ACCS – Pathology questions with correct
answers
CXR of Emphysema Answer✔✔ - diminished marking
- flattened diaphragms
-hyperlucency
- increased AP diameter
treat Emphysema Answer✔✔ - in emergency treat with 100% FiO2
d/t impending hypoxic state
- otherwise low flow O2 at home using oxygen
conserving devices
- bronchodilation meds via MDI or nebs
- corticosteroids
Emphysema ABG Answer✔✔ compensated respiratory acidosis
CHF/ Pulmonary Edema CXR Answer✔✔ -batwing/butterfly pattern, fluffy
infiltrates
CHF clinical evidence Answer✔✔ -watch for increasing hemodynamics (PCWP,
PAP,
CAP)
- Pink frothy secretions (marked congestion)
- tachypnea, tachycardia, anxiety
- edema of fluids (pedal edema)
- +2 or +3 pitting edema
,- significant reduction in CO
- cardiogenic vs non cardiogenic
CHF - treatment Answer✔✔ - TREAT FAST
- 100% FiO2
- diuretics (lasix)
- NPPV
- cardiac inotropic stimulating drugs
(Dig if increased PCWP and PAP)
- be prepared to MV
Barrel chest, accessory muscle use, digital clubbing, wheezing and diminished BS
Answer✔✔ Emphysema clinical evidence
PFT Emphysema Answer✔✔ FEF 25-75$ and Fev1 decreased
CHF ABG Answer✔✔ ventilatory failure with moderate to severe hypoxemia
ARDS Answer✔✔ - a condition that result in significant decrease of
lung compliance and profound hypoxemia
Ards Clinical Evidence Answer✔✔ - rapid RR, cyanosis
- decreased lung compliance
- refractory hypoxemia
- will have increased CPV and PAP
, chest xray - ground glass, granular, honeycomb, diffuse infiltrates Answer✔✔
ARDS
ARDS tx Answer✔✔ - keep FiO2 60% or below and use peep
- increase peep until obvious degradation in
hemodynamic value (especially CO) is witnessed
- minimize MAP
- as ventilatory pressures get higher ok to consider
PC, HFV
- keep VT 6ml/kg or below
-ARDS.NET PROTOCOL
ALI (ACUTE LUNG INJURY) Answer✔✔ - early stage of ARDS
- use lung protection
- 4-6 ml/kg
- diffuse B/L opacities and infiltrates
ALI clinical evidence Answer✔✔ - OLD SCHOOL PaO2/FiO2 ratio <300 ALI
PF Ratio <200 = ARDS
- NEW SCHOOL P/F ratio <200-300 Mild ARDS
P/F ratio <100-200 Moderate ARDS
P/F ratio <100 Severe ARDS
hx exposure to heated gas, caustic chemicals, massive trauma, plasma infusion
answers
CXR of Emphysema Answer✔✔ - diminished marking
- flattened diaphragms
-hyperlucency
- increased AP diameter
treat Emphysema Answer✔✔ - in emergency treat with 100% FiO2
d/t impending hypoxic state
- otherwise low flow O2 at home using oxygen
conserving devices
- bronchodilation meds via MDI or nebs
- corticosteroids
Emphysema ABG Answer✔✔ compensated respiratory acidosis
CHF/ Pulmonary Edema CXR Answer✔✔ -batwing/butterfly pattern, fluffy
infiltrates
CHF clinical evidence Answer✔✔ -watch for increasing hemodynamics (PCWP,
PAP,
CAP)
- Pink frothy secretions (marked congestion)
- tachypnea, tachycardia, anxiety
- edema of fluids (pedal edema)
- +2 or +3 pitting edema
,- significant reduction in CO
- cardiogenic vs non cardiogenic
CHF - treatment Answer✔✔ - TREAT FAST
- 100% FiO2
- diuretics (lasix)
- NPPV
- cardiac inotropic stimulating drugs
(Dig if increased PCWP and PAP)
- be prepared to MV
Barrel chest, accessory muscle use, digital clubbing, wheezing and diminished BS
Answer✔✔ Emphysema clinical evidence
PFT Emphysema Answer✔✔ FEF 25-75$ and Fev1 decreased
CHF ABG Answer✔✔ ventilatory failure with moderate to severe hypoxemia
ARDS Answer✔✔ - a condition that result in significant decrease of
lung compliance and profound hypoxemia
Ards Clinical Evidence Answer✔✔ - rapid RR, cyanosis
- decreased lung compliance
- refractory hypoxemia
- will have increased CPV and PAP
, chest xray - ground glass, granular, honeycomb, diffuse infiltrates Answer✔✔
ARDS
ARDS tx Answer✔✔ - keep FiO2 60% or below and use peep
- increase peep until obvious degradation in
hemodynamic value (especially CO) is witnessed
- minimize MAP
- as ventilatory pressures get higher ok to consider
PC, HFV
- keep VT 6ml/kg or below
-ARDS.NET PROTOCOL
ALI (ACUTE LUNG INJURY) Answer✔✔ - early stage of ARDS
- use lung protection
- 4-6 ml/kg
- diffuse B/L opacities and infiltrates
ALI clinical evidence Answer✔✔ - OLD SCHOOL PaO2/FiO2 ratio <300 ALI
PF Ratio <200 = ARDS
- NEW SCHOOL P/F ratio <200-300 Mild ARDS
P/F ratio <100-200 Moderate ARDS
P/F ratio <100 Severe ARDS
hx exposure to heated gas, caustic chemicals, massive trauma, plasma infusion
