ICU & Pulmonary

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Author:
morme
ID:
106865
Filename:
ICU & Pulmonary
Updated:
2011-10-06 08:43:10
Tags:
ICU
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ICU & Pulmonary cards
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  1. Components of ventilator affecting oxygenation? Ventilation?
    • Oxygenation = PEEP and FiO2
    • Ventillation = TV and RR
  2. Normal PaO2 based on age? (equation)
    PaO2 = 100 - Age/3 (i.e. nml PaO2 for 60y/o = 80)
  3. Stages of COPD severity?
    • Mild: FEV1 >80% predicted
    • Moderate: FEV1 50-80% predicted
    • Severe: FEV1 30-50% predicted
    • Very severe: FEV1 <30% predicted
  4. Differential for an anterior mediastinal mass?
    • terrible lymphoma
    • Teratoma
    • Thymoma
    • Thyroid mass/cancer
  5. Light's criteria for pleural effusions?
    Exudative: Protein F:S >0.5; LDH F:S >0.6; LDH >2/3 ULN
  6. What albumin gradient supports exudative vs. transudative in pleural effusions?
    Serum Protein Albumin Gradient <1.2 = exudative; >1.2 = transudative
  7. What level of cholesterol in pleural fluid supports exudative vs. transudative?
    Exudative = >45; Transudative = <45 (especially if <20)
  8. Initial treatment of chronic cough? (definition of chronic cough?)
    Chronic cough = >8wks; Initial: stop ACE-I, stop smoking, CXR; Start flovent 110mcg BID, PPI, & Zyrtec-D x3mo
  9. Common causes of chronic cough?
    GERD, upper airway cough syndrome (post-nasal drip), Asthma, non-asthma eosinophilic bronchitis
  10. Most common causes of hemoptysis
    bronchitis, lung cancer, pneumonia, TB
  11. Causes of low DLCO with nml spirometry?
    • Early infiltrative lung disease
    • Early Emphysema
    • PE, pulmonary HTN
    • CO toxicity (smokers)
    • Anemia
  12. How is the DLCO corrected for anemia?
    Corrected = DLCO / (Hgb * 0.07)
  13. Name 5 general causes of hypoxia.
    • 1) decreased FiO2 (rare)
    • 2) Altitude (decreased barometric pressure)
    • 3) Hypoventilation
    • 4) V/Q Mismatch and decreased diffusion
    • 5) Shunts
  14. How can you determine what the cause of hypoxia is (algorithm)?
    • 1st: A-a gradient.
    • -- If nml = hypoventilation or altitude/dec FiO2
    • -- If elevated, see if hypoxia is corrected by supplemental oxygen
    • * If corrected by oxygen = V/Q mismatch
    • * If NOT corrected by supplemental oxygen = Shunt
  15. A-a gradient equation? (condensed) Nml?
    [150 - (PaCO2/0.8)] - PaO2 = A-a gradient

    Nml = 10-15 (adj for age: 2.5 + 0.2*Age)
  16. How do you adjut BiPap settings to improve oxygenation & ventilation?
    • IPAP = CO2
    • EPAP = PEEP = Oxygen

    • Increase IPAP to decrease CO2
    • Increase EPAP to increase oxygen
    • **keep at least a gradient of 4 between EPAP & IPAP

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