8. Hypoxia DSAs Flashcards
Acute cough lasts less than 3 weeks while subacte is 3 to 8 weeks. What is the MCC of acute cough?
Viral upper respiratory tract infection
Influenza A/B, parainfluenza, RSV, coronavirus, adenovirus, rhinovirus
Viral coughs/rhinitis/sinusitis have normal chest sounds and usually present rhinorrhea, sneezing, nasal congestion and postnasal discharge without headache, tearing throat discomfort or?
Fever*
Influenza A/B has sudden onset of fever and malaise followed by cough, HA, myalagia and ?
nasal/pulmonary sx, during the appropraite season (Oct-Mar)
Bordatella pertussis, M pneumoniae, and C pneumoniae are nonviral cuases of uncomplicated acute bronchitis and cough in adults (5-10%) and do not gram stain, treatment should not be given unless they have a cough for greater than 2 weeks with an unknown cause =?
Probably pertussis - give antimicrobial therapy (gone in 7-10 days)
Pneumonia is the 3rd MCC of acute cough illness and most serious, the absense of the following point to pneumonia not being the cause…. HR below 100, RR below 28, oral temp below 100, or what on chest examination?
no crackles or diminished breath sounds
Asthma should be considered in someone with an acute cough, but need a hx of asthma/ wheezing and shortness of breath to determine if its asthma– note all of these that would present with asthma also present after acute ?
bronchitis (up to 8 weeks after may see asthma like sx)
Chronic cough is greater than 8weeks, detailed hx and physical all pts should undergo chest radiography causes include, asthma, GERD, upper airwau cough syndrome, brochiectasis, medication reaction (ACE) or?
chornic bronchitis due to smoking
asthma, GERD, upper airway cough syndrome (UACS) are responsible for 90% of cases in nonsmokers with normal CXR and not on ACE inhibitors. UACS is when mucus from the nose goes down the oropharynx and causes?
cough
In GERD cough is d/t vagally mediated distal esophageal tracheobronchial reflux. what may be given to treat this once found a + pH esophageal test?
Proton pump inhibitors - takes 3 months to work
Patients with chronic cough who have normal CXR, normal spirometry and negative methacholine challenge tests should be considered to have what dx?
nonasthmatic eosinophilic bronchitis (NAEB)
Chornic bronchitis is diagnosed by?
chornic cough with sputum for 3 months for the past two consequetive years
Hemoptysis is defined as coughing up blood and may be assoc with acute or chronic cough syndromes. MC seen in ambulatory patients after infection (pneumonia/bronchitis) followed by?
malignancy
Hemotypisis- get chest CT and fiberoptic bronchoscopy if everything is normal then what can it be classified as?
cryptogenic hemoptysis (dont know why)
Dyspnea is described as work or effort in breathing, tightness and unsatisfactory inspirations usually originiating from the cerebral cortex with two main mechanisms including impaired ventilartory mechanisms and an increase in ?
respiratory drive
impaired ventilartory mechanisms may be d/t airflow obstruction (COPD) muscle weakness or dec chest wall compliance, impaired respiratory drive due to parenchymal or pulmonary lung disease, CHF, impaired gas exchange or?
pregnancy
In acute dyspnea developed rapidly over minutes to a day, vital sign assesment and stabilization of the pt should be performed. Then do history and physical, what is the initial diagnostic tool?
CXR
Dyspnea becomes chronic when symptoms persist longer than 1 month, in 2/3 of people usually due to COPD, asthma interstitial lung dz or?
heart failure
***need detailed hx
What describes a common disorder encountered in the critical care unit that remains a significant cause of morbidity and mortality?
ARDS
acute respiratory distress syndrome
Pts with ARDS is quick onset (within 7 days), bilateral diffuse lung infiltrates, non cardiac origin, and oxygenation of?
less than 200 (paO2)
*severe hypoxemia
managment strategies for ARDS include using low tidal volumes (6cc instead of 12cc/kg), prone ventilation, fluid management, cardiopulm monotiriing and?
corticosteroids (although no clear benefit)
80 to 90% of developing COPD is due to smoking cigarettes. And cessation is the most clinically effective and cost effective way to prevent and slow COPDs progression. Screening for airway obstruction is not?
recommended in asymptomatic patients
dx of COPD- hx of smoking, hyperinflation, barrel chest, hyperresonant percussion distant breath sounds and prolonged?
expiratory time
pursed lips breathing, paradoxical chest or abdominal wall movements
Cor pulmonale may be seen with COPD, including JVD, liver enlargement, peripheral edema. also flattening of what may be seen ?
of the diaphragms in emphysema
*COPD is confirmed with spirometry
Therapy of COPD has 3 options in a stepwise approach. Bagonists, anticholergic agents and methylxanthines. ICS are not commonly used for COPD unless they are paired with?
long acting beta agonists LABA
COPD exacerbations are due to infection or air pollution, SABAs are preferred for tx, nonpharm adjunctive tx to alleviate dyspnea and sputum production can help too including: percussion, vibration to enhance clearance sputum, relaxation techniques, OMM, andbreathing throuhg?
pursed lips and diaphragmatic breathing to alleviated dyspnea
usual interstitial pneumonitis (UIP) hetergenous involvement of the lung with different stages of progression of fibrosis in adjacent areas of the lung- usually seen in what diagnosis?
idiopathic pulmonary fibrosis
Nonspecific interstitial pneumonitis (NSIP) has uniform involvement with cellular infiltration or fibrosis, usually bilateral and can see?
honeycombing
Cryptogenic organizing pneumonia (COP) shows small airway bronchiolitis with granulation tissue (granulomas) and organizing pneumonia. What is the hallmark?
granulomas
pt with progressive dyspnea, reduced exercise tolerance, and persisitent dry cough should raise the possibility for DPLD which is?
diffuse parenchymal lung
disease
(restrictive lung dz)
Obstructive sleep apnea OSA is extremely common and can be dx by excessive daytime sleepiness, snoring, insomnia, ED, What is the most important risk factor for OSA?
excess body weight
inc in weight = inc in OSA prevalence
Polysomnopgraphy is used to test for OSA becaus what is not specific or sensitive enough for a dx?
clinical features
The mediastinum has 3 compartments. Anterior MC are thymomas, lymphomas, teratomatous neoplasms, and thyroid masses. Middle is vascular masses, LN enlargement and bronchogenic cysts. posterior are neurogenic tumors, meningoceles, meningomyeloceles, gastroenteric cysts and?
esophageal diverticula
acute mediastinitis are due to esophageal perforation or occur after median sternotomy for cardiac surgery. Chronic mediastinitis ranges from granulomatous inflammation of LN to mediastinum fibrosing medisastinitis. most cases are due to?
tuberculosis, histoplasmosis
Community acquired pneumonia is the most common type- streptococcus pneumonia is 40% of CAP. others include h influenzae, and atypical such as?
mycoplasma pneumoniae
chlamydia pneumoniae
Klebsiella pneumonia is common in alcoholics and pseudomonas is more common in patients with structural lung disease after abx therapy or hospitalization. What should be expected with aspiration pneumonia?
enteric gram negative or anaerobic organisms
Pneumonia should be considered in a pt with cough, sputum, fever, chills, or dyspnea- sx developing abruptly or getting worse over the past few days. What is CURB65 which identifies high risk patients and to predict complicated course?
Confusion blood UREA nitrogen >19.6 Respiration Rate >30 systolic BLOOD pressur <90 or diastolic <60 Age >65
for hospitalized patients, order CXR and two sets of blood cultures, CMP, pulse oximetry, and CBC. what should be considered in pts who do not respond to empiric therapy in 48 hrs?
unusual pathogens (M tuberculosis, fungi, viruses, pneuocytitis)
if the pt is previously healthy w no risk factors for drug resistant strep, give a macrolide. If there are risk factors for drug resistant strep then give?
respiratory fluoroquinolone or B lactam plus a macrolide or doxycyline
health care associated pneumonia aka hospital acquired pneumonia is pneumonia that develops 48 hours after hospitalization, most commonly being gram negative and?
staph aureus
Ventilator associated pneumonia is suspected if the patient has infiltrates that is new or progressive along with clinical findings suggesting infection such as fever, purulent sputum, leukocytosis and a decline in?
oxygenation
Tb is common worldwide and 80% mortality in untreated persons. Pt with Tb are usually asymptomatic with constitutional symptoms such as anorexia, fatigue, weight loss, chills, fever, night sweats and some local sx such as?
cough may develop
if suspecting Tb, obtain acid fast bacilli smears and cultures, CXR and skin tests or IGRA in patients suspective of having active Tb. What makes a Tb patient or likely to get/have tb?
HIV
What is the standard tx for someone with Tb?
RIPE for 6 months Rifampin Isoniazid Pyriazinamide Ethambutol
Fat embolisms can cause hypoxia and clinical present with a TRIAD of hypoxemia, neurologic abnormalities and?
petechial rash - none specific for FES (usually due to broken bones-femur fractures)
most tx for fat embolism is supportive care and the prognosis of fat embolisms is that they will?
fully recover spontaneously
Upper and lower airway obstruction may present with similar symptoms such as SOB, noisy breathing and physical findings such as wheezing and diminished?
breath sounds
*stridor is loudest during inspiration and is loudest in the neck
Must use CT scan for upper airway obstructions or can also use endoscopy. What is an infectious process that causes varibale degress of inflammation and edema of the epiglottis causing UAO?
epiglottitis
present: odynophagia, cant swallow, sore throat, dyspnea, hoarseness, fever, tachycardia, and stridor
Venous thromboembolism collectively refers to deep venous thrombosis and pulmonary embolism together. usually due to venous stasis, hypercoagulability and ?
endothelial damage
DVT patients with no contraindications should undergo immediate anticoagulation with usually warfarin, initiated simultaneously with heparin for 5 days. all pts should be treated with anticoags for a minimum of?
3 months
PE sx include dyspnea, pleuritic chest pain, cough and hemoptysis; tachypnea, crackles, tachycardia and accentuated S2 are the?
most common findings
normal D dimer = no PE
