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Pulm 3: ARDS

ARDS and Obstructive Airway Diseases

QuestionAnswer
What heart sounds are considered benign when there is no evidence of disease? Split S1, Split S2 on inspiration, S3 in pt <40yo, quiet systolic murmur
A young woman presents with amenorrhea, bradycardia, and abnormal body image. What is the diagnosis? Anorexia nervosa
A pt presents with a h/o intermitten tachycardia, wild fluctuations in BP, HA, diaphoresis, and panic attacks. What is the diagnosis? Pheo
What is the transfusion cutoff in ARDS pts? Only if Hgb <7. Transfusion may increase risk of death in ARDS so you can't be aggressive.
What kind of asthma am I?: no more than 2 daytime episodes/wk or no more than 2 nighttime episodes per month Mild intermittent
What kind of asthma am I?: 3-6 daytime episodes per week or 3-4 nighttime episodes per month Mild persistent
What kind of asthma am I?: Daily daytime episodes or >1 nighttime episode per week Moderate persistent
What kind of asthma am I?: continual daytime episodes or frequent nighttime symptoms Severe persistent
What is the exepected FEV1 with mild intermittent asthma? >/= 80% (same as mild persistent)
What is the exepected FEV1 with mild persistent asthma? >/= 80% (same as mild intermittent)
What is the exepected FEV1 with moderate persistent asthma? 60-80%
What is the exepected FEV1 with severe persistent asthma? <60%
What is the tx for mild intermittent asthma? PRN albuterol
What is the tx for mild persistent asthma? PRN albuterol + LOW dose inhaled steroid. Can also add Singulair or cromolyn if needed.
What is the tx for moderate persistent asthma? PRN albuterol + MOD dose inhaled steroid. Can also add long agcting beta 2 agonist and/or theophilline.
What is the tx for severe persistent asthma? PRN albuterol + HIGH dose inhaled steroid + long-acting beta 2 agonist + PO steroid. Can also add singulair and/or theophylline.
Name 3 dangerous side effects of theophylline. How would you treat them? Hypotension, tachycardia, and seizures. Tx tachy with beta blockers and seizures with benzos. Phenytoin will NOT work for these types of seizures.
Prolonged, nonresponsive asthma attack that can be fatal and should be treated aggressively. Dx? Tx? Dx: Status asthmaticus Tx: bronchodilators, corticosteroids, O2, and possible intubation
How would you manage a pt with an obstructive airway dz who develops a normal CO2 during an exacerbation? Additional beta 2 agonists, supplemental O2, and possible ventilation as this signals impending respiratory failure.
What is a normal PaO2:FiO2 ratio? 300-500mmHg
What PaO2:FiO2 ratio indicates a gas exchange deficit? <300mmHg (normal is 300-500)
What PaO2:FiO2 ratio indicates ARDS? <200 (normal is 300-500)
In a pt with pulmonary edema, how can pulmonary capillary wedge pressure (PCWP) distinguish ARDS from cardiogenic edema? <18= non-cardiogenic cause (e.g., ARDS) >18= cardiogenic cause (e.g., pulmonary edema)
WHat are the diagnostic characteristics of ARDS? Acute onset, PaO2:FiO2 <200, B/L pulmonary infiltrates on imaging ("double white out" appearance), No evidence of cardiac origin (PCWP <18)
What is the hallmark lung testing finding found in COPD? Decreased FEV1/FVC ratio
A pt has an FEV1/FVC of 40%. What medications are used in the daily management? Inhaled steroids, long acting bronchodilators, PRN short acting bronchodilator, risk factor reduction (stop smoking!), annual flu and pneumococcal vaccines
At what point do pts with chronic COPD qualify for home O2? Any of the following: pulse ox <88%, pulmonary HTN, peripheral edema, or polycythemia.
What is the goal O2 sat for a chronic COPD'er? 90%
What tx is proven to decrease morbidity and mortality in a COPD pt? Supplemental oxygen
Created by: sarah3148