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- Oxygen Extraction Ratio
-
(CaO2 - CvO2) / CaO2
Consumption or demand / delivery
Normal: 0.25 - Pulmonary Function Test
- spirometry + lung volumes + diffusion
- Cheyne Strokes
-
crescendo/decresendo --> apnea --> repeat
Associated with CHF or increased ICP - Tactile Fremitus
-
Peripheral vibrations because of lung consolidations at saying \"99\"
- not able to perceive if pleural effusion
- able to perceive in pneumonia - No Pause sounds
-
Vesicular - normal. soft/rustling
- Inspiration:Expiration - 5:1
Bronchiovesicular - can be heard over R apex - Pause sounds
-
Tracheal breath sounds - harsher & lower pitch that vesicular
Bronchial - expiration is longer and harsher than inspiration - Rales (crackles)
-
Crepitant - \"velcro opening\"
- increased fluid in alveoli/small bronchioles
CHF, pulmonary edema - Acute EKG criteria for acute pulmonary HTN
-
axis shift of vent depolarization to the RT
inverted T waves in V1, V2, V3
RT atrial or ventricular hypertrophy - Lordotic x ray view
- clavicles moved \'up\' and out of lung field
- Ludwigs Angina
- Cellulitis at the floor of the mouth
-
Tram lines - walls of bronchi are parallel to each other
Peribronchial cuffing - thickened walls of large bronchi - x ray of COLD
- BOOP
-
Bronchiolitis obliterans + organizing pneumonia
- patchy airspace dz
- restrictive!
...B.O. by itself is an obstructive process w/ hyperinflation - PET results for malignancy
-
SUV > 2.5 - likely a malignancy, perform biopsy
False + : granuloma, infection
False - : bronchoalveolar carcinoma - Decongestants
-
Pseudoephedrine (direct & indirect) -
Phenylephrine & Oxymetazoline (direct acting)
Contraindications - HTN, hyperthyroidism, DM, imidazlines, glaucoma - Dextromethorhan
-
NMDA-R antagonist
\"skittles\"
- Codeine
- decreases medullary cough center
- Expectorant
-
Guafenesin
reflex irritation GI mucosa.. increases mucus -
Flunisolide,
Becleomethasone,
Budesonide,
Triamcinolone,
Dexamethasone -
nasal adrenocorticoid
Anti-inflammatory action.
Interact with epithelial cells --> decrease release of mediators --> decrease inflammation
*nasal polyps* - Cromolyn sodium
-
No release of histamine, LT, or Ca flux from mast cells
- no bronchodilating effects
*Prophylaxis for allergic rhinitis (cannot reverse symptoms) - Rimantidine/Amantadine
-
Blocks the uncoating of Influenza A virus (virus can still enter cell, but cant leave)
Acts on M2 proton selective ion channel - Oseltamivir/Zanamivir
-
Blocks neuraminidase --> no viral spreading
O: N&V, HA
Z: cough.. contraindicated in asmath, COPD
*Influenza A and B, H1N1 - Ribavirin
-
Blocks synthesis of viral nucleic acid
- aerosal administration
*RSV
contraindicated in pregnancy - Avoid in asthmatics
-
Adenosine
Bethanecol (ACh agonist)
*can cause bronchoconstriction -
Ipratropium bromide
Tiotropium bromide -
muscarinic cholinergic antagonist
.. decrease cGMP
T: longer duration than I
*COPD - Theophylline
-
Blocks adenosine
..blocks PDE therefore decreases cAMP hydrolysis
*COPD, CHF, neonatal apnea
- Omaluzumab
- Bind to IgE --> decreases free IgE --> decreases expression of IgE on mast/basophils
-
Advair =
Combivent = -
A = salmeterol + fluticasone
C = albuterol + ipratropium - PMN defense system
- mainly bacteria (staph, pseudomonas)
- Antibody mediated pulmonary defense system
-
encapsulated organisms
- pneumococcas
- H. influenza
- klebsiella - Cell mediated pulmonary defense system
-
Intracellular pathogens
- Pneumocystis carinii
- CMV
- Cryptococcus
- toxoplasmosis - Gram negative coccobacillus
-
Pertussis
Start antibiotics within 2 weeks or wont shorten the 100 day course! - Macrolides
-
Bind 50S ... prevent translocation along mRNA
Mycoplasma/Legionella/Chlamydiae
(Gentamycin binds 30S) - Amphotericin B
-
binds ergosterol on fungal cell membrane - cells leak
*Preferred agent for systemic infection at pregnancy! - Terbinafine
-
Inhibits squalene epoxidase
Blocks ergosterol synthesis (like azoles)
*dermatological problems - Bivalirudin
-
direct thrombin inhibitor
(*leeches!*)
- doesn\'t cause thrombocytopenia like heparin ..heparin antagonist is protamine sulfate - Legionella
-
Fastidious gram negative bacilli that grow aerobically
WBC > 10,000 w/ LT shift
Direct fluorescent antibody stain - Gram + diplococcus
-
Strep pneumo
tx with PCN, or ceftriaxone if resistant or macrolides - Urine Ag
-
Very useful for disseminated dz in histoplasma capsulatum (indianapolis, bat caves)
TNF inhibitor can cause disseminated infection
Hilar, mediastinal nodes - INH - Isoniazid
-
Hepatotoxicity and peripheral neuropathy
LFTs monthy and pyridoxine - Ethambutol
-
Hypersensitivity
Optic neuritis - check visual acuity - Rifampin
-
Orange discoloration of secretions
Hepatitis - LFTs monthly - Stretopycin
-
- aminoglycoside
Ototoxicity - vestibular damage
Renal toxicity - creatine monitoring - Slightly curved bacillus
-
M. Leprae .. spread thru nasal discharge!
Tuberculoid (Africa) - neuro damage, well developed granulomas
Lepromatous (India, Japan, China, Korea) - plentiful organisms, skin thickening on face, destruction of nasal maxillary structures - Hyaline membrane disease
-
decrease surfactant
- fine granular appearance
- decrease lung volumes
- air bronchograms - Type of ventilator where patient determines the rate
-
Pressure Support Ventilation (PSV)
- for patient with good effort & has minimal needs - Synchronized IMV (SIMV)
-
set rate, but patient cant take UNASSISTED breaths between set rate.
Machine breaths delivered only after patient exhales to prevent stacking
*different than Assist/control mechanical ventilation where every breath is assisted..patient can still initiate a breath but machine will assist to get to set volumes - Complications after extubation
-
immediate - laryngeal edema, change in vocal cords
early - aspiration, pneumonia
late - tracheal stenosis
- Clinical Signs/Symptoms of ARDS
-
- dyspnea prior to radiographic change
- persistent hypoxemia, resistant to administration of O2
- increase dead space - decrease compliance - pHTN (PW < 18 tho) - linear opacities on XR - Rhinitis Medicamentosa
-
*Addicting, mucosal damage, rebound HTN*
- from using intranasal decongestants for longer than 5 days (oxymetazoline)
tx: beconase and nasal saline 2x a day - ligate maxillary artery
- in pterygopalatine fossa
- ligate sphenopalatine artery
- incision near the middle turbinate
- ligate ant/post ethmoid artery
-
for posterior bleeds
*be aware of optic nerve posterior to ethmoid* -
Acute OM causes
Chronic OM causes -
A: S. pneumo, H infl (not B, therefore vaccine is no good), moraxella
C: pseudo, staph aureus
OM - bulging TM
OM + effusion - retracted TM and amber color - Bilateral compression ultrasound
-
Dx of DVT
(bilateral leg US doppler is for dx of PE) - Protein B (on chrom 2)
-
respiratory failure
- does not respond to surfactant
- lung transplant needed - Logren\'s Syndrome
-
- Sarcoidosis
enlarged LNs, erythema nordosum + arthritis - Garland\'s Triad
-
bilateral hilar, paratracheal adenopathy, + normal lung field
Stage II sarcoidosis - Histology of sarcoidosis
-
Star-shaped crystals
Schaumann body - blue calcified body of calcium and protein
*hypercalcemia
*increase ACE - LDH = exudate (>.6), but protein = transudate (
-
malignant effusion,
pneumocystis carinii effusion - Signs of asbestos
-
furrunginous bodies
comet tail sign - Squamous cell carcinoma
-
- overexpression of EGFR in 80%
- keratin pearls, intracellular bridges
- grey-white mass
- pancoast tumor
- mediastinal spread --> SVC syndrome
- PTH-like --> hypercalcemia - Adenocarcinoma
-
Age doesn\'t match appearance
- slow growing, early metastasis
glistening mass
**epigallocatechin gallate in tea inhibits cancer**