Morning Report 2/2/16

  • 5 Classic Causes of Hypoxemia
    • V-Q Mismatch (elevated A-a gradient)
    • Diffusion problems (elevated A-a gradient)
    • Shunting (right to left shunt, PE) (Elevated A-a gradient)
    • Hypoventilation (normal A-a gradient)
    • Altitude, low inspired FiO2 (normal A-a gradient)
  • Illness script for PCP Pneumonia: Usually HIV +, chronic non-productive cough (due to high viscosity of sputum), often normal lung exam and chest film, may see ground glass opacities in the bilateral lower lung fields, hypoxia worse with exertion
  • Start steroids in addition to Bactrim for FiO2 < 70 or A-a gradient > 35, treatment of PCP fungal death causes a profound inflammatory reaction which is why steroids decrease mortality, treatment course is for 21 days
  • Prophylaxis for PCP in HIV for CD4 < 200, 95% effective in preventing PCP

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