Which acid-base buffering system works minute by minute? - ✔✔Respiratory
Which acid-base buffering system works second to second? - ✔✔Carbonic acid-bicarb
Mass transfusions — citrate - ✔✔A lot of citrate in blood products. It destructs 2-3 DPG.
Also binds to calcium & mag. Therefore always give calcium gluconate (or ca chloride) & mag to
hemorrhagic trauma pt.
Also destroys stress hormones - vasopressin & cortisol.
Corrected anion gap formula - ✔✔[Na - (Cl + HCO3)] + K
Normal corrected anion gap range - ✔✔16-20
ARDS - Vent Settings - ✔✔- High peep to overcome alveolar collapse.
- High fiO2
- Lower tidal volumes 6ml/kg
ARDS
Common Causes - Direct - ✔✔Direct Lung Injury
- pneumonia
- aspiration
,- near drowning
- inhalation injuries
- pulmonary contusion
- pulmonary edema from reperfusion
ARDS
Common Causes - Indirect - ✔✔Indirect Lung Injury
- sepsis
- trauma from shock
- CABG
- drug overdose
- blood product administration
- acute pancreatitis
ARDS Criteria - ✔✔- Acute Onset
- Bil infiltrates on CXR
- PAWP <18 mmHg
- PaO2/FiO2 <200 = ARDS
- PaO2/FiO2 <300 = ALI
How to determine good quality CXR
RIP - ✔✔R - rotation: pt upright & centered. Spinous process line up, clavicles even.
I - inspiration: look at diaphragm. Which anterior rib intersects diaphragm at midclavicular line.
Should be 5-7. Less than 5 = under inflation. Greater than 7 = hyperinflation or something in
lung field.
,P - penetration: should be able to see vertebrae in front of or behind heart.
Chronic Bronchitis - ✔✔- No destruction of lower airways.
- Excessive mucous production.
- Hypoxemia
- Polycythemia due to increased circulating RBC's to increase carrying capacity of O2 in blood.
- Increased CO2 retention.
- May have rt heart failure. Fatigue, edema, exertional dyspnea.
"Blue Bloaters"
Emphysema - ✔✔- Destruction of distal airways decreases the ability to oxygenate.
- V/Q mismatch limits blood flow through oxygenated lung d/t destruction of distal airways.
- Compensation occurs by decreasing CO & increasing ventilation, hyperventilation.
- Prevention of fresh air coming into lungs & preventing blood flow to capillaries d/t V/Q
mismatch d/t destruction of lower airways.
COPD X-Ray - ✔✔- Flattened diaphragm
-should still see curve & costophrenic angle.
- Hyperinflation
- Increased AP diameter of chest in lateral view.
- Long, narrow heart.
- Abnormal air collections.
- Diff to see vertebrae over heart.
COPD
, Capnography Waveform - ✔✔Shark fin d/t resistance to exhalation
Emphysema X-Ray - ✔✔- Hyperinflation
- Flattening of hemidiaphragm
- Small heart
Pt with acute onset dyspnea, PAWP 8, CXR with bil infiltrates. What is the most appropriate
diagnosis? - ✔✔ARDS
Tension Pneumothorax - X-Ray - ✔✔- Vascular marking on affected side may not be visible.
- Mediastinal & tracheal deviation towards contralateral (unaffected) side.
- Ipsilateral (affected) heart border flattening.
Needle Decompression Landmark - ✔✔2nd - 3rd intercostal space over the rib.
Chest tube size - ✔✔4 x ETT size
Chest Tube insertion
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