Acute Respiratory Disorders (Part 1)

Acute Respiratory Distress Syndrome

acute lung injury; acute insult at the level of the alveoli causing severe hypoxemia and decreased compliance of the lungs.

1. Shock

2. Aspiration

3. Sepsis

precipitating factors of ARDS.

1. Pneumonia

2. Aspiration

3. Pulmonary contusion

direct lung injury factors related to ARDS.

1. Sepsis

2. Severe burns

3. Shock

indirect lung injury factors related to ARDS.

1. Major surgery

2. Hematologic disorders

3. Drug ingestion & overdose

other risk factors related to ARDS.

1. Histamine

2. Serotonin

3. Bradykinin

chemical mediators of inflammation.

Third Space Fluid Shifting

leakage of fluid into the alveolar interstitial space.

Stiff Lungs

lung compliance becomes markedly decreased.

1,800-3,000 mL

normal value of functional residual capacity.

Crackles

auscultated as the fluid begins to leak into the alveolar interstitial space.

4-12 mmHg

normal reading of pulmonary artery wedge pressure.

Pulmonary Artery Wedge Pressure

diagnostic test for ARDS.

Left-Sided Filling Pressure

interpretation of elevated PAWP.

1. Hypovolemia

2. Reduced preload

indicative of low PAWP.

Positive End

Bronchodilators

mainstay treatment o

Pulmonary Embolism

obstruction of of one or more pulmonary arteries by a thrombi.

Pulmonary Infarction

refers to necrosis of lung tissue that can result from interference with blood supply.

Greater and Lesser Saphenous Veins

common site of thrombus formation in the deep veins of the legs.

Stasis

term for slowing blood flow.

Sharp & Stabbing Chest Pain

description of pain in pulmonary embolism.

Fast, Thready but Weak Pulse

description of pulses in pulmonary embolism.

Homan’s Sign

pain in the calf or thigh pain.

Thoracic Imaging

test of choice for suspected PE.

1. Single Photon Emission Computed Tomography

2. Helical Contrast-Enhanced CT Scan

machines for thoracic imaging.

Pulmonary Angiography

if noninvasive testing is inconclusive or not candidate for noninvasive testing.

Doppler Ultrasonography

test results confirm or exclude diagnosis of PE.

D-Dimer Assay

for low to intermediate probability of pulmonary embolism.

Respiratory Alkalosis

ABG findings in pulmonary embolism.

1. Dobutamine (Dobutrex)

2. Dopamine (Dopamax)

inotropic medications; increase the force of contraction thereby, increasing cardiac output.

Digitalis Glycosides

mainstay of congestive left heart failure.

Digoxin (Lanoxin)

digitalis glycoside for adults.

Digitoxin

digitais glycoside for pedia patients.

IV Morphine

given for pain; check RR first before administering.

1. Dabigatran (Pradaxa)

2. Apixaban (Eliquis)

non-vitamin k antagonist oral anticoagulants.

Protamine Sulfate

antidote for heparin toxicity.

30-40 seconds

normal value of aPTT.

1. Streptokinase (Streptase)

2. Alteplase (Activase)

thrombolytic therapy.

3 Hours

window period of thrombolytic therapy.

25-30 seconds

normal time for PTT.

Interruption of Vena Cava

reduces channel size to prevent lower extremity emboli from reaching lungs.

Pulmonary Embolectomy

requires a thoracotomy with cardiopulmonary bypass technique.

Transvenous Catheter Embolectomy

a technique in which a vacuum-cupped catheter is introduced transvenously into the affected pulmonary artery.

Respiratory Failure

alteration in the function of the respiratory gas exchange system.

Hypoxemic Respiratory Failure (Type I)

characterized by arterial oxygen (PaO2) level to fall below 60 mmHg with a normal/low arterial CO2 tension (PaCO2).

Hypercapnic Respiratory Failure (Type II)

characterized by PaCO2 level of > 50 mmHg.

Acute Respiratory Failure

characterized by hypoxemia and/or hypercapnia and acidosis.

Chronic Respiratory Failure

characterized by hypoxemia, hypercapnia, normal pH; occurs over period of days, months, years.

Metabolic Alkalosis

compensatory mechanism of px with respiratory acidosis.

ABG Analysis

shows change sin PaO2, PaCO2, pH, and possibly HCO3.

Diuretics

medication for pulmonary vascular congestion or pulmonary edema.

Fraction of Inspired Oxygen of 100%

avoided for COPD patients.

Atelectasis

alveolar collpase.

Pneumothorax

air in the pleural space occurring spontaneously or from trauma.

Thoracentesis

only used in removing small amount of air/fluid in parietal space.

Spontaneous Pneumothorax

sudden onset of air in the pleural space with deflation of the affected lung in the absence of trauma.

Tension Pneumothorax

buildup of air under pressure in the pleural space.

Open Pneumothorax

sucking wound of chest which implies an opening in the chest wall large enough to allow air to pass freely.

Hemothorax

presence of blood in the pleural space as a result of penetrating or blunt chest trauma.

Hyperresonance

heard upon percussion due to air buildup in the lungs.

Needle Aspiration

if less than 50% pneumothorax.

Water-Seal Drainage

used to avoid atmospheric air to get inside the bottle.

Flail Chest

blunt or direct injury to lungs.

Status Asthmaticus

severe, prolonged asthma exacerbation that causes persistent bronchospasm, airway inflammation, and mucus production and does not respond adequately to standard treatment.

Hypocapnia

develops from hyperventilation.

Elevated PaCO2

ominous sign of impending respiratory failure.

1. Albuterol (Ventolin HFA)

2. Salbutamol (Ventolin)

short-acting bronchodilators.

Ipratropium Bromide (Atrovent)

anticholinergic; added in severe exacerbations.

1. IV Methylprednisolone

2. Oral Prednisone

systematic corticosteroids.

IV Magnesium Sulfate

may be given for severe attacks that respond inadequately to initial therapy.

Cardiac Tamponade

compression of the heart as a result of accumulation of fluid within the pericardial space.

Starling’s Law

how much the ventricles stretch before contraction.