Resp Flashcards

Question

Control methods of ventilation

Answer 1

Volume or pressure Vol - to be delivered, Paw determined by resistance and compliance Pressure - we choose the pressure, resistance, compliance, and insp time determine volume

Answer 2

Terminates the insp phase to allow expiration Time - cycling by Tinsp Flow - cycles when flow decreases by a designated % of peak insp flow Volume - cycles when volume delivered Limit - terminates insp if limits of pressure or volume reached

Answer 3

Variable that triggers insp Time - after a designated period Pressure - fall in pressure Flow - decrease in flowNeural activity

Answer 4

Constant or decel Constant - rapid increase then remains constant to target variable Volume mode Decel - Pressure controlled mode Flow falls as alveolar pressure increases Improves distribution of gas

Answer 5

FiO2 Mean airway pressure - itself determined from PEEP and I:E (more time spent in insp = higher MAP)

Answer 6

Frequency tidal vol volume of dead

Answer 7

Anaesthetic - dose related hypotension, loss of drive, brady, reactions AIrway - damage to structures, loss of airway Haemo - PPV —> instability, decreased preload VILI

Answer 8

Volutrauma - overdistention with excess Vt Barotrauma - damage by excessive pressures Atelectrauama - damage to sheer forces by repeated opening and closing Biotrauma - alveloar membrane damagae Oxygen toxicity

Answer 9

PH<7.35 and PaCO2 > 6.5 Despite optimum medical therapy

Answer 10

Persitent or worsening acidosis despite NIV Resp arrest/peri arrest Contra indictation to NIV

Answer 11

Severe facial deformity Fixed upper airway obstruction Burns Excess secretions Low GCS

Answer 12

Deliberate transient increase in intra thoraci pressure with improve oxygenation Principle of reopening collapsed units by pressurising beyond critical opening pressure Ways: -Sigh breath - Large Vt or high Pinsp for one breath -Sustained inflation 40cmH2O for 40 seconds -Extended sigh, increase in PEEP with same driving pressure -Incremental PEEP

Answer 13

Homogenous distriubtion of ventilation Improved thoraco-abdo compliance Pressures evenly distributed Heart/mediastinum moved off lung units Drainage of secretions Homogenous perfusion Proning diverts blood to better aerated units Reduces EVLW

Answer 14

Turning and whilst prone Turn Loss of airway/devices Spine, shoulder injury Increased sedation Transient hypoxia Instabiltiy Prone Oedema and pressure areas Conjunctival oedema Retinal damage Airway obstruction Nerve damage Line damage

Answer 15

Simple difficult and prolonged Simple - extubated after first SBT Difficult - upto 3 SBTs or 7 days Prolonged - exceeds limits of difficult weaning Long term - more than 21 days and more than 6 hours a day

Answer 16

Airway - patent airway —> leak test B - Minimal O2, low PEEP, low pressure support Adequate vent drive Good cough, secretion clearnece C - haemodynamically stable D - good GCS to protcet airway, no agitation E - original pathology gone, no procedures needed

Answer 17

RSBI = Vt/F. (Aim less than 105) (If peep=0 and ps=0) P0.1 < -5MIP

Answer 18

Physiology, gases, clinical Phys: HR 20% above base or > 140Sys BP >20%, or >180 or <90Arrhythmia RR>50% baseline or >35 RSBI > 105 Gases PaO2 <8 of 50% PaCO2 > 6.5 PH < 7.32 Clinical Cyanosis, pale, clammy, increased resp effort, agitation

Answer 19

Age>65 COPD Heart failure OSA/obsesity Neuromuscular disorders Postive balacne Vent>6 days

Answer 20

Elective surgery, head and neck cancer Emergency - loss of patent airway, pathology, neurological impairment Prolonged wean Excess secretions or no cough

Answer 21

Shorter - less dead space, less resistance to flow, reduced WOB, easy suction Reduced sedation needs Improved cough and secretions Ability to communicate Conduct physio Avoid ETT - speech, ?eat, mouth care, comfort

Answer 22

Local - infection to site - Absnormal anatomy - Known difficult airway - Short neck / obesity (???) - C spine injury (no extension) Systemic - Coagulopathy - haemodynbamic or resp comprimise - raised ICP

Answer 23

Immediate, early and late Im: Hypoxia/carbia Loss of airway Aspiration Haemorrage Damage to tracheal rings, bleeding, Ptx, exphysema Anaesthesia Early Infection Displaced tube Ocllusion Tracheal ulcer, fistula, Bleeding via erosions Late Tracheal dilation, tracheomalacia, stenosis Changes to voice

Answer 24

Diagnosis, therapeutic, assist Diag: BAL for MC&S, cyto Biopsy Inhalational injury ETT position Therapy -Remove obstructions, sputum, blood, FB Bronchial stent, BPF Assist - fibreoptic tube, Perc trachy, DLT, Broncho blocker

Answer 25

Timing, within 1 week of known clinical insult Chest image - bilateral opacities, not explained by collapse, effusion or nodules Origin - Resp failure not fully explained by cardiac failure or fluid overload Hypoxia by PF ratio 39.9 to 26.6 mild 13.3 to 26.6 moderate <13.3 severe On a ventilator, with PEEP 5

Answer 26

Cardiogenic pulmonary oedema Eosiniphilic pneumonia Cryptogenic organising pneumonia Diffuse alveloar haemorrhage

Answer 27

Direct and indirect Direct Pneumonia Viral pneumonitis, COVID Chemical Smoke Drowning Contusion Reperfusion Irrdation Indirect Sepsis trauma pancreatitis Eclampsia, AFE TLE TRALI

Answer 28

Low Vt - 6ml/kg of IBW Plateau < 30cmH20 PEEP - high or titrated by compliance curves Recruitment manouvres —> improves O2, no effect on outcomes Permissive hypercapnoea Proning HFO VECMO

Answer 29

Steroids - improve O2 but mort benefit?? Surfactant - no benefit Statins - no benefit iNO - improve O2 but no benefit

Answer 30

Heat —> oedema, erythema, ulceration Toxins - sulphur, acids, damage by pH or free radicals Environmental hypoxia

Answer 31

Exudative and fibrotic phase Exudate - neutophil influx, increased permeability, type 2 pneumocyte loss and surfactant loss Fibrotic - alveolitis

Answer 32

Salbutamol Heparin NAC

Answer 33

Binds Hb 250x more than O2 left shift of curve Also - cytochrome oxidase inhibition Therefore tissue hypoxia Pulse ox cannot differentiate

Answer 34

- >10% is a problem>100% oxygen via high conc facemask ->25% O2 and ventilation - >40% or coma OR pregnant, OR non responding -HBO 100% O2 changes half life from 4 to 1 hour HBO at 3atm reduces to 30 minutes

Answer 35

Binds to the ferric ion on cytochrome oxidase —> no aerobic cellular metabolism Cytoxic hypoxia Look out for unexplained lactic acidosis

Answer 36

Aim to induce a metHb - amyl nitrate, sodium nitrite Bind cyanide - dicobalt edetate, hydroxycobalamin Sulpur donation - cyanide to thiocyanate —> sodium thiosulphate

Answer 37

PEFR 40-75%

Answer 38

PEFR 33 to 50% predicted Resp Rate >35 HR 110 Low/Normal CO2 Cannot complete sentence

Answer 39

PEFR <33% Reduced resp effort Silent chest Arrhytmia Hypotension Brady Hypoxia - SpO2 <92% or <8kPa Altered GCS

Answer 40

Rising CO2| Need for MV

Answer 41

Previous life threatening with need for ventilation Hostpial admission in the last year Three or more chronic meds Use of salbutamol +++++ Brittle - type 1 - wide PEFR variability Type 2 - sudden severe attacks when usually well controlled

Answer 42

Airflow limitation —> in small ariways. Flow limitation in exp. Active exhalation increases intrathoracic pressures —> makes it worse Dynamic hyperinflation - reduced exp time —> residual volume increases —> gas trapping Hyperinflation moves you up the compliance curve, decreases compliances

Answer 43

Identify - failrue of flow to return to baseline, before vent triggers, incomplete exp. Measure by intrinsic/auto PEEP Measured pressure on exp hold minus PEEP from vent is iPEEP Under spontaneous breathing - measured by oesophageal balloon

Answer 44

NIV - limited role. Theoretical reducing WOB through IPAP, EPAP keeps airways open Anaesthesia - use ketamine. BEWARE HYPOTENSION FROM PRELOAD LOSS Sedation - ketamine, sevoflurane Hyperinflation - prolong I:E ratio, short Tinsp, high flow rate, slow RR PEEP -extrinsic PEEP usually at 80% of iPEEP. Airway pressures - plat 30.

Answer 45

CAP - evolving in community of within 48 hours of admission HAP - more than 48 hours after admission

Answer 46

CAP -strep. Pneumonia, -H. Influenza ] -Legionella # -Chlamydiea -Mycoplasma HAP - gram negs -Pseudomonas -E.coli -Klebsiella -Acinebacter

Answer 47

Reduce micro asp: 30 degree head up Prone vent Cuff pressures >30 Supraglottic suction Enteral feeding - no evidence of post pyloric feeding or prokinetics Acid - PPI may increase risk Colonisation - chlorhex. SDD Extubate ASAP, sedation holds, SBT

Answer 48

Diffuse or focal infiltrate Diffuse -CMV, PCP, Aspergilllius, cryptococcus, Drugs, radiation, GvHD Focal Gram negs S.aureus Aspergillus Cryptococcus

Answer 49

Blood culture Sputum for gram stain and MC&S Urine pneumococcal anitgens, legionalle PCR mycoplasma, PCP BAL

Answer 50

```Confusion (AMTS<8)Urea >7RR>30BP<90Age>65```

Answer 51

0 - 0.7% 1 - 3.2% 2- 13% 3 - 17% 4 - 41% 5 - 57%

Answer 52

Tool for if needing mechanical ventilation Sys<90 Multilobe involement Albumin RR (age adjusted) Tachycardia>125 Confusion Oxygen pH <7.355 6 points —> high risk

Answer 53

Parapneumonic effusion (50%) —> tap and drain if empyema Abscess formation (worse in alcohol abuse, and aspriation) Metastatic infection - S.aureus and pneumoniae.Joints meninges and endocardium Legionella specific - encephalitis, pericarditis, pancreatitis, hyponatraemia, deranged liver, low plts

Answer 54

Protein level - >30g - exudate, <30 transudate Transudate: increased hydrostatic pressure OR reduced oncotic pressure Heart, liver or kidney failure Meigs Hypothyroids Small number of pituitary tumours Exudative Increased permabilityInfection - TB, pneumonia, empyema - Malig - bronchial Ca, mesothel - Connective tissue - RA, SLE, - Inflammation - pancreatitis

Answer 55

Exudate if: Pleural to serum protein ratio >0.5 Pleural to serum LDH > 0.6 Pleural LDH > 2/3 upper limit of normal serum LDH

Answer 56

pH < 7.2 Glucose <3.3 Bacteria on microscopy Pus LDH >1000 in fluid

Answer 57

Diagnosis Worsening resp failure Infected Options for organised effusion - Radiologically guided drainaget - PA instillation to break down - VATS

Answer 58

Primary - young tall men etc SEcondary - empysema, cancer, TB, ARDS Iatrogenic - pleural biospy, cental line,PPM Traumatic Ventilator assocaited

Answer 59

Small <2cm - conservative, high FIO2 may increased absorption Larger - decompress and drain Refractory - medical pleurodesis, VATS pleurectomy, open thoracotomy and pleurectomy

Answer 60

Post pulmonary surgery (pneumonectomy > lobectomy) Post pneumonia Cancer, bronchial, oesophageal Trauma Iatrogenic ARDS Radiation

Answer 61

Chest drain without suction Minimise airway pressures: -Avoid PPV where possible, SBT ASAP Low pressures ?HFOV ?ECMO DLT/bronchial blocker -Closure: Bronch - stent, glue, blocker Lung surgery, stapling stump, lobectomy, segementectomy

Answer 62

Blood loss within the airways at a rate that is an immediate risk to life Could be as small as 200ml/24hr Death from suffocation NOT haemorrhage

Answer 63

Bronchial vessels 90% Pulmonary 5% Nonpulmonary systemic 5%

Answer 64

Tb, lung absess Neoplasia Inflammation - chronic bronchitis, fungal lung disease, vascullitis, CF, bronchiectasis Coagulopathy iatrogenic

Answer 65

Large ETT for bronch Place bleeding side down Conisder DLT, bronchial blockers Volume Correct coagulopathy TXA Anti-tussive Definitive: Bronch and find bleeding point Balloon tampanade Direct injection of haemostasis Isolate bleeding lobe with blockers CT angio and IR embolization