Common presentations and Resp infections Flashcards
Pathology of cough
Is an important defensive reflex, but can be a marker of disease
Syndromes of cough
Acute cough
90 days duration
Rarely infectious in origin
Causes of chronic cough
Smoking
ACEi
Upper airway cough syndrome aka post-nasal drip
Cough variant asthma
Non-asthmatic eosinophilic bronchitis (not very severe)
GERD
Common causes of dyspnea
Pneumonia/aspiration Acute exacerbation of COPD Asthma exacerbation Pulmonary edema Pulmonary embolism
When is dyspnea an emergency?
Hypoxic
Hypercapneic
In extremis (not doing well)
Tx of dyspnea
Treat the underlying cause of their dyspnea
Supplemental O2
Establish IV access and monitor as necessary
Non-invasive mechanical ventilation (bipap)
Intubation/Ventilation
↑PEEP/ ↑FiO2
If still doing poorly after that, more intense measures
Common causes of hemoptysis
Diffuse intrapulmonary hemorrhage, tracheoarterial fistula, TB, cancer, mitral stenosis
Confirm not from nosebleed or stomach
Investigations of hemoptysis
CXR, Urinalysis (see if blood in urine too)
in a smoker or >50 or massive: more likely malignancy -> bronchoscopy (see if bleed is actually from airway) and CT (find malignancies); maybe ECHO
Tx of hemoptysis
ABCs first
Supportive measures
Protect the non-bleeding lung if unilateral
Consider arteriographic embolization (actually block off bronchial aa. to resolve)
Surgical therapy
Once temporized, consider the underlying cause
Common presentation of pneumothorax
acute onset of right sided chest pain accompanied by shortness of breath
Stable vital signs
Distended neck veins
Decreased intensity of breath sounds on right
No peripheral edema
Tx of tension pneumothorax
Insert large needle b/w 2 and 3 ribs.
Will hear hiss from lung.
Pt is supine, so air will rise to top of chest.
Put in chest tube after this.
Difference b/w tension pneumothorax and just a pneumothorax?
Tension has distended veins, will have mediastinum push over on CXR.
Cause of pneumothorax
Young tall male smokers have risk, not sure why. Sometimes some blebs at top of lung which can rupture and release air.
Other pts: don’t know
Presentation of pleural effusion
SOB, pleuritic or non chest pain, referred shoulder pain, cough
What do you do with a pleural effusion?
Sample the fluid and compare to normal (low-protein (<15 g/l) filtrate containing relatively few cells)
Physical exam for pleural effusion
Might not detect small vols Dullness to percussion Absent tactile fremitus Absent breath sounds Bronchial breath sounds and egophony at the upper margin of the fluid collection
Investigations for effusion
PA and lat CXR can detect effusions >100-150 ml in volume
U/S Able to detect as little as 5-50 ml of fluid
CT is the ultimate to find small effusions, and gives extra information
Thoracocentesis: type of fluid
Thoracocentesis.
Can diagnosis type of fluid and/or relieve symptoms
Complications: pain, pneumo-/hemothorax, reexpansion
Is it transudate or exudate ?
Exudate if any of the following:
pleural fluid to serum (P:S) protein >.5
P:S Lactate Dehydrogenase (LD) > .6
LD > 200 IU/L
Causes of transudate?
CHF, Cirrhosis/Ascites, Nephrotic syndrome, PE, others
Causes of Exudate?
Usually pneumonia
-uncomplicated: no cells in fluid
-complicated: cells, more solid, lower pH
-empyema: pus
Others: infection, cancer, PE, GI, drugs, trauma, lupus, RA, etc.
Tx transudate and exudate
Transudate: diuresis. Draining is not helpful really.
Exudate: drain fluid.
If recurrent, try pleurodesis (obliterate the space)
Common Cold/Rhinitis
rhinovirus, RSV etc. Mostly Viruses -NO ANTIBIOTICS -Vapor, Vit C maybe? -Zn and Honey seem a little helpful -Symptomatic: —decongestant: oxymetazoline, phylephrine, Antihistamines —Analgesics: Ibu, ASA, NSAIDS
Pharyngitis
Group A Strep (others maybe C diphtheria, N gonnorhea)
- sudden, fever, tonsilitis/exudate, headache, nausea
- give amoxicillin for 10 days
Sinusitis
S pneumoniae, H influezae, other bacteria
- After a cold (but rare)
- face hurts, discharge, fever
- give amoxicillin, 2nd line doxycycline
- but many people resolve within 2 weeks w/o meds…
Bronchitis/Laryngitis
Viruses
give ß2 agonist if wheezing
