2) Pulm Flashcards
Best imaging for pneumothorax
Expiratory films
Small pneumothoraces tx
If <15% and otherwise healthy patient = conservative
-can be managed outpatient; air is resorbed at 2% per day
Tx of larger pneumothoraces or if small in unhealthy patient
Observation and supplemental oxygen (conservative)
+/- needle or tube thoracostomy
Tension penumothorax tx
Immediate needle decompression (14 guage needle into the pleural space at the second intercostal space, midclavicular line)
Followed promptly by tube thoracostomy
Dx of VTE
duplex ultrasound
Tx of VTE
IV unfractionated heparin or subQ low molecular weight heparin to PTT of 1.5-2
-require 3-6mo of anticoagulation
Most common findings in patients w/ PE
- sinus tachycardia & nonspecific ST-T wave changes
(also: right sided strain pattern w/ S wave in lead 1 Q wave in and t wave in lead 3 (S1Q3T3), R axis deviation, new R BBB, T wave inversion in anterior leads)
CXR findings suggestive of PE
-atelectasis, pleural effusions, elevated hemidiagphragm, westermark sign (oligemia in the embolized lung zone) or hampton hump (wedge shaped pleural based density)
Tx of Asthma Exacerbation
- Oxygen to maintain sats >90%
- B2 agonists via nebulizer or meter dose inhaler
- Aeroslized antichoinergics (ipratropium bromide)
- corticosteroids (PO prednisone or IM methylprednisololne)**6-12h to maximum efficacy
- Magnesium sulfate
- Inhaled heliox
Most useful measurement in acute setting COPD
FEV1 (easily measured, less variable than other, correlates w/ mortality)
Arrhythmia associated w/ COPD
-multifocal atrial tachycardia
Left shift in pneumonia
Predominance of segmented neutrophils and bands
= Bacterial
Right shift in pneumonia
lymphocytic pneumonia = Viral etiology
Empiric inpatient therapy for CAP
-cephalosporin (ceftriaxone) & a macrolide (azithromycin) & vancomycin
Empiric outpatient therapy for CAP
Clarithromycin or Azithromycin or a Fluoroquinolone such as levofloxacin
