Pneumonia, Influenza, Covid-19, ARDS Flashcards Preview

CPR II Exam 2 > Pneumonia, Influenza, Covid-19, ARDS > Flashcards

Flashcards in Pneumonia, Influenza, Covid-19, ARDS Deck (38)
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1

What are the risk factors for developing MDR gram negative bacterial PNA and MRSA?

hospitalization >2 days in last 90 days 

use of abx in last 90 days 

immunosuppression

nonambulatory status

tube feedings

gastric acid supression 

severe COPD 

2

What are the risk factors for developing MRSA?

hospitalization >2 days in last 90 days 

use of abx in last 90 days 

chronic hemodialysis in last 30 days 

documented hx of MRSA

CHF

gastric acid suppresion

3

What are the risk factors for Community acquired MRSA?

cavitary infiltrate or necrosis 

gross hemoptysis

neutropenia 

erythematous rash

concurrent influenza

young, previous healthy 

summer month onset

4

What is the most common cause of community acquired pneumonia?

S. Pneumoniae 

5

What are the risk factors for CAP?

alcoholism, asthma, institutionalization, over age 70

decreased cough/gag reflex in elderly 

dementia, sz disorder, HF, Cerebrovascular disease, smoking, COPD, HIV

6

What is a likely cause of CAP if recent travel to ohio river valley? 

travel to southwest USA?

 

Travel to SE asia?

 

hotel or cruise?

histoplasma 

 

hantavirus, coccidioides

 

Burkholderia, avian flu 

 

Legionella 

7

What is the most important thing in making a diagnosis of pneumonia?

History and physical 

8

What is the treatment for pneumonia based upon?

History 

consider co-morbidities 

9

What are risk factors for peudomonas and MRSA?

prior isolation of either organism on culture

recent hospitalization AND receipt of parental abx within last 90 days 

10

What are the risk factors of Pseudomonas with CAP?

1. compromized immune system 

2. recent prior abx use

3. structural lung abnormalities such as cystic fibrosis or bronchiectasis 

4. repeated exacerbations of COPD reqiurring glucocorticoids or abx use

11

What are the risk factors for pseudomonas with HAP?

increased age, ventilation, abx at admission, transfer from unit or icu, admission in ward with high incedence of P. aurgeinosa infections 

 

12

What is the definition of HAP?

infection acquired after at least 48hrs of hospitalization 

 

13

When treating HAP and VAP, consider the following risks 

1. increased mortaloity

2. MDR pathogens and MRSA

3. MDR pathogens without MRSA

4. MRSA alone 

14

What is the definition of VAP?

HAP that develops more than 48hrs after endoracheal intubation 

-difficult to wean of ventilator

lack improvement

new infiltrates on xray, new fever

 

15

What is aspiration PNA?

Macroaspiration of fluid/food into lungs 

usually due to neurologic dysfunction

16

What is a trasudate pleural effusion and likely cause?

usually from systemic influences on pleural fluid formation and resorption 

Left HF, cirrhosis, neprhotic syndrome, myxedema, peritoneal dialysis 

17

What are the causes of exudative pleural effusions?

caused by local influences on pleural fluid formation and reabsorption 

bacterial PNA, malignancy, virus, PE, TB, fungus, parasites 

18

How to diagnose a plueral effusion?

 

When is a thoracentesis indicated?

Thoracentesis 

 

for all effusions with >1cm layer in decubitus view 

if effusion suspected r/t HF, then can try diuresis and 75% do so in 48 hrs 

if effision suspected to be r/t infection, thorecentesis is done ASAP

19

What does Light's Criteria determine?

What are the criteria?

Determines an exudative effusion

  1. protein pleural fluid/serum protein ratio >.5 
  2. pleural fluid LDH greater than 2/3 of the labs normal upper limit for serum LDH
  3. pleural/serum LDH ratio >.6 

 

Transudative effusions will not meet any of these criteria 

 

20

For exudative effusions, pleural fluid should be tested for what? 

Ph

glucose

WBC with diff 

micro stidues

cytology 

21

What is the definition of ARDS?

severe dyspnea

diffuse pulmonary infiltrates

hypoexemia 

22

What is the key diagnostic feature for ARDS?

PaO2/FIO2 <300mmHg

diffuse bilateral pulm. infiltrates

absence of elevated left atrial pressure

acute onset 

23

What PaO2/FIO2 ratio indicates severe hypoxemia?

What indicates abnormal gas exchange?

<200

<300 

24

What are the risk factors for ARDS?

sepsis

ONA

trauma

blood transfusions

gastric acid suppression

drug overdose 

25

What is the exudative phase of ARDS?

alveolar edema and neutrophil inflammation

diffuse alveolar damage

atelectasis and reduced lung compliance

hypoxemia, tachypnea, progressive dyspnea, hypercarbia due to loss of alveolar exchange

CXR with bilateral opacities consistent with pulmonary edema 

26

What is the proliferative phase of ARDS?

progressive lung injury and pulmonary fibrosis

27

What is the fibrotic phase of ARDS?

prolonged progressive fibrosis and need for more ventilator support or supplemental O2

increased risk for PTX, increased dead space

28

In ARDS, alveolar collapse can occur due to alveolar/interstitial fluid accumulation and loss of worsening hypoxemia, therefore low tidal volumes are combined with the use of what to minimize what? 

low TV are combined with the use of positive end-expiratory pressure (PEEP) at levels that strive to minimize alveolar collapse and achieve adequate oxygenation with the lowest required FIO2

can also try to improve oxygenation by putting pt in prone position

29

What are some ancillary therapies for patients with ARDS?

due to interstitial and alveolar edema, limit IV fluids to only as needed 

most patients require sedation and even paralytic agent s

Avoid glucocorticoids or NO in ARDS

30

What are some respiratory complications of influenza?

PNA due to influenza or a secondary bacteria