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Obstructive diseases
at least two on the test,

acute case and non acute case- pre op patient, home care situation, pulmonary function testing, emphysema, bronchitis, bronchiectasis, asthma.
Classic signs of chronic hypoxemia
Clubbing, polycythemia, increased AP diameter, cyanotic , using accessory muscles.
Secondary Assessment for chronic hypoxemia?
Laboratory tests - x-ray; you will see flat diaphragm. Changes in the heart shadow, the classic compensated respiratory acidosis - with some hypoxemia. Pulmonary function - DLCO decreases with emphysema not true with other obstructive diseases because of the decreased surface area. Fev1 decrease
How would you treat chronic respiratory patients? Example emphysema
Low flow oxygen, 1 - 2 liters nasal cannula, 24 - 28% face mask. Antibiotics, CBCs, WBC\'s, rehab, home care , bronchodilators, cleaning equipment at home.
Chronic bronchitis how is it diagnosed?
By asking a couple of questions: do you have a productive cough, for the last 3 months for a couple of years? If the answer is yes, you have chronic bronchitis. Sputum culture - looking out for infection. PFT\'s consistent with other pulmonary diseases, ABG will show that they are hypoxemic.
Definition of chronic bronchitis
Chronic inflammation of the bronchi, producing secretions.
How to treat chronic bronchitis?
bronchial hygiene, antibiotics, bronchodilators.
Bronchiectasis how\'s it different from the other obstructive diseases
Abnormal dilation of the bronchi, facts filled with secretions and pus, gram negative infection , coughing up blood- hemoptysis, the key test for determining bronchiectasis is a bronchogram.
Bronchiectasis, what is the key test for determining this disease?
bronchio gram
How to treat bronchiectasis?
Pulmonary hygiene, antibiotics, so forth.
Sleep apnea syndrome definition
Not breathing during sleeping periods, more than 10 seconds.
name the 3 types of sleep apnea?
Central - brian is not communicating to breathing muscles, -Obstructive - brain is trying to breathe but there is an obstruction. This is the most common. The third type is the combination of central / obstructive.
How do you recognize a candidate for sleep apnea ?
Sleepy during day , loud snoring - identified by family, obesity, periods of apnea, short stocky neck large tongue.
head trauma cases keep co2 high or low ? Also keep oxygen at what percentage?
low, between 20 - 30 torrs , keeping oxygen high near 100 %
What is status asthmaticus ?
A sustained asthma attack not responsive to therapy - not getting better getting worse.
pulseless paradoxes helps to determine what disease state?
status asthmaticus
How to treat status asthmaticus?
Subcutaneous epinephrine every 20 -30min up to 3 injections if needed, isoprel given in some pediatric cases, if no improvement intubate, sedate, ventilate.
Most common trauma on test ?
1 simulation - 2 most common chest trauma , flail chest. Identified easily bedside assessment with mediastinal / tracheal shift .
Chest trauma - pneumothorax or hemothorax can be identified by what assessment?
Tracheal / mediastinal shift - away from the problem. percussion over the area that gives you a high pitch sound , hyperresonance or tympanic - pneumothorax. dull/ flat sound - hemothorax.
How to treat pneumothorax?
chest tube greater than 20%, 3 - 5 % will resolve itself. Same treatment for hemothorax.
Neck injury patient during a code situation , hostage you manipulate the neck?

Modified jaw thrust.
How should you get a pulse if a person has a neck brace?
femoral pulse
What is the best way to intubate patient with a neck brace or neck injury ?
Bronchoscope
ARDS
Adult respiretory distress syndrome, illness that affects the lung compliance, caused by trauma, infection, X ray shows - honeycomb pattern, ground-glass appearance. Refractory hypoxemia - don\'t get better with more oxygen.
How to treat a ARDS?
Peep or CPAP , keep fio2 no higher than 60% , and treat underlying cause; burn patient , infection, trauma.
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