Wayne Shared "COVID 19" - 75 Picmonics
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COVID 19
COVID 19 symptoms (SARS-COV-2)
- Transmissible through close contact
- SARS-CoV2 is COVID 19
- Early Symptoms
- Fever
- Cough
- Dyspnea
- Happy or silent hypoxia
- Anosmia
- Diarrhea and Nausea
- Abdominal Pain
- Muscle ache
- Sore Throat
- 2-14 day incubation time
- Medical Complications
- ARDS
- Septic Shock
- respiratory failure
- Cardiomyopathy
- Increased Risk of Venous Thromboembolism (VTE)
- organ failure
- Atypical pneumonia
- enveloped ss(+)RNA
- IgG indicates active infection and IgM past infection
- hemagglutinate positive
- replicating in CD4+ T cells, cardiac, hepatic, renal tissue, leads to cytokine storm
3 mins
Severe Sepsis and Septic Shock Assessment
- Microthrombi
- DIC
- Decreased Oxygen Saturation
- Decreased WBC
- Oliguria
- High Output Heart Failure
- Multiple Organ Failure
2 mins
Reading a Chest X-Ray
- ABCDE Approach
- Airway and Appliances
- Bones
- Cardiac
- Diaphragm
- Everything Else
- Masses
- Pulmonary Vasculature
- Lung Parenchyma
2 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
- Cause
- Damaged Alveolar-Capillary Membrane
- Assessment
- Restlessness
- Dyspnea
- Refractory Hypoxemia
- Decreased PaO2
- Diffuse Pulmonary Infiltrates
- Atelectasis
- Pulmonary Hypertension
2 mins
ARDS Etiologies
- SSPPARTA Mnemonic
- Sepsis (most common) & Shock
- Pancreatitis
- Pneumonia
- Aspiration
- uRemia
- Trauma
- Amniotic Fluid Embolism
- Nml. PCWP b/c Noncardiogenic Pulm Edema
ARDS Assessment
- Criteria/Diagnosis
- Onset within
- Bronchoscopy w/ BAL if infection suspected
- Bilateral infiltrates on CXR/CT
- Rule out CHF, fluid overload
- PCWP
- Pathogenesis
- Increased capillary permeability
- -->Massive pulmonary edema
- Causes
- Sepsis
- Aspiration of gastric contents
- Trauma
- Acute pancreatitis
- Intracranial HTN
- Cardiopulmonary shunt
- Near drowning
- PCWP>18 suggests CHF
- Treatment
- Oxygen
- Mechanical ventillation
- high PEEP
- low tidal volume
- IV Fluids
- Goal: CVP 4-6
Acute Respiratory Distress Syndrome (ARDS) Interventions
- Interventions
- Closely Monitor Patient
- ABG's (Arterial Blood Gases)
- Oxygen
- Assess for O2 Toxicity
- Mechanical Ventilation
- PEEP
- Assess for Pneumothorax
- Permissive Hypercapnia
- Considerations
- High Mortality Rate
2 mins
ACE Inhibitors should be administered...
- Patients with Acute Coronary Syndrome (on admission)
- ACE inhibitors
- Ejection Fraction < 0.40
- CHF
- Hypertension
- Diabetes
- Stable chronic kidney disease
- Recent MI
ACE Inhibitor Toxicity
- CAPTOPRIL Mnemonic
- Cough
- Angioedema
- Potassium Changes (Hyperkalemia)
- Taste Change
- Hypotension
- Pregnancy Changes
- Rash
- Increased Renin
- Lower Angiotensin II
2 mins
ACE Inhibitor Drugs indicated for Heart Failure
- Heart failure
- Increase survival
- Drugs indicated for CHF
- Captopril
- Enalapril
- Lisinopril
- Contraindications
- Do NOT use with Aliskiren
- Do NOT use in Pregnancy
- Do NOT use in pts w/ Angioedema
- Do NOT use in pts w/ Bilateral Renal Artery Stenosis
Angiotensin II Effects
- Efferent > Afferent Constriction
- Increased Filtration Fraction
- Direct effect on proximal tubule
- Increased aldosterone
- Increased reabsorption
- Increased Sympathetic Nerve activity
- Peripheral Vasoconstriction
- Maintain Blood Pressure
Renin Angiotensin Aldosterone System
- Angiotensin Converting Enzyme (ACE)
- Angiotensinogen
- Renin
- Angiotensin II Induces Vasoconstriction
- Aldosterone Causes Na+ Reabsorption
- Increased Blood Pressure
- Stimulates Hypothalamus Causing Thirst
- Activated Na+/H+ ATPase in PCT
- Beta Blocker Blocks Renin Release
- Endothelin 1
Angiotensin Receptor Blockers (ARBs)
- -sartan suffix
- Indications
- Hypertension
- CHF
- Diabetic Nephropathy
- Mechanism of Action
- Angiotensin II Receptor Blockers
- Side Effect
- Hyperkalemia
- Contraindication
- Pregnancy
1 min
Pulmonary Alveolar Proteinosis
- GM-CSF or Macrophage Dysfunction
- Accumulation of Surfactant in Intra-alveolar and Bronchiolar Areas
- Alveoli Filled with Protein-lipid Granular Precipitate (Amorphous)
- Surfactant Mutation ABCA3
- Males, 30-50 Years Old
- Chunky Gelatinous Sputum
- Bilateral Patchy Asymmetric Pulmonary Opacifications
- Increased Superinfection Risk
- Treatment is Lung Lavage
- No Inflammatory Cell Infiltration
Alveolar Gas Exchange
- Characteristics
- Pulmonary Artery Blood is O2-Poor, CO2-Rich
- Two-Cell Thick Air-Blood Barrier
- CO2 Diffuses Into Air
- O2 Diffuses Into Blood
- Gases Equilibrate
- Pulmonary Vein is O2-Rich, CO2-Poor
- Thermoregulation
2 mins
Alveolar Gas Equation
- Equation
- Partial Pressure of Alveolar Oxygen (PAO2)
- Partial Pressure of Oxygen in the Inspired Air (PIO2)
- PIO2 Normally Approximated = 150 mmHg
- Arterial Partial Pressure of CO2 (PaCO2)
- Respiratory Quotient (R)
- R Normally Approximated = 0.8
- PAO2 = PIO2 - (PaCO2/R)
1 min
Respiratory Anatomy
- Characteristics
- Nasal Cavity
- Hair Filters
- Mucus Filters and Moistens
- Capillaries Warm
- Pharynx (Throat)
- Larynx (Voice Box)
- Cilia Expel Mucus and Dust
- Trachea
- Bronchi
- Alveoli
2 mins
Physiologic Dead Space (VD)
- Tidal Volume (Vt)
- Partial Pressure of Arterial CO2 (PaCO2)
- Partial Pressure of CO2 in Expired Air (PECO2)
- VD = VT x (PaCO2-PECO2) / PaCO2
2 mins
A-a Gradient
- Partial pressure of alveolar oxygen (PAO2)
- Partial Pressure of Arterial O2 (PaO2)
- Normal 10 to 15 mmHg
- Hypoxemia with an Abnormal A-a Gradient
- Diffusion problem
- Shunting (Low V/Q)
- Dead space (high V/Q)
1 min
Winter's Formula
- Evaluates Respiratory Compensation
- Used in Metabolic Acidosis
- Equation
- (HCO3 x 1.5 ) + 8 plus-minus 2 = PCO2
- Steps
- Bicarbonate (HCO3) x 1.5
- + 8
- ± 2
- = Expected Value for PCO2
2 mins
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