6 Etiologies of Secondary Spnt Pneumothorax
- COPD
- CF
- Lung malignancy
- Necrotizing PNA
- Catamenial (occuring w/ menses)
- Asthma/Sjogrens/ILD
Is the clinical presentation more severe in SSP or PSP?
SSP (less reserve due to underlying lung disease)
- Tx for all pts w/ SSP?
- Most require drainage
- ___ _____ is preferred over needle aspiration
- Again what do we always recommend for tx?
- Hospitalization
- Tube thoracostomy
- Smoking cessation
A tension pneumothorax is a medical emergency bc/ it can lead to what?
Cardiac Arrest
3 specific clinical findings of Tension Pneumo
- Worsening dyspnea
- Distended neck veins
- trachel deviation
Tx for tension pneumo?
Immediate decompression
Needle decompression can be used as temporizing measure, but chest tube needs to be placed
Acute hypoxemic respiratory failure following a systemic or pulmonary insult w/o evidence of HF
Acute Respiratory Distress Syndrome
What are the 2 “hallmarks” of ARDS
- Clinical: bilateral radiograph opacities and hypoxEMIA
- Pathologic: diffuse alveolar damage
- Is measured by periphal O2
- Is measured by ABG
- Peripheral: Hypoxic / Hypoxia
- ABG: Hypoxemia
- A diagnosis of exclusion
- Must exclude acute decompensated HF and other causes of hypoxemic respiratory failure
Acute Respiratory Distress Syndrome (ARDS)
What is the most severe form of acute lung injury
ARDS
4 things needed to dx ARDS according to the _____ definition.
Berlin Definition
- Acute onset within 1 wk of insult
- Bilateral infiltrates
- Resp failure (not from HF or volume overload)
- Moderate-severe oxygen impairment
- What causes *systemic insult* to cause ARDS? (1)
- *pulmonary insult* (2)
- Order them from most to least common (3)
(PROBABLY ON EXAM)
- Systemic: Sepsis
- Pulm: Diffuse PNA & Aspiration
- Diffuse PNA
- Sepsis
- Aspiration
(PSA)
2 key clinical findings of ARDS
(ON EXAM)
- Respiratory distress (tachypnea, accessory muscles, diaphoresis)
- Hypoxemia that is unresponsive to supplemental O2****
CXR or CT chest of ARDS will show what 2 things?
(ON EXAM MAYBE)
- Diffuse / patchy infiltrates bilaterally
- Usually spares the costophrenic angles!***
What diagnostic test MUST you get to dx ARDS?
Arterial Blood Gas (ABG)
(will show dramatic AA gradient w/ PE)
Tx for ARDS
- Intubate
- Prone position
Prognosis of ARDS
High mortality, especially w/ sepsis (90%)
Patients w/ hx of ARDS may have emotional distress. What type of PTSD do they have?
Post-intensive care syndrome
