Pulmonary critical care Flashcards
(27 cards)
Causes of respiratory alkalosis
- sepsis
- pulmonary embolism
- pregnancy
- anxiety and pain
- hypoxia
- salicylate intox
causes of respiratory acidosis:
- drug OD
- CVA
- asthma
- COPD
- obesity
- sleep apnea
PFT
* DLCO reduced in diseases of lung itself
- when lung volumes are normal, decreased DLCO suggests pulm vasc problem: PE, PAH, vasculitis
*high DLCO suggests: pulmonary hemorrhage, L-R shunt, polycythemia
Obstructive lung diseases
asthma
COPD
bronchiectasis
cystic fibrosis
Restrictive lung diseases of parenchymal
sarcoidosis
pulmonary fibrosis
pneumoconiosis
interstitial lung dz due to drugs or radiation
Restrictive neumuscular diseases
Gullain Barre syndrome
myasthenia gravis
muscular dystrophies
diaphragm weakness
Restrictive lung dx due to chest wall stiffness
kyphoscoliosis
ankylosing spondylitis
obesity
Methemoglobinemia
*clinical features: central cyanosis, SOA, blood appears BROWM
- causes: benzocaine spray/local anesthesia, dapsone, nitrides
- tx: IV methylene blue
hypoxia in COPD
indications for oxygen home therapy
- PaO2 of 55 or less
- saO2 of 88%or less
- PaO2 56-59 or SaO2 89% or less if edema, P pulmonale on ECG,hematocrit >56%
- noc sats 88% or less
stages of COPD
all COPD have FEV1/FVC ,70%
Mild FEV1 80% or more of predicted
moderate FEV1 50-79% predicted
severe FEV1 30-49% predicted
very severe <30% predicted
Tx exac of COPD
- keep sats 90-92% and PO2 60-65
- do ABG 30-60min on O2 to check for CO2 retention or acidosis
- bronchodilators:ipatropium & albuterol
- abx cover H influenzae, strep pneumonia, moraxela: quinolone, 3rd gen cephalosporin & macrolide
- steroids IV/po x 2weeks
acute exac COPD - indications for noninvasive ventilation
- moderate-severe dyspnea w use of accessory muscles
- pH 45
- RR >25
exac COPD indications for invasive ventilation
- if they cant tolerate noninvasive ventilation
- severe dyspnea with RR > 25
- severe hypoxia, severe acidosis pH 60
* impaired mental status, hypotension, shock
Bronchiectasis
- chara by permanent abnormal dilatation & destruction of bronchial walls
- PFT: obstructive pattern
- best dx test: HRCT
- s/s: cough, mucopurulent sputum, dyspnea, hemoptysis, pleuritic CP
- CXR: dilated & thickened airways, linear atelectasis, mucus plugs
causes of bronchiectasis
- airway obstr: foreign body aspiration, tumors, enlarged nodes
- lung infections: M avium, allergic aspergillosis
- hypogammaglobulinemia,RA, scleroderma
- Kartageners syndrome: bronchiectasis + sinusitis + infertility + situs inversus
- cystic fibrosis
Cystic Fibrosis
- CFTR gene mutation, autosomal recessive
- dx: sweat chloride >60
- s/s: recur lung infection (#1 pseudomonas), bronchiectasis, clubbing, steatorrhea,infertility, pancreatitis, DM, obstr biliary dz
- Tx: acute tx infection, prevent infections w inhaled tobramycin
- persistent airway secretions- aerosolized recomb human dnase
- airway obstr- bronchodilators, steroids, chest physiotherapy
- pancreatic insuff- pancreatic enzyme
- severe hemoptysis-bronchial artery embolization
causes of acute cough (<3 wks)
- common cold
- allergic or bacterial sinusitis
- bordetella pertussis
- exac of chronic bronchitis
causes of subacute cough (3-8 weeks)
- post infection
- asthma
- subacute sinusitis
- B pertussis
Causes of chronic cough (>8 wk)
GERD ACE inhibitors cough asthma postnasal drip chronic or eosinophilic bronchitis
factors assoc with increased risk of death from asthma
- prior intubation or ICU admit
- 2 or more hosp or 3 or more ER visits in past year
- low socioeconomic status
- use of >2 canister of short acting beta agonist/ month
Signs of life threatening asthma
- altered MS
- paradoxical chest or abdominal movement
- absence of wheezing
Mild intermittent asthma:
-day s/s 2or less times/week, noc s/s 2 or less/month
-tx: prn inhaled short acting beta agonist
Mild persistent asthma:
-day s/s>2/wk, noc>2/month, tx low inhaled steroid+prn beta
Moderate persistent:
-daily day s/s, >1/wk noc s/s, tx add low to med dose inhaled steroids + long acting beta agonist
Severe persistent: cont daily s/s, freq noc s/s, add high dose inhaled steroid + systemic steroids
Ventilator settings: VT 5-10ml/kg (ARDS 6ml/kg) RR 8-14 Min vent pressure not >355 FiO2 lowest to maint PaO2 60 or sat 90%
Inspiratory flow: 60liter/min (most), COPD 100liter/min
trigger sensitivity -1 to -2cm
PEEP 5-10
complications of mechanical ventilation:
-toxicity of oxygen-keep FiO2
- hyperinflation (auto PEEP)
- vent assoc pneumonia-onset at least 48hrs after on vent, gram -,staph, anaerobes-prevent w head elevation 45 degrees
- deconditioning of resp muscles
- stress ulcers-PPI or H2 prophylaxis
hyperinflation -auto PEEP
- decreases venous return, cardiac output, and decr BP
- increases HR,incr workof breathing,wheezing,expir prolongation
- tx:decrease minute ventilation=>increases expiratory time, increase inspiratory flow, bronchodilators, fluids
- the need to decrease minute ventilation may require tolerating PCO2 above baseline - permissive hypercapnia
