Pulmonology Heliox (inhaled helium) used for obstruction (esp w/ asthma)Nebulized N-acetylcysteine- for chronic bronchitis/bronchiectasisNon invasive + pressure intubations ↓ for 24hr after extubation, ↓ the for re-intubation

DLCO is often low in anemic (need corrected DLCO) & pulmonary vascular dz with regular lung volumes; pulmonary hemorrhage causes high DLCO and if test redone the low DLCO

6 min walk test: walk as fast as they can measure max distance); tracks functional capacity; is a prognostic indicator to assess response to therapy or need for lung transplantation

Pulse Ox- accurate w/I 2-3% are Falsely low in peripheral vaso onstriction, cardiac arrthmias, excess ambient light; carboxy Hgb falsely high; limitation: partial pressure may ↓ well below normal before saturation fall; does not give you adequacy of ventilation; cannot measure FRC/RV/TLC

Chest Xray: pneumothorax, pleural effusion, pneumonia, HF, catheter/ intubation, serial following progression;

Need CT for interstial lung dz, bronchiectasis, pul nodules, cancer spread, PE, LAD, aspirate/biopsy; PET CT give FDGlucose stage lung cancer, if nodule cancerous (does not exclude cancer but makes less likely); COPD exacerbation pts get Xray to rule out pneumonia

Upper lobe preference: sarcoidosis & silicosis, Langerhans cell histiocytosis, CF, 2˚ TB

Lower lobe preference: idiopathic pul fibrosis, asbestosis, cryptogenic organizing pneumonia, ILD mimic of HF

Contrast enhanced CT: differentiate BV from large LN, metastases to liver, can also eval PE, aortic dissection; 1CT=40X-ray (so can induce cancer)

Persistent neuropsychiatric impairment affect up to 75% pt a/w age, glycemic control & mechanical ventilation (pt w/ sepsis or ARDS)

FP PET scan: infection (TB, fungal), sarcoidosis; FN PET: variants of adenocarcinoma, carcinoid tumor; not useful for nodules<1cm;

PET CT has higher specificity/sensitivity; used for cancer staging; still need biopsy

Bronchoscopy useful for: sarcoidosis, silicosis, HY pneumonitis,Bronchoalveolar lavage- 90% MAC is nrml; LYM, EOS, NEU is abnrml; proceducer can cause resp dep/arrest due to anesthesia, or pneumothorax; helps w/ mucus clearance, removing foreign body, stenting airway

70-90pt w/ asthma have allergies confirmed w/ skin testing; mediators do short term while cytokines mediate long term ; px w/ episodic cough, dyspnea, chest tightening; worse at night/early morning (1/mo);

Asthma Differential: COPD, vocal cord dysfunction (wheezing from upper airway, younger age monophonic wheezing), mechanical obstruct, CF (clubbing of digits), HF (lower edema & bilateral ins crackles), bronchiectasis, ABPA

Rhino is upper airway while RSV is lower airwayChronic cough= cough variant asthamaSome people w/ asthma have GERD (need to have relationship w/ 2 Sx then treating it will prove beneficial, otherwise no)

ABPA- common in pt w/ asthma/CF; cause brochiectosis, fibrosis; screen by measuring IgE levels; Atb/skin test; tx with systemic steroids

Aspirin sensitivity= nasal polyp + asthma (Samter triad in adult often)FEV1 <50 order pulmonary rehabilitation program (have to walk, no MI); great for COPD, ILD, CF

Area ↓ in emphysema;