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EM - Exam 1 > Chest Pain and SOB > Flashcards

Chest Pain and SOB Flashcards

1
Q

Possible ddx of pleuritic chest pain and SOB (atraumatic)

A
  1. PE
  2. Spontaneous PTX
  3. PNA
  4. Pericarditis
  5. Pleurisy
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2
Q

Possible ddx of pleuritic chest pain and SOB (traumatic)

A
  1. Pericardial tamponade
  2. Pulmonary contusion
  3. Tension PTX
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3
Q

Possible ddx of reproducible chest pain

A
  1. Strain
  2. Costochondritis
  3. Fracture
  4. Infectious
  5. Zoster
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4
Q

Possible ddx of substernal chest pain

A
  1. MI/angina
  2. Dissecting TAA
  3. GI
  4. Pneuomediastinum
  5. Mediastinitis
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5
Q

Possible ddx of SOB

A
  1. Pericardial effusion
  2. Pleural effusion
  3. CHF
  4. Asthma/COPD
  5. Anemia
  6. Anxiety
  7. Sickle cell crisis
  8. ARDS
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6
Q

Clinical presentation of PE

A
  • Virchow’s triad
  • Impending doom
  • Tachy
  • Cyanosis
  • Leg edema/calf pain
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7
Q

Tests to diagnose PE and what they may show

A
  • Wells/PERC score
  • D dimer
  • EKG (S1Q3T3)
  • CXR (Fleischner, Westermark, Hampton)
  • CTA
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8
Q

Tx of PE

A
  • Coumadin
  • Factor Xa inhibitors
  • LMWH
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9
Q

Clinical presentation of spontaneous PTX

A
  • Tall/thin person
  • Decreased/absent BS
  • Tracheal shift
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10
Q

Tests to diagnose spontaneous PTX and what they may show

A
  • CXR (linear demarcation)

- Bedside U/S (absent sliding)

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11
Q

Tx of spontaneous PTX

A

Observation vs. chest tube vs. needle decompression

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12
Q

Presentation of PNA

A
  • Gradual onset
  • Fever
  • Cough
  • Rhonchi
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13
Q

Tests to diagnose PNA and what they may show

A
  • CBC (leukocytosis, neutropenia)
  • Blood/sputum culture
  • Flu test
  • CXR (infiltrate)
  • CT
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14
Q

Treatment of PNA

A
  • Abx
  • Antipyretics
  • IVF for sepsis
  • O2
  • Admit based on PORT score
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15
Q

Presentation of pericarditis

A
  • Viral prodrome
  • Pain relieved by sitting forward
  • Pericardial friction rub
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16
Q

Tests to diagnose pericarditis and what they may show

A
  • Mainly clinical diagnosis
  • EBV/HIV/Hep/Lyme (negative)
  • EKG (diffuse ST elevations or low voltage)
  • Echo
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17
Q

Treatment of pericarditis

A
  • NSAIDs
  • Colchicine
  • Steroids
  • Pericardiocentesis for effusion
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18
Q

Presentation of pleurisy

A
  • Viral illness (MC)
  • Trauma
  • Localized pains including w/deep inspiration
  • Pleural friction rub
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19
Q

Tests to diagnose pleurisy and what they may show

A
  • CXR (normal)

- Testing based on work up of suspected underlying etiology

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20
Q

Treatment of pleurisy

A
  • NSAIDs
  • Narcotics
  • Tx any underlying etiology other than viral
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21
Q

Presentation of pericardial tamponade

A
  • Recent surgery or penetrating injury
  • Pulsus paradoxus
  • Beck’s triad (JVD, hypotension, muffled heart sounds)
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22
Q

Tests to diagnose pericardial tamponade and what they may show?

A
  • CXR (water bottle heart)
  • U/S (effusion)
  • EKG (electrical alternans, low voltage)
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23
Q

Tx of pericardial tamponade

A
  • Pericardiocentesis

- May require dobutamine

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24
Q

Presentation of pulmonary contusion

A
  • Recent blunt trauma
  • Chest wall bruising or crepitus
  • Hypoxia
  • Tachypnea
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25
Tests to diagnose pulmonary contusion and what they may show?
- CXR (acute or delayed haziness) | - CT will show up earlier than CXR
26
Treatment of pulmonary contusion
- Analgesics - O2 PRN - Incentive spirometer
27
Presentation of tension PTX
- Penetrating injury - Decreased or absent BS - Tracheal shift - Absent chest rise - Significant distress
28
Test to diagnose tension PTX and what they may show?
- CXR (linear demarcation, tracheal shift) | - U/S (lack of pleural sliding)
29
Treatment of tension PTX
- Needle decompression | - Chest tube
30
Presentation of costochondritis
- Sharp, parasternal, non-radiating pain | - Recent coughing/sneezing episodes
31
Tests to diagnose costochondritis?
Generally nothing required
32
Treatment of costochondritis
- NSAIDs - Rest - Cough meds
33
Treatment of Herpes Zoster
- Antiviral - Steroid - Analgesics
34
Presentation of aortic dissection
- Tearing, ripping pain - PE may be WNL - Tachy - Decreased pulses
35
Tests to diagnose aortic dissection and what they may show?
- CXR (wide mediastinum) - US (aortic root) - CTA
36
Treatment of aortic dissection
-BB until BP
37
Presentation of pneumomediastinum
- Radiating chest pain to neck/back/shoulders - Onset w/forceful coughing - PE may be WNL - Hamman sign (crepitus w/cardiac auscultation)
38
Tests to diagnose pneumomediastinum and what they may show?
CXR (SQ air along hilum or into neck soft tissues)
39
Treatment of pneumomediastinum
- Usually no tx required | - Close FU
40
Presentation of mediastinitis
- Recent dental infection or post-surgery - Gradual, sharp pleuritic pain - PE may be WNL - Hamman sign (crepitus w/cardiac auscultation)
41
Tests to diagnose mediastinitis and what they may show?
- CBC (leukocytosis, bandemia) - CRP/ESR - Barium swallow - CT neck and chest
42
Treatment of mediastinitis
- ABCs - Abx - IVF
43
Presentation of pleural effusion
- Dullness to P/A - Pleural friction rub - Cough - Recent PNA, cancer, CHF
44
Tests to diagnose pleural effusion and what they may show?
CXR (blunting of costophrenic angles)
45
Treatment of pleural effusion
- Spontaneous resolution - Diuresis - Thoracentesis
46
Presentation of CHF
- Crackles/rales - JVD - Pitting edema - Hypoxia
47
Tests to diagnose CHF and what they may show?
- CXR (Kerley B, cardiomegaly) - BNP - US (B lines)
48
Treatment of CHF
- Diuretics - NTG - CPAP - Dialysis
49
Presentation of asthma/COPD
- Wheezing, tightness - Anxious - Decreased air movement
50
Tests to diagnose asthma/COPD and what they may show?
- Peak flow | - CXR
51
Treatment of asthma/COPD
- Nebulizers - Steroids - Mg - Ativan
52
Presentation of anemia
- Fatigue - DOE - Cold intolerance - Pallor - Splenomegaly
53
Tests to diagnose anemia and what they may show?
- Low H/H - Increased BUN w/GIB - Reticulocyte ct in sickle cell
54
Treatment of anemia
- Blood transfusion | - Treat underlying disease
55
Presentation of anxiety
- Generally constant, non-exertional SOB - Recent trigger event - Hyperventilating
56
Tests to diagnose anxiety
- R/o other etiology | - DAU-8
57
Treatment of anxiety
- Anxiolytics | - Non rebreather w/o O2
58
Presentation of sickle cell crisis
-Pain -SOB, tachypnea -Fever, cough -Hypoxemia (acute chest syndrome)
59
Tests to diagnose sickle cell crisis and what they may show?
- CBC (low reticulocyte count) | - Hgb electrophoresis (if new)
60
Treatment of sickle cell crisis
- Analgesics - O2 - Transfusion for drop in Hgb - IVF
61
Define ARDS
Respiratory failure 2/2 pulm or systemic insult WITHOUT evidence of heart failure
62
Onset of ARDS
Within 12-48 hrs (but up to 1 wk) of triggering event
63
Etiologies of ARDS
- Sepsis - Aspiration or inhalation of harmful substances - Trauma/burns - PNA
64
Pathophys of ARDS
- Damage to capillary and alveolar endothelial cells - Causes increased vascular permeability and low surfactant - Results in pulm edema and alveolar collapse (hypoxemia)
65
Presentation of ARDS
- Rapid onset of significant tachypnea, retractions - Crackles - Hypoxemia refractory to O2
66
What does CXR show in ARDS?
- Diffuse bilat patchy infiltrates | - Air bronchograms
67
Treatment of ARDS
- Aggressive diagnosis and tx - Intubation usually and set ventilator to avoid O2 toxicity - Supportive (fluids, fever)
68
How are steroids used in ARDS?
Not proven effective
69
Preventive measures of ARDS
None have been identified

EM - Exam 1 (5 decks)

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