CardioPulm Flashcards
A patient comes in with SOB. On auscultation, you hear expiratory wheezing and retractions. What is the most likely diagnosis and how would you treat it?
Asthma
Tx:
- short acting beta agonist: albuterol
- anticholingeric: ipratropium
- corticosteroid: prednisone - give within 1 hr of arrival to ED to decrease need for admission
What are the 3 main components to asthma?
Airway inflammation
Intermittent airflow obstruction
Bronchial hyperresponsiveness
How would you test someone for asthma?
Peak flow
Pulmonary function test
CXR - only if febrile and focal lung findings
A patient presents with severe asthma exacerbation, including AMS, hypercapnia, and respiratory exhaustion. What is your most likely management for this patient?
Epinephrine
Mg
Ketamine
CPAP
A patient was admitted for asthma exacerbation. Under what conditions would you consider discharging them?
If peak expiratory flow >70% and they are able to obtain their meds.
A patient comes in with complaints of SOB. On PE, you notice the patient is tachypneic, tachycardic, coughs frequently, and uses their accessory muscles. Lung exam reveals rhonci and wheezing with diminished breaths sounds. What is the most likely diagnosis and how would you treat it?
COPD
Tx:
- Duoneb/ipratropium/albuterol
- O2
- Prednisone
A patient presents with what you believe to be is COPD. How would you test it?
Pulmonary function test - gold standard
EKG
Labs
GOLD criteria
In what disease process is the GOLD criteria used and what does it include?
COPD
Increased dyspnea
Increased sputum production
Sputum purulence or purulence
Pt requiring vent
You determine that the patient with asthma exacerbation must be intubated. They then develop a pneumothorax. What symptoms did this patient show that helped you arrive to this diagnosis? How would you treat it?
Pleuritic chest pain Dyspnea Tachypnea Tachycardia Hypotension Hypoxia
PE: Decreased breath sounds, hyperresonance
Tx: O2 & chest tube
A patient comes in with a cough and SOB. On PE, you notice the patient has a rash, is tachycardic, tachypneic, and has rales, rhonci and wheezing on auscultation. What is the most likely diagnosis and how would you treat it if inpatient?
Pneumonia
Tx:
- ABCs: patients often come in septic
- IV fluoroquinolone (and B-lactam if severe) OR
- B-lactam +macrolide
A patient presents with substernal chest pain. He has a history of HTN, and TDM2. He notes he first noticed it 1 hour ago while doing some yard work, but reports that even with rest, the pain persists. What other pertinent past medical/social history may this patient have?
Acute coronary syndrome
Cocaine use
What’s the difference between stable and unstable angina?
Stable angina:
- chest pain with exertion
- relief with rest
- ST depressions
- 70% occlusion
Unstable angina
- chest pain at rest
- ST segment depressions and T wave inversions
- 90% occlusion (chest pain at rest indicates >90% occlusion)
A patient presents with tachycardia, diaphoresis, N/V, abdominal pain, and dyspnea. How would you manage?
ECG within 10 minutes of presentation (door to doctor)
Worried about ACS
This is an atypical presentation, which is common in women, the elderly, and those with diabetes.
What are the three criteriaused to diagnose infarction in patients with LBBB?
Sgarbossa Criteria
- ≥ 1 lead with ≥1 mm of concordant ST elevation
- ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
- ≥ 1 lead anywhere with ≥ 1 mm ST elevation and proportionally excessive discordant ST elevation, as defined by ≥ 25% of the depth of the preceding S-wave.
A patient with chest pain presents to the ED. ECG shows ST segment elevations. What is the next best step in managment?
Cath lab/PCI within 90 min.
Door to fibrinolysis within 30 min+transfer
