Pearls from Dr. Kristin Burkart
- Venous Blood Gas: Useful to screen for hypercarbia (not hypoxemia). If elevated, will need an ABG.
- RVSP on TTE: Estimation is with large S.E. - need RHC to formally evaluate
- If RVSP >50 unlikely acute process since this degree of elevation in pressures acutely would cause RV failure and HD compromise
- Shunt Physiology: Increasing FiO2 will only result in minimal improvement in PaO2. With serial ABGs on different O2 settings can actually calculate shunt fraction.
- Intrapulmonary Shunt Examples:
- Hepatopulmonary Shunt
- Hereditary hemorrhagic telangiectasia
Posted 07/25/16 02:16:36 PM by Adam Faye
Pulm HTN Groups:
- PAH (idiopathic, connective tissue disorders, drugs and toxins)
- Secondary to Left Heart Disease
- Secondary to chronic lung disease and/or hypoxemia
Posted 07/25/16 02:22:35 PM by Adam Faye
- Group 1 PAH - administer inhaled NO. See if Mean PA decreases by >10mmHg to a value less than 40 mmHg. If positive trial a calcium channel blocker - untreated median survival of 2-3 years
- V/Q scan for diagnosis (more distal emboli which CTA can have difficulty picking up).
Posted 07/25/16 02:24:34 PM by Adam Faye
Posted 07/25/16 02:31:07 PM by Adam Faye
- 2 potato
sign on CXR (refers to hilar nodes)
Posted 11/10/16 01:52:37 PM by Adam Faye
- Mycetoma- chronic subcutaneous infection caused by actinomycetes or fungi (results in granulomatous)
- CAP can cause hemoptysis if patient has bronchiectasis
- Fungitell not particularly sensitive/specific; useful for PCP detection
Posted 11/10/16 02:07:52 PM by Adam Faye
- Death usually from asphyxiation not exsanguination
- Whichever lung the bleed is suspected in - put that side down in the lateral decubitus position (protects the "good" lung from being filled with blood).
- **Get IR involved right away, and can think about intubating just a mainstem bronchus of the good lung or placing an endobronchial blocker/double lumen ETT.
- Bronchial Artery most likely to bleed
- Remember to correct coagulopathy
Posted 11/10/16 02:15:48 PM by Adam Faye
- B/L hilar adenopathy (regression of nodes occurs in 75% of individuals)
- B/L hilar adenopathy and reticular opacities (upper lobe predominant)
- Reticular opacities with shrinking hilar nodes
- Reticular opacities with evidence of volume loss
- Many undergo spontaneous remission
- When giving steroids- clinical effectiveness is defined by improvement in lung function rather than by just "feeling better"
Posted 11/10/16 02:40:30 PM by Adam Faye
Created by Christopher Kelly
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The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.