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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
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3 mins
Severe Sepsis and Septic Shock Assessment
Microthrombi
DIC
Decreased Oxygen Saturation
Decreased WBC
Oliguria
High Output Heart Failure
Multiple Organ Failure
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2 mins
Reading a Chest X-Ray
ABCDE Approach
Airway and Appliances
Bones
Cardiac
Diaphragm
Everything Else
Masses
Pulmonary Vasculature
Lung Parenchyma
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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
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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
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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
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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
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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
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ACE Inhibitor Toxicity
CAPTOPRIL Mnemonic
Cough
Angioedema
Potassium Changes (Hyperkalemia)
Taste Change
Hypotension
Pregnancy Changes
Rash
Increased Renin
Lower Angiotensin II
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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
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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
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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
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Angiotensin Receptor Blockers (ARBs)
-sartan suffix
Indications
Hypertension
CHF
Diabetic Nephropathy
Mechanism of Action
Angiotensin II Receptor Blockers
Side Effect
Hyperkalemia
Contraindication
Pregnancy
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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
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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
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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)
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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
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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
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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)
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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
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2 mins

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Wayne Shared COVID 19 - 75 Picmonics