiratory time --- can also increase inpsiratpory time --- I:E 1:6 Auto peep- --- detection with expiratory hold .5-1 sec --- detect with auscultation Reduce MV --- decreased TV --- Decreased RR ```

Answer 21

maintain PaO2 at 55-75 mmHg or near the pts norm, with FiO2 less than .5

Answer 22

normal range 50-60 mmHg (pH .3-7.4)

Answer 23

Yeahhhhhhh!!!!!

Answer 24

an infection of the lower respiratory tract caused by bacteria, viruses, fingi, protazoa, or parasites; results in an inflammatory response and fluid accumulation in the alveoli

Answer 25

``` fever/chills N/V Cough Chest pain diaphoresis cyanosis in nailbeds/lips AMS headache muscle pain weakness crackles ```

Answer 26

``` advanced age immunocompromised underlying lung disease alcoholism impaired swallowing AMS immobilization ETT malnutrition CV or liver disease Chronic exposure to irritants ```

Answer 27

``` HIV Cystic fibrosis Meds from transplants autoimmune diseases Asplenia pregnancy DM ```

Answer 28

bacterial viral Fungal Parasitic

Answer 29

streptococcus pneumoniae

Answer 30

green, yellow, rust colored

Answer 31

``` rhinovirus coronavirus INFLUENZA VIRUS RSV CMV ```

Answer 32

AIDS (PCP) | chemotherapy

Answer 33

Immigrants immune deficient people after traveling

Answer 34

``` atypical community acquired nosocomial aspiration ventilator associated ```

Answer 35

Lobar | bronchial

Answer 36

aka walking PNE sicker than they appear caused by atypical organisms atypical symptoms

Answer 37

Pt has not been in hospital | most common pathogen is streptococcus pneumoniae

Answer 38

>48 hrs after admission

Answer 39

``` Semi-recumbent position (when able) NGT-OGT secretion management NPO status ensure proper cuff pressure (20-30 cm H20 TCDB H2 blockers Antiemetics higher FiO2 may be needed (if active) watch for airway irritation ```

Answer 40

I meant smart ass!!! but none-the-less you still got this shit!!!

Answer 41

impaction of foreign material into the pulmonary circulation, specifically the pulmonary arteries

Answer 42

90% DVT Less common -- air, bone, tumor, amniotic fluid, fat, CO2

Answer 43

factor V leidan protein C deficiency Protein S deficiency Antithrombin Deficiency

Answer 44

Contraceptives HRT Air travel Cancer

Answer 45

venous stasis hypercoagulbility Vessel wall injury ====virchow's triad

Answer 46

``` virchow's triad thrombus dislofgement occlusion of pulmonary circulation vascular changes symptoms ```

Answer 47

``` dyspnea tachypnea tachycardia hypotension cyanosis hemoptysis chest pain syncope JVD ```

Answer 48

``` minimize myocardial depression high fiO2 Monitor PAP intotropes/vasopressors etomidate or ketamine induction ```

Answer 49

``` Decreased ETCO2 Tachycardia Decreased SaO2 Increase in PAP or CVP decreased B/P bronchospasm EKG ```

Answer 50

``` airway established (if not already) D/c anesthetic 100% fiO2 PEEP Circulatory support Sympathominetics/Inotropes Anticoagulation -----heparin 5000-1000 units bolus gtt 1000-1500 units an hour ```

Answer 51

persistant hypoxia | reperfusion edema

Answer 52

LMWH 12 hours before sx SCDs Warfarin (INR 3) inferior vena cava filter

Answer 53

Inhaled Nitric oxide

Answer 54

specific to lungs effective dose 10-20ppm pulmonary vasodilation decreases RV afterload

Answer 55

keep it up Lets go onto pulm HTN ps this is the 2 person one may be long but I am going to keep it condensed!!!!!!!

Answer 56

``` TREAT THE CAUSE O2 diuretics in RV failure vasodilators CCB ACEi Epoprostenol, trespitinil Sildenafil prostacyvlin Nitric oxide atrial septostomy transplant anticoagulation ```

Answer 57

inhibit nitric oxide degradation

Answer 58

``` sildenafil (PDE-5 inhibitor) --- decreases PAP/PVR --- min effects on systemic vasculature --- synergistic with NO --- Reduction in RV mass-prevention or reversal of RVH Milrinone (PDE-3 inhibitor) --- decreases PVR/PAP/SVR --- nebulized form minimizes systemic vasodilation ```

Answer 59

Endothelin-1 - neurohormone that casuses pulm vasoconstriction, smooth muscle proliferation, and fibrosis - stimulates endothelin receptors A and B - -A- vasoconstriction - -B- vasodilation

Answer 60

``` CBC, Coags, LFTs EKG CXR ABG Echo Cardiac Cath ```

Answer 61

``` type of sx METS Severty of Pulm HTN RV function Comorbidities ```

Answer 62

``` O2 Brinchodilation antibiotics steroids vasodilators inotropes ```

Answer 63

``` preload SVR Contractility CO NSR ```

Answer 64

MI hypotension Increased PVR

Answer 65

ASA standards A-line CVP TEE

Answer 66

``` Maintain spont breathing postop analgesia continuous vs bolus plexus/nerve catheters anti-coagulation??? Reduce LA dose ```

Answer 67

``` Method of choice for major sx Airway management systemic vasodilation mechanical ventilation reduced coronary perfusion ```

Answer 68

Small doses of midazolam (avoid hypoventilation)

Answer 69

opiods (blunt DL) Lido (blunt DL) prop, etomidate (either) muscle relaxants (avoid histamine releasing)

Answer 70

``` PROPOFOL decrease SVR Decrease Venouse return Decrease contractility ETOMIDATE maintain hemodynamics no PVR effect KETAMINE (CONTROVERSIAL) INCREASES PVR??? ```

Answer 71

``` ISOFLURANE - attenuate magnitude of HPV -potentiates vasodilator response to B1 -No effect on Alpha 1 DESFLURANE - potentiates pulm vasoconstriction SEVO- -can be used safely NITROUS OXIDE- -depresses myocardial contractility -increased PVR and RAP -Caution ```

Answer 72

maintain opioids maintain muscle relaxation Avoid histamine releasing drugs

Answer 73

high O2 Moderate TV HYPOcarbia (increase rate) low PEEP (5-10)

Answer 74

``` inhaled NO (20-40 ppm) Milirone (50 mcg/kg bolus) ```

Answer 75

Here is goes

Answer 76

an infection caused by mycobacterium tuberculosis (an acid fast bacillus) that infects pulmonary tissues and other organs

Answer 77

acid-fast sputum test

Answer 78

``` EARLY INFECTION -immune fight infection -no s/s EARLY PRIMARY PROGRESSION (ACTIVE) - immune system loses fight - inflammation ensues - NON-productive cough -fatigue weight loss fever -diagnosis difficult LATE (ACTIVE) - cough is PRODUCTIVE - more s/s -progressive weight loss anemia, rales - present on X-ray - diagnosis via sputum LATENT - Myobacteria persist on body - no s/s occuring -pt's DO NOT feel sick - infection can reappear ```

Answer 79

airborne droplets 1-5 mcg

Answer 80

N95 mask (except for rudy's bad ass beard) neg pressure air system surgical mask for pt all equip sterilized after use air filter in Y peice CHANGE OUT SODA LIME after pt elective procedures postponed till post infection

Answer 81

oh well!!!

Answer 82

ok one more big breath!!!!

Answer 83

end stage lung disease, refractory to standard medical or sugical therapy, to pts with NO other significant functional impairment

Answer 84

single 5.5 years double 6.5 years (i only added this b/c I thought It was odd that you have a better expectancy with 2 lungs vs one) seems tricky!!

Answer 85

``` RESTRICTIVE LUNG DISEASE - idiopathic pulmonary fibrosis, ILD OBSTRUCTIVE LUNG DISEASE -COPD, bronchitis SUPPORATIVE LUNG DISEASES - cystic fibrosis, bronchiectasis PULMONARY VASCULAR DISEASE - pulm artery HTN OTHER - sarcoidosis ```

Answer 86

PaO2/FiO2 >300 clear Chest X-ray Negative bronchoscopy (minimal to no secretions) age < 20 years

Answer 87

``` H&P EKG CxR labs-ABG, Coags, lytes, CBC Type and Cross -PRBCs, PLTs, FFP IV Review- ECHO, Cath, VQ immunosupression ```

Answer 88

Lungs must be visualized and deemed acceptable. | CROSS CLAMPING TIME DECLEARED--starts ischemia time

Answer 89

``` Induction intubation ventilate ASA monitoring A-line CVL PA line warming blankets TEE??? ```

Answer 90

``` I:E ration 1:4 or 1:5 check for auto peep avoid hyperinflation (Pnemo) permissive hypercarbia bronchodilators (if indicated) ```

Answer 91

``` NO inhaled Low volume ventilation high RR Minimal PEEP AUTO PEEP= NOT A CONCERN ```

Answer 92

agressive pulmonary toilet avoid hyperinflation NO inhaled

Answer 93

``` end ischemia time record ischemia time ventilate intra-op bronch for anastomosis check avoid reprofusion injury (NO) protective ventilation(PCV < 25 mmHg) ```

Answer 94

``` If single lung - remove DL tube- place SL tube - assess chest tube -transport to ICU If double lung - turn pt to opposite lateral decubitis -switch ventilation to transplanted lung - remove next lung ```

Answer 95

ok her we go!!

Answer 96

this should be interesting get ready set and go!!!!!!!!!!!

Answer 97

``` cough wheeze hemoptysis diaphragmatic paralysis unexplained hoarsness vocal cord paralysis' suspected TEF airway obstruction chest trauma intubation abnormal cXr ```

Answer 98

airway assessment respiratory CV focus dental premedication - antisialogogue, sedative

Answer 99

trachea and proximal/central airways GA needed analyzes expired gases

Answer 100

``` tumor foreign body removal stent placement dilation viscous secretions ```

Answer 101

in a picture in the ppt it shows a side port where the anesthesia circuit can connect!! ( no need for ETT (?????)

Answer 102

``` most common visualizes to segmental bronchi (3rd generation) LA conciuos sedation GA suction, bx, and irrigation channels need large diameter ETT ```

Answer 103

``` clearing secretions hemoptysis control tumor staging stent placement topical placement (meds) ```

Answer 104

``` arrhythmia (their dead) refractory hypoxemia inability to tolerate recent MI Creatinine > 3.0 platelets < 50,000 uncorrected coagulopathy SVC obstruction Pulm HTN Unstable neck or c-spine immobility Limited ROM of TMJ ```

Answer 105

``` Bronchospasm hypoxemia hemoptysis pneumothorax hemorrhage infection edema Ok this list goes on for about another 20 answers. just know it it is bad it could happen ```

Answer 106

- epiglottis to cricoid cartilage | - 3 single cartilages, 3 paired cartilages

Answer 107

-10-15 cm long - RMB 25-30 degrees LMB 45 degrees

Answer 108

too much to make card on many different anatomical locations I feel this is more important to a pulmonoligist not anesthesia as we wont be going that deep into the lungs but if you have alot of free time and want to learn go look!!!

Answer 109

not a radiologist not going into detail.. look for big signs like why your pt is breathing maybe its a pneumothorax you know what to look for. and pulm htn or pulm edema and ARDS white out!! if you crave the need for more see ppt i don;t think it is important!!!

Answer 110

you bet your ass you are!!!!!

Answer 111

Thanks for your cooperation

Answer 112

on atelectasis and hypoxemia!! drop your socks grab your cocks!!! this will be an adventure

Answer 113

type I- squamous alveolar- cells that form the structure of an alveoli type II-(greater alveolar)- cells that secrete pulmonary surfactant

Answer 114

loss of lung "units" impaired gas exchange V/Q mismatch

Answer 115

diaphragmatic

Answer 116

abdominal pressure id transmitted into thoracic cage and compresses pulmonar parachyma in dependent areas

Answer 117

high fiO2 induces atelectasis by absorption of )2 in oulmonary areas with low V/Q

Answer 118

reabsorption atelectasis

Answer 119

smoker elderly (b/c they have pre-existing low V/Q areas)

Answer 120

not really! remember reabsorption atelectasis. increasing fiO2 is effective for treating the symptom but not the cause

Answer 121

Alveolar recruitment strategy (ARS) controlled and step wise increment and decrement of airway pressures using fixed settings in PCV. driving pressure of 15 cm H2O, RR 10-15 I:E 1:1 fiO2 1.0

Answer 122

hemodynamic preconditioning phase recruitment phase decremental phase peep titration phase

Answer 123

-test hemodynamic response to high PEEP -Change of 15-20% from base line of VS halts test -3-5 ml/kg of crystalloid to correct hypovolemia actual test 1) 5 cm increments of PEEP from 0-20 2) each PEEP step maintained for 5 breaths -spend a few minutes at PEEPS 10-15 to test hemodynamic stability

Answer 124

- opening pressures of lung is 40cnH2O - once hemodynamics have been tested and stabilized - increase both driving pressures and PEEP to 20cmH20

Answer 125

- progressive decrease in PEEP of 2 cmH2O every few minutes | - identify lung closing pressures in dependent zones

Answer 126

once after induction | whenever the airway is open to atm

Answer 127

LMA or facemask hemodynamically unstable -broonchospams, TEF, high ICP , pneumothorax

Answer 128