Pulmonary Htn

Pulmonary HTN • @ rest mean of 25, with exercise > 30 • Primary (idiopathic) F:M 3:1, age 20-40 • Secondary: o pul disease: asthma, COPD, restrictive lung disease, cystic fibrosis, o heart disease: MS, AS, ASD, VSD o collagen vascular disease o thromboembolic disease: PE, sickle cell • S/S → SOBOE, easy fatigue wheezing, graham steel murmur • Lab: CXR, ECG(RVH, RAD, Rt atrial enlargement), Echo, ABG, PFT, NO test to if responsive or not (Viagra) • Cardiology consult and ICU • Monitors: CAS, 5 leads EGC, art-line, CVP, PAC???, TEE, ECG look for acute strain pattern in leads II, III and aVF • Options RA Vs GA, better RA • Have NO ready, and inotropic support (milrinon, dobutamine) SNP, NTG • Keep 100 O2 all time

• • • •

Avoid things ↑ PVR ( hypoxia, acidosis, hypothermia, ↑ PCO2) With induction ask the Pt to hyperventilate to ↓ PCO2 Maintenance → narcotic based as possible NO → may cause methemoglobinemia → Rx → Methylene blue