lung diseases

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Author:
marshenski
ID:
212395
Filename:
lung diseases
Updated:
2013-04-09 12:30:36
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BC Boston College CRNA resp lung disease
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BC Boston College CRNA resp: lung disease
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  1. What is pulmonary embolism?
    occlusion of the pulmonary vascular bed
  2. What causes pulm embolisms?
    • air
    • thrombus
    • lipids
    • tissue fragments
  3. What is Vichow triad and what are they?
    • venous stasis
    • hypercoagulability
    • vascular injury
    • they are risk factors for the development of thromboemoblus
  4. Where do the majority(90%) of pulm emboli come from?
    The veins of the legs and the pelvis
  5. What are the grades of PE?
    • 1 massive occlusion
    • 2 embolism with infarction
    • 3 embolism without infarction
    • 4 multiple PE
  6. What is a massive pulm embolism?
    occlusion of a major portion of the pulm circulation (main pulmonary artery)
  7. What is an embolism with infarction?
    an embolism that is large enough to cause infarction of a portion of lungs
  8. what is an embolism without infarction?
    doesn't cause permanent tissue damage
  9. What pathophysiological effects can an infarct have on the lungs?
    • hypoxic vasoconstriction
    • decreased surfactant
    • release of neurohormonal substances (stress response)
    • pulmonary edema b/c of loss of surfactant
    • atalectasis b/c of loss of surfactant
  10. What s/s would we see with a PE?
    • tachypnea
    • dyspnea
    • chest pain
    • increased dead space
    • V/Q imbalance
    • decreased PaO2
    • pulmonary infarction
    • pulmonary HTN
    • < CO
    • hypotension
    • shock
  11. What does a V/Q scan show?
    ventilation and perfusion to the lungs
  12. how would ABG's reflect PE?
    • unexplained hypoxemia and hyperventilation
    • CO2 may be normal or decreased (alveolar collapse)
  13. Are chest Xrays and PFT's helpful in the diagnosis of PE?
    not definitively
  14. What two exams are definitive for PE?
    • VQ scans
    • pulm angio
  15. What is the best treatment for PE?
    • prophylaxis by:
    • early and often ambulation
    • low dose anticoagulant therapy
    • Ted hose
  16. During what type of PE would we see streptokinase used?
    massive, life threatening
  17. What manifestations might we see for PE while our pt's are under anesthesia?
    • Unexplained arterial hypoxemia
    • Hypotension
    • Tachycardia
    • Bronchospasm (b/c tissue damage to the lung=release of cytokines and histamine)
  18. Will there by a widening gradient between ETCO2 and PaCO2 with PE?
    yes because PE=dead space
  19. A large unexplained drop in ETCO2 indicates what?
    sudden increase in dead space (PE)
  20. What is the normal gradient for ETCO2 and PaCO2?
    5 or less
  21. What is pulm HTN?
    • a rise in pulm pressure of 5 mmHg above normal
    • mean normal is 15-17
  22. What is primary pulm HTN?
    In primary hypertension the small pulmonary arteries (arterioles) become narrow or obliterated as a result of hypertrophy of smooth muscle in the vessel walls and formation of fibrous lesions around the vessels.
  23. What is cor pulmonale?
    Right ventricular disease resulting from pulmonary hypertension
  24. What is secondary pulm HTN?
    • any respiratory or cardiovascular disorder that:
    • -Increases the volume or pressure of blood entering the pulmonary arteries or
    • -Narrows or obstructs the pulmonary arteries
  25. What is an example of secondary pulm HTN?
    lung disease and the chronic hypoxemia that it is associated with it cause extreme HPV
  26. What are the four causes of secondary pulmonary HTN?
    • elevated left ventricular filling pressures
    • increased blood flow through the pulmonary circulation
    • obliteration or destruction of the vascular bed (PE, Emphysema)
    • Vasoconsrtiction of the vascular beds (hypoxemia, acidosis, or both
  27. Why do the smooth muscles in the vascular bed hypertrophy?
    in response to increased pressures form pathological conditions
  28. Is the smooth muscle hypertrophy associated with pulm HTN reversible?
    no this leads to chronic pul HTN
  29. What end organ changes does chronic pulm HTN lead to?
    • cor pulmonale
    • right sided HF
  30. What meds are available to help with pulmonary HTN?
    • sildafenil (viagra)
    • Flolan
    • NO

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