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Pulm disease exam 3


Diagnostic Bronchoscopy indications? Abnormal radio graphic findings, mass lesion, aspiration, pulm infiltrate, for assessment of ET tubes and trachs(tracheal damage, tube placement, obstruction), bronchiectasis, foreign body, hemoptysis, recurrent laryngeal nerve paralysis
Therapeutic bronchoscopy indications? endotracheal intubation, retained secretions or mucus plugs, foreign body aspiration, bronchial strictures, endobronchial malignant obstruction ( removing tumor, brachytherapy)
Bronchoscopy contraindications? absence of informed consent, no experienced bronchoscopist, lack of emergency facilities, inability to adequetly oxygenate the patient, cardiac instability, uncontrolled asthma, coagulopathy, tracheal obstruction, uremia, pulm htn
Pneumothorax can be identified on their basis of origin, such as? traumatic pneumo, spontaneous pneumo, iatrogenic pneumo
What is a closed pneumothorax? gas in the pleural space is not in direct contact with the atmosphere
What is an open pneumothorax? the pleural space is in direct contact with the atmosphere, gas can move freely in and out
What is a tension pneumothorax? the intrapleural pressure exceeds the intra-alveolar (atmospheric) pressure
How is a traumatic pneumo caused? penetrating wounds to the chest wall
When this type of traumatic pneumo occurs the pleural space is in direct contact with the atmosphere, gas can move in and out, this is called? A sucking chest wound and it is also a open chest wound
A piercing chest wound may also result in a closed or tension pneumo through a one way valve, this works by? a ruptured parietal pleura, gas enters the pleural space during inspiration but cannot leave during expiration
When a pneumo occurs suddenly without any obvious underlying cause, it is called? a spontaneous pneumo, can sometimes be cause by the rupture of a small bleb or bulla on the surface of the lung.
An iatrogenic pneumo occurs? during diagnostic or therapeutic procedure, medically caused.
What is pendelluft? a paradoxical movement of gas within the lungs caused by a sucking chest wound, causes the patient to hypoventilate
What are chest assessment findings of a pneumothorax? hyperresonant percussion not over the pneumothorax, diminished breath sounds over pneumo, tracheal shift (away with tension pneumo), displaced heart sounds
How do you diagnose a pneumothorax? chest x-ray
When the pneumothorax is relatively small what tx? 15-20% Pneumo, pt will need bed rest or limited physical activity
When the pneumothorax is larger than 20%? should be evacuated, in less severe cases it can be withdrawn from pleural cavity by needle aspiration, in more severe cases use a chest tube
A chest tube is inserted into the? 2nd intercostal space, midclavicular line
Pneumothorax= Restrictive = Decreased venous return= Decreased BP
With bronchoscopy trans bronchial needle aspirations are performed with? needle catheters
Diagnostic brushings are done with bronchoscopy? bacterial culture, cytology, using a double sheathed protected catheter brush
Needle aspiration with bronchoscopy are done for? cytology, biopsy, culture
Biopsy and bronchoalveolar lavage can also be done? with bronchoscopy
The bronchoscope should be cleaned thoroughly following the? manufacturers instructions, transmission of infectious agents to patients by bronchoscopes is possible ( most important part is cleaning the scope)
The bronchoscope requires? A 45 minute soaking time in glutaraldehyde , ready for use in approximately an hour
What is a pleural effusion? an accumulation of fluid in the pleural cavity, there is normally about 10cc to lubricate breathing
What are some surgical complications of a tracheostomy? hemorrhage, air leaks (pneumo and sub q emphysema), cardiac arrest, airway trouble, fistula
Complications while tracheostomy is in place? injury, perforation, infection, displacement, air leak
Complication during and after decannulation? scar, granuloma, keloid, persistent open stoma, dysphagia, tracheal stenosis, tracheomalacia, web formation
A percutaneous tracheostomy is done at the bedside instead of the OR, benefits of this are? decrease operative time, decrease cost ( do not decrease amount of staff needed)
Transtracheal 02 catheters are used for? patients that need high flows, they conserve 02, reduce 02 flow requirements by 50-75%
Complications of transtracheal 02 catheters? hemoptysis, subcutaneous emphysema, site infection
A tension pneumo signs? tachycardia, low BP, due to decreased venous return
What are signs of a pleural effusion? decreased breath sounds, dull percussion, decreased tactile fremitus, diminished breath sounds
A chest x ray must be done to determine pleural effusion, you will see? blunted costo phrenic angles, and fluid level on the affected side
Pleural effusion= restrictive
what is the treatment for bacterial pneumonia caused pleural effusion and empyema? thoracentesis (drain cavity) and antibiotics.. surgery ONLY when nothing else works
Empyema is? infected pus in the pleural space, begins as bacterial pneumonia
You must do a thoracentesis with a pleural effusion too? determine what caused it and if it is an extrudate or transudate
Exudate fluid has a high protein content, transudate? has a low protein content
Common causes of transudative pleural effusion ( not infections) CHF, nephrotic syndrome, hypoalbuminia, hepatic hydrothorax, peritoneal dialysis, pulmonary embolism or infarction
Common causes of exudative effusions? bacterial pneumonia, cancer (malignant), lymphoma, empyema, tuberculosis, fungal disease
Signs of ARDS? tachypnea, refractory hypoxemia, crackles, intercostal and substernal retractions, tachypnea, decreased compliance (increased ventilatory rate)
What happens with ARDS? pulm capillaries become engorged, AC membrane permeability increases, interstitial and alveolar edema, decreased alveolar surfactant, alveolar collapse, atelectasis
Causes of ARDS? sepsis, aspiration, pneumonia, trauma, massive blood transfusion, drug abuse
ARDS will appear as? ground glass on an x ray
Hypoxemia develops with ARDS because of? alveolar consolidation, atelectasis, increased alveolar capillary thickening
Lung expansion measures for ARDS? peep and cpap are used to offset the alveolar consolidation and atelectasis
Vent settings for ARDS? Low VT, Higher peep, Higher RR's, Diuretics, permissive hercapnia
What is the ph for adds? 7.2
On an X-ray an ards pt will look like? Ground glass
Created by: juialynn92
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