Pulm IC

Question 1

Phases of capnogram

Answer 1

I. inspiration and early expiration’
II. interface dead space and early expired alveolar gas
-usually brief and steep. Borader where there is substantial VQ inhomogeneity
III. Alveolar plateau, values of alveolar gas
-gradual rise, slope depends on VQ heterogeneity and pace of CO2 production
-higher slope, severe obstructive diseases like COPD and status asthmaticus
-PE would flatten phase III
IV. rapid fall back to baseline after onset of inspiration.

Question 2

Equation of Motion

Answer 2

Paw+Pmus= (Flow x Resistance) + (Volume/System Complicance) + PEEP

Question 3

Definition of Pre-eclampsia

Answer 3

After 20wk of gestation

1. Proteinuria (>300mg/d)
2. HTN >140/90

Question 4

Treat of Pre-eclampsia

Answer 4

1. Mg to reduce risk of seizures
2. Keep SBP <160 (hemorrhagic stroke)
3. AVOID: ACE and Ni-pride (contra-indicated)

Question 5

Stress Index

Answer 5

• cocave up, stress index >1, compliance decreasing over time (overdistension)
• Downward concavity, stress index <1, complicance increasing over time, room for lung recruitment with PEEP

Question 6

TPP define

Answer 6

TPP static: PEEP - esoph pressure at end of expir. Negative value indicates repetitive collapse
TPP dynamic: Plat pressure - esoph pressure at end of inspir; value >25 is overdistension
Driving pressure= Pplat- PEEP

Question 7

Complicated Parapneumonic, require chest tube

Answer 7

1. pH <7.2
2. Pus
3. Positive gram stain
4. LDH >1000
5. Air-fluid level or loculations