ICU & Pulmonary
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Components of ventilator affecting oxygenation? Ventilation?
- Oxygenation = PEEP and FiO2
- Ventillation = TV and RR
Normal PaO2 based on age? (equation)
PaO2 = 100 - Age/3 (i.e. nml PaO2 for 60y/o = 80)
Stages of COPD severity?
- Mild: FEV1 >80% predicted
- Moderate: FEV1 50-80% predicted
- Severe: FEV1 30-50% predicted
- Very severe: FEV1 <30% predicted
Differential for an anterior mediastinal mass?
- terrible lymphoma
- Thyroid mass/cancer
Light's criteria for pleural effusions?
Exudative: Protein F:S >0.5; LDH F:S >0.6; LDH >2/3 ULN
What albumin gradient supports exudative vs. transudative in pleural effusions?
Serum Protein Albumin Gradient <1.2 = exudative; >1.2 = transudative
What level of cholesterol in pleural fluid supports exudative vs. transudative?
Exudative = >45; Transudative = <45 (especially if <20)
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
Common causes of chronic cough?
GERD, upper airway cough syndrome (post-nasal drip), Asthma, non-asthma eosinophilic bronchitis
Most common causes of hemoptysis
bronchitis, lung cancer, pneumonia, TB
Causes of low DLCO with nml spirometry?
- Early infiltrative lung disease
- Early Emphysema
- PE, pulmonary HTN
- CO toxicity (smokers)
How is the DLCO corrected for anemia?
Corrected = DLCO / (Hgb * 0.07)
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
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
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)
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
What would you like to do?
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