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Related Flashcards
Cards In This Set
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Chronic Bronchitis: Diagnostic Criteria
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Chronic Cough • +Sputum production• 3+ months/year • 2+ yrs
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COPD Treatment Approach
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1. MDI: ß-agonists a/o Anticholinergics (Ipratropium)2. ICS3. Theophylline, systemic4. Continuous O2 therapy
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Management of Acute COPD Exacerbation
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• CXR (PMA is the #1 cause of acute exacerbations)• Duoneb (Albuterol + Ipratropium)• Systemic Corticosteroids (IV Methylprednisolone)• Supplemental O2 (SaO2 > 90%)± Noninvasive PPV (BIPAP or CPAP)± Intubation/Mech Vent if above ineffective
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Asthma: Bronchodilator Response criteria
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1. Increase in FEV1 ≥10% over Predicted Value2. Increase in FEV1 ≥12% and 200mL over Baseline
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Asthma Exacerbation: significance of a nl or high PaCO2
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• During an asthma attack, pts hyperventilate leading to low PaCO2• If a pt has a nl or high PaCO2, this is indicative of decompensation, most likely 2/2 respiratory muscle fatigue and is worrisome for impending Respiratory Failure• Must consider Intubation/Mechanical Ventilation
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Single Pulmonary NodulesA. DDxB. Approach
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A. DDx: Malignancy, Granuloma, HamartomaB. Approach:1. If High likelihood of Malignancy: Resection2. If intermediate risk: Aspiration Bx or Bronchoscopy3. Low Risk: Serial CXR/CT (Q3mos, then Q6mos)
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Acute Respiratory Failure: Criteria
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Definition: inadequate oxygenation (hypoxemia), ventilation (CO2 removal), or both.1. Hypoxia: PaO2 < 602. Hypercapnia: PaCO2 > 50
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Pulmonary HTN: causes
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PHTN: Mean Pulmonary Arterial P ≥ 25 at rest (≥ 35 during exercise)1. Increased Flow: left-->right shunts2. Increased LH pressure: L Valve dz, LVH, LAE, etc.3. Increased Pulmonary Vascular Resistance: a) Chronic Hypoxia --> Hypoxic Vasoconstriction b) External compression: tumors/masses c) Internal compression: Chronic PE, Inflammation
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Minute Ventilation equation
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Minute Ventilation = TV • RR
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Alveolar Ventilation equation
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VA = RR•(TV - DS)Since Ventilation is regulated by the need for CO2 removal... VA = 0.863 • VCO2 / PACO2where VCO2 = rate of CO2 production]
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Accessory Muscles of Respiration
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Inspiratory1. SCM2. Scalenes3. External ICsExpiratory1. Abdominals2. Internal ICs
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Surfactant: composition and secretion
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Composition• Phosphatidylcholines (85%): DPPC (Dipalmitoyl-phosphatidylcholine) makes up ~50%• Phosphatidylglycerol (10%)• Surfactant-associated Proteins: SP-A,B,C,D (5%)• Cholesterol & Neutral Lipids: traceSecreted by Type 2 Pneumocytes
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Obstructive Lung Diseases: etiologies
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"FACES" mnemonicForeign body obstructionAsthmaChronic bronchitis & BronchiectasisEmphysemaSmall Airway disease (Bronchiolitis)
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Restrictive Lung Disease: etiologies
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"PAINT" mnemonicPleural diseaseAlveolar filling: PMA, pulmonary edema, hemorrhageInterstitial LDzNeuromuscular dzThoracic cage disease: obesity, sever kyphoscoliosis
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DLCO utility
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Decreased when their is...A. Loss of Alveolar SA: Emphysema, Alveolar fillingB. Increased BM thickness: Pulmonary FibrosisC. Loss of Pulm Vasculature SA: PE
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