It ain't easy being wheezy
Status Asthmaticus is characterized by an acute onset, worsening expiratory air flow and is refractory to what treatment?
What is bronchodilator therapy?
Interstitial lung disease is a group of several disorders that causes this in your lungs.
What is scarring?
Neuromuscular disorders include a wide range of diseases affecting the peripheral nervous system, which consists of all the motor and sensory nerves that connect the ______ and ______ to the rest of the body.
What are the brain and spinal cord?
What is a relative contraindication?
Classify this blood gas result;
7.28/90/60/35/+8
Changes in the airway can cause severe airflow obstruction, leading to premature closing of the airway on expiration. This leads to air trapping, which is also known as....
What is dynamic hyperinflation?
Patients with ILD experiencing acute respiratory failure have known poor outcomes. Studies have reported patients to have roughly what mortality rate in the first year?
What is 60%
Neuromuscular diseases are characterized by weakened inspiratory and expiratory muscles. A measure of maximal strength of the respiratory muscles can be done by the following 3 tests.
What are MIP, MEP and VC
Name a minimum of 2 radiographic findings that you would observe on CXR for a patient with a right sided tension pneumothorax.
What are left mediastinal shift, left tracheal shift, collapsed lung borders with no lung markings to periphery, deep sulcus sign.
Name 3 radiographic findings that you may see on a patient with COPD exacerbation secondary to pneumonia.
What are; large lung volumes, flattened diaphragms, increased opacities, hilar engorgement, thin elongated heart.
The primary pathophysiology of status asthmaticus is characterized by...
What is smooth muscle spasm, mucosal edema and mucous plugging?
ILD patients requiring mechanical ventilation are difficult to ventilate due to what key features? Provide a minimum of 2.
What are decreased compliance, decreased gas exchange and increased PVR?
This is a chronic autoimmune neuromuscular disease that causes weakness in skeletal muscles and often can cause ocular symptoms such as ptosis and diplopia.
What is myasthenia gravis?
Name 2 monitored ventilation parameters that could be affected by a pneumothorax and what would happen to those parameters.
What are Ppeak (increases), Pplat (increases), Compliance (decreases), Pmean (increases), Vte (decreases).
Give 2 reasons why patients with AECOPD are difficult to ventilate.
What is; increased inspiratory a/w resistance, increased exp a/w resistance, dynamic hyperinflation, autoPEEP, respiratory muscle weakness, deteriorating gas exchange due to damaged membranes and increased secretions.
When ventilating a status asthmaticus patient, we allow for permissive hypercapnia. What are the blood gas goals when ventilating a status asthmaticus patient?
List the ventilation settings when treating a patient with ILD in acute respiratory failure. Include all parameters.
What is...
pH > 7.25
Vt 4-6ml/kg
RR 8-16
PEEP 5 cmH2O
SpO2 88-90%
Ti 0.6-1.0 sec
Waveform decelerating
This is an acute autoimmune disorder in which your body's immune system attacks your nerves causing demyelination leading to progressive paralysis.
What is guillian barre syndrome?
Explain how hemodynamic compromise can occur when a patient has a pneumothorax.
What is; Large or increasing pneumothoraxes can increase intrathoracic pressure. This causes decrease in venous return to the heart, decrease in stroke volume, decreased cardiac output, cardiac index, blood pressure and tachycardia eventually leading to hemodynamic compromise.
Name 4 medications that can be used to treat patients experiencing AECOPD.
What are; ventolin, atrovent, methylprednisone IV, solumedrol IV, prednisone PO, antibiotics
What is the ventilation strategy to ventilate status asthmaticus? Include all parameters.
What is...
Mode AC
RR 10 bpm
Vt 6-8ml/kg
PEEP 0-5 cmH2O
Flow 60-80lpm
Decelerating waveform
Pplat <30cmH2O
Although the benefits may be unclear, ILD patients requiring mechanical ventilation for respiratory failure may occur. This could potentially be used as a bridge to what?
What is a bridge to lung transplant?
List the criteria for when we would consider intubation in respiratory failure secondary to neuromuscular disease. Name a minimum of 4.
Decreased LOC
Cardiorespiratory arrest
Shock
Arrhythmias
Gas exchange abnormalities
Bulbar dysfunction
20/30/40 rule
Your patient has a BP fistula. You are ventilating them on volume control with a set volume of 500ml. Your Vte is 350ml. Explain what is happening and how you could improve ventilation on a patient with BP fistula. Name a minimum of 5 things you could do.
What is the 150ml is leaking out of the fistula and not being returned to the ventilator in the exhaled breath. To fix this you would NEVER increase your set volume. You would want to ensure you are ventilating with the lowest possible pressures (peep, driving pressure, MAP etc.), that there is a chest tube that is patent and correctly working, position patient with the fistula side up, communicate to the MRP, discuss advanced options if ABGs worsening such as single lung ventilation (endobronchial blocker), arndt blockers depending on fistula location, ECMO
Your AECOPD patient is intubated but has been weaned to PSV. What ventilator settings could you change and optimize to improve ventilator synchrony?
What are Esens (higher may work better) and increasing PEEP to meet AutoPEEP. (Consider changing rise time and trigger sensitivity.)