3 Pneumonia, Pleural Effusion, and Hiccups Flashcards
Other term of hiccups
Singultus
persistent vs intractable hiccups
persistent: >48 hours
intractable: >1 month
physical maneuvers to treat hiccups
Foreign body removal
Ice water, sip
Quickly drink water
Sugar, swallow a teaspoon
Many of these physical maneuvers are based on the concept that stimulating the pharynx will block the vagal portion of the reflex arc and abolish the hiccups
Cyanosis is usually visible when deoxygenated Hgb exceeds
50 g/L
| 5 g/dL
at least ____ of pleural fluid in the hemithorax exists if seen on upright CXR
150-200 cc
criteria to determine pleural exudate
LIGHT CRITERIA: 1 or more of the ff:
PF/serum protein ratio >0.5
PF/serum LDH ratio >0.6
PF LDH >2/3 of UL for serum LDH
Remarks on pleural fluid analysis
Neutrophil predominance: parapneumonic, PE, pancreatitis
Lymphocytic predominance: CA, TB, postcardiac surgery
Low glucose: parapneumonic, CA, TB, RA
how to determine pleural fluid that may be empyematous
normal pH is around 7.64
In parapneumonic effusions, a pleural fluid ~pH <7.10~ predicts development of empyema or persistence and indicates need for thoracostomy tube drainage
therapeutic thoracentesis is indicated if
patient has dyspnea at rest
acute drainaige of volumes larger than 1-1.5 L is associated with reexpansion pulmonary edema, so large-volume drainage is to be avoided
remarks on pleural effusion in heart failure
To confirm exudative etiology in heart failure patients undergoing diuretic therapy, determine serum to pleural fluid albumin gradiant (SPAG)
>12 g/L (1.2 g/dL) means exudative
optimization of medical therapy typicaly resolves >80% of effusions d/t heart failure
remarks on acute bronchitis
naproxen reduces coughing in patients with acute bronchitis
For intractable coughing paroxysms in the ED, some patients respond to
4 mL of 1-2% preservative-free lidocaine (40-80 mg) by nebulization
This will cause transient suprression of the gag reflex due to posterior pharyngeal anesthesia
remarks on kelbsiella pneumoniae pneumonia
usually in alcoholics or nursing home patients
bulging fissure sign with abscess formation on CXR
pneumonia agent in elderly and COPD
Haemophilus influenzae
COPD: also Moraxella catarrhalis
considered the initial and most effective treatment of massive and recurrent hemoptysis
bronchial artery embolization followed by bronchoscopy
2 organisms that account for the most severe CAP in otherwise healthy adults
Streptococcus pneumoniae and Legionella
Still the most common pathogen causing pneumonia in alcoholics
S. pneumoniae
but Klebsiella and Haemphilus are also important agents of infection
most common infection in the elderly
pneumonia
most comon serious viral infection in the elderly
Influenza
Most common cause of bacterial pneumonia in patients with HIV
S pneumoniae
CURB 65
Confusion
Urea >7 mmol/L (>19 mg/dL)
RR ≥30
BP ≤90/60
≥65 years of age
dyspnea in the upright position
platypnea
results from
-loss of abdominal wall muscular tone
-R-to-L intracardiac shunting (patent foramen ovale)
dyspnea when lying on one side but not on the other side
TREPOPNEA
the patient lies on the side of the more affected lung where gravity increases blood flow to the worse lung and reduces it to the better lung
patients with trepopnea prefer to lie and sleep on the opposite side of the diseased lung, as the gravitation increases perfusion of the lower lung
remarks on hiccups
afferent arm: phrenic and vagus nerves, thoracic sympathetic chain
in most cases in which a specific cause can be assigned, hiccups appear to result from stimulation, inflammation, or injury to one of the nerves of the reflex arc
acute (benign, self-limited) causes of hiccups
Alcohol intoxication
Gastric distention
Abrupt change in env temperature
Psychogenic
Excessive smoking
chronic (persistent, intractable) causes of hiccups
CNS structural lesions
vagal or phrenic nerve irritation
metabolic: uremia, hyperglycemia
general anethesia
surgical procedures
foreign body in ear touching tympanic membrane (especially hair)
