DOB + Flashcards
question
answer
pulmonary etiologies of DOB
COPD asthma restrictive lung disorder hereditary lung disorder pneumonia pneumo-thorax
cardiac etiologies of DOB
CHF Coronary artery disease (CAD) MI cardiomyopathy valvular dysfunction left ventricular hypertrophy pericarditis arrythmias
mixed cardiac/pulmonary etiology of DOB
chronic pulmonary emboli
pleural effusion
deconditioning
COPD with HTN and/or cor pulmonale
noncardiac or nonpulmonary etiology of DOB
metabolic disorders pain trauma neuromuscular disorders functional cheminal exposure
< 20 yo
asthma
COPD
asthma
worse during night or early morning
asthma
COPD
asthma
lung function normal between symptoms
asthma
COPD
asthma
variable airflow limitation
asthma
COPD
asthma
CXR normal
asthma
COPD
asthma
> 40 yo
asthma
COPD
COPD
daily symptoms and exertional dyspnea
asthma
COPD
COPD
persistent airflow limitation
asthma
COPD
COPD
lung function abnormal between symptoms
asthma
COPD
COPD
CXR shows severe hyperinflation
asthma
COPD
COPD
possible clinical features of severe asthma
tachypnea tachycardia silent chest cyanosis accesssory muscle use altered consciouness
Why use PEF for asthma dx
more convinient and cheaper than FEV1
What SpO2 level do you seek to maintain withoxygen therapy
92% O2
When is ABG necessary for DOB?
patients with SpO2 <92% or features of life threatening asthma
Management of asthma accronym
ASTHMA
Adrenergics (beta 2 agonists - Albuterol) Streoids Theophylline Hydration (IV) Mask O2 Anticholinergics
digital clubbing + DOB
COPD
pursing of lips + DOB
COPD
COPD airflow obstruction level
FEV1/FVC ratio <0.7 post-bronchodilator
What is performed to diagnose COPD
spirometry, post-bronchodilator
COPD spirometry is performed (pre/post) bronchodilator
post bronchodilator
COPD exacerbations mangement
O2 bronchodilators (SABA with or without short-acting anticholinergics) systemic corticosteroids (40 mg prednisone per day for 5 days)
Type 1 pneumonias (2)
lobar and bronchopneumonia
Type 2 pneumonia (2)
CAP and HAP
patch consolidation usually in bases of both lungs
what type of pneumonia?
bronchopneumonia
What is the point criteria for treatment of penumonia? Acryonym and scoring
CURB 65
Confusion Uremia Respiratory Rate >30 Blood pressure low 65 yo or greater
Uses structure for classification
ACCF/AHA stages of HF
NYHA functional
ACCF/AHA stages of HF
Cardiogenic shock. Hypotension, peripheral vasoconstriction
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage IV
Severe HF. Frank pulmonary edema with rales
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage III
HF. Rales, S3 gallop and pulmonary venous hypertention
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage II
Acute HF management
SpO2 95-98%
patent airway and FiO2 can be increased
diuretics (secondary to fluid retension)
MC cause of dyspnea in AHF
pulmonary edema
In AHF, morphine induced the following
venodilation
mild aterial dilation
redude HR
In AHF, what is a potential adverse effect?
increasing need for inasive ventilation
reduce LV-preload and after-load wo imparing tissue perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
nitrates
hypertensive HF or MR, severe HR with predominantly increased after-load
nitrates
sodium nitroprusside
nesiritide
inotropes
sodium nitroprusside
reduce preload and after-load, increase CO wo direct inotropic effects
nitrates
sodium nitroprusside
nesiritide
inotropes
nesiritide
Pts with severely reduced cardic output compromised vital organ perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
inotropes
When are vasopressors indicated?
combination inotropic agent and fluid challenge fails to restore adequate arterial pressure and organ perfusion
HVS causes (increase/decrease) pCO2 which leads to (metabolic/respiratory) (alkalosis/acidosis)
HVS causes DECREASE pCO2 which leads to RESPIRATORY alkalosis
common ddx for HVS
acute coronary syndrome
pulmonary embolism
CO2 poisoning
HVS has (abnormal/normal) pH with (high/low) PaCO2 and a (high/low) bicarbonate level
HVS has NORMAL pH with LOW PaCO2 and a LOW bicarbonate level
Pharmaco therapies for HVS
benzodiazepines
lorazepam (ativan)
diazepam (valium)
paroxetine (paxil)
define tachypnea
A respiratory rate greater than
normal.
Normal rates range from 44 cycles/min
in a newborn to 14 to 18 cycles/min in adults
normal RR for newborn
44 cycles/min
normal RR for adult
14 to 18 cycles/min
central control
- medulla
oblongata - chemoreceptors
- medulla
oblongata
peripheral control
- medulla
oblongata - chemoreceptors
- chemoreceptors
where are the chemoreceptors that control breathing peripherally
located near the carotid bodies, and
mechanoreceptors in the diaphragm and skeletal muscles
what causes the perception of dyspnea
imbalance in either central or peripheral control of breathing
differential diagnoses for acute dyspnea
- pulmonary
- cardiac
- abdominal
- psychogenic
- metabolic or endocrine
- infectious
- traumatic
- hematalogic
- neuromuscular
acute dyspnea associated with normal or increased respiratory effort
- abdominal
- psychogenic
- metabolic or endocrine
- infectious
- traumatic
- hematalogic
neuromuscular etiology is primarily associated with (increased/decreased) respiratory effort
neuromuscular etiology is primarily associated with DECREASED respiratory effort
most common causes of dyspnea in ER (5)
- obstructive airway disease (asthma, COPD)
- decompensated heart failure
- ischemic heart disease
- pneumonia
- psychogenic
most immediately life-threatening causes of dyspnea in ER (5)
- upper airway obstruction
- tension pneumothorax
- pulmonary embolism
- neuromuscular weakness
- fat embolism
