Cardiopulm - 3 - Pulmonary pathologies

11

100

1. V_T
2. FEV₁
3. FVC
4. Response to bronchodilator tx 

Diagnose restrictive and obstructive patterns, disease severity and progression 

Pulmonary PFT 

200

- Visualize (via invasive scope) larynx, trachea, large bronchi and small bronchioles (flexible scope)
- Examine airway, tissue a/o respiratory fluid abnormalities
- Diagnose - EX: biopsy
- Intervention: remove foreign tissue or secretions; instill medication

Bronchoscopy 

300

Tap/drain excessive fluid or blood from pleural space
- Used to Rx large or reoccurring pneumothorax and pleural effusion 

Thoracentesis 

400

- Tough to detect in time to stage, let alone to treat
- Tumors not usually detected with traditional imaging because it can be behind the lungs 

Lung cancer 

500

Radiographic image to study size, shape and location of anatomical structures and anomalies (fluid accumulation, tumors, consolidations and translucencies) 

Chest X-ray 

12

100

Sterile fluid syringed down airway then suctioned out; obtains lung tissue cells/fluid from lower respiratory tract, for biopsy dx 

Bronchioalveolar lavage 

200

- Specific blood test to determine adequacy of ventilation and respiration
- Calculates arterial partial pressure of O2 and CO2, peripheral O2 saturation, total CO2 content (bicarbonate and carbonic acid), and systemic pH level
- Indicates respiratory and metabolic acid-base imbalances
- PaO2 levels indicate how well oxygen is moving [diffusion] from the lungs into the bloodstream

Arterial blood gas (ABG) 

300

Caustic agent (usually talc) introduced to pleural sac to produce inflammatory reaction in order to seal the visceral and pleural linings of lung
- Used to Rx large or reoccurring pneumothorax and pleural effusion; typically done via V.A.T.S
(Like putting acid in the pleural sac to burn them, causing inflammatory reaction to make scaffolding between the lung and sac so it wont keep collapsing) 

Pleurodesis 

400

A test that projects a flat image through the body, displaying 2-D densities

- Good for pneumonia, and clearing patient for surgery  

X-ray *** 

500

Sliced X-ray images using IV contrast to get more distinguished density gradients; often used to dx PEs 

Chest computerized tomography (CT) 

13

100

Wedge shaped sections of abnormal/cancerous lung tissue excised
- Used to excise blebs (air) or can rupture and infect pleural space = empyema (pus) need removed too 

Wedge resection 

200

Small sacs of air in/on lung tissue that can rupture, cause air to leak into the pleural space
- increase risk of pneumothorax and infection (empyema) 

Blebs 

300

- Removal of numerous small wedges of damaged lung tissue that add to overall dead space
- PT implication: VATS or open thoracotomy
- Contraindicated if patients FEV₁ < 20% 
- Possible alternative for treatment to lung transplantation for selected individuals in end-stage COPD (emphysema) and ILD
- controversial Rx with limited outcomes 

Lung-volume reduction surgery 

400

Test that is magnetic and radio waves create an image of the body, viewed in the 3 major planes without using radiation
- great for soft tissue and vessels (water-filled structures)
- con: certain metal implants (TITANIUM IS SAFE!!!)
- most expensive 

MRI *** 

500

Offers 3D to detect small masses - spin continuously with lower radiation than traditional CTs 

Spiral CT 

14

100

Test that is an axial view
- X-ray images using computer to take 360 degrees cross-sectional views using low-dose radiation.
- contrast dye can be given to enhance image details
- great for seeing bone, calcium, CA; vascular and pleural changes
- con: radiation; contrast use 

CT or CAT scan *** 

200

T/F: Xrays are able to pick up the lymphatic system

FALSE.. cannot get to the lymphatic system 

300

Test in sagittal plane
- can tell where exactly down the bronchi there is something abnormal 

Chest CT with 3-D bronchial association 

400

Test for arterial system using dye
- Avoid contrast with renal disease because it is hard to excrete from the body 

Chest CT angiogram 

500

Nuclear study to detect moderate to large lesions or study cancerous growth progression; also used for metabolic changes in brain 

Positron emission tomography (PET scan) 

15

100

Sensitive but non specific blood test for coagulopathy (EX: PE)
- Provides a number, corretion to probability range 

D-dimer 

200

Which PE - diagnostic tests are the least expensive and often 1st choice tests? 

1. D-dimer
2. V/Q scan 

300

Uses radioactive gas to display air distribution compared to scanned blood flow through lungs; degree of V/Q mismatch determines probability of diagnose PE 

Ventilation/Perfusion scan (V/Q scan) 

400

U/S guided catheter for dx and rx (thrombolytic med) 

EkoSonic Endovascular technology (EKOS) 

500

IV contrast mapping arterial route; definitive test for PE but chest CT is gold standard *** 

CT angiogram