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2 Pulm: ARDS

Step Up to Medicine, Chap 2: Pulmonary, ARDS

QuestionAnswer
3 pieces of info needed to determine underlying mechanism of hypoxemia? 1. PaCO2 level 2. A-a gradient 3. Response to supplemental oxygen
Definition of hypoxia. PaO2 <60 or PaCO2 >50 (hypercapnia).
Hypoxia or hypercapnea?: V/Q mismatch Hypoxia withOUT hypercapnea (CO2 levels low or normal)
Hypoxia due to a shunt is/is not responsive to supplemental oxygen. Is NOT
How does the A-a gradient help distinguish between different causes of hypoxemia? If hyperventilation is the cause, A-a gradient will be normal. In most other causes, A-a gradient will be increased.
Which pts have the highest risk of developing ARDS? Sepsis or septic shock
What is the key pathophysiologic event in ARDS? Massive intrapulmonary shunting of blood--> severe hypoxemia with no significant improvement on 100% O2. Shunting is 2/2 widespread atelectasis, collapse of alveoli, and surfactant dysfunction
Classical criteria for diagnosing ARDS? *Hypoxemia refractory to oxygen therapy (ratio of PaO2/FiO2 </= 100) *Bilateral diffuse pulmonary infiltrates on CXR *No evidence of CHF: PCWP </= 18mmHg
Where should the tip of the ET tube be in relation to the carina? 3-5cm above the carina
Minute ventilation formula? Minute ventilation= RR x Tidal volume
Normal I:E ratio used in ventilators? 1:2 (twice as much time spent in expiration as in inspiration)
Definition of pulmonary HTN? Mean arterial pulmonary pressure >25mmHg at rest or >30mmHg during exercise
CXR findings in primary pulmonary HTN? Enlarge central pulmonary aa, enlarged RV, and clear lung fields. PFTs show restrictive pattern. EKG shows R axis deviation and RV hypertrophy.
Tx for primary pulmonary HTN? Pulmonary vasodilators (IV prostacyclins/epoprostenol and CCBs), anticoagulation with warfarin, and lung transplantation (optional)
Definition of cor pulmonale? RV hypertrophy with eventual RV failure resulting from pulmonary HTN 2/2 pulmonary disease
MCC cor pulmonale? COPD
Nature of the A-a gradient in PE? Elevated
Situations in which pts with PE should be considered as candidates for treated with thrombolytics (streptokinase, TPA)? 1. Massive PE + hemodynamic instability 2. Evidence of R heart failure (thrombolysis can reverse this)
MCC of hemoptysis? Bronchitis (50% of cases)
Created by: sarah3148