EM - Pulm Flashcards
when is it considered bronchiolitis?
under 2 years old
MCC of bronchiolitis
RSV (Respiratory Syncytial Virus, idk)
s/s of bronchiolitis
-increased RR
-retractions
-grunting
-cough
-expiratory wheeze
diagnosis of bronchiolitis
mainly clinical
treatment of bronchiolitis
-nasal suction
-hydration
Also, Ribavirin
discharge criteria for bronchiolitis
-RR <60
-clear airway
-adequate oral intake
MCC of acute bronchitis
viral
s/s of bronchitis
-cough
-wheezing
-SOB
-dyspnea
-fatigue
-rhonchi that clears with cough
diagnosis of bronchitis
clinical
treatment of bronchitis
reassurance and symptomatic
etiology of epiglottitis
Hib
s/s of epiglottitis
-dysphagia
-drooling
-tripod position
-fever
-stridor
-odynophagia
diagnosis of epiglottitis
visualization of erythematous epiglottis
managment of epiglottitis
-maintain airway
-vanc + rocephin
etiologies of ARDS
-sepsis
-aspiration pneumonia
pathophys of ARDS
excess fluid leading to…
-impaired gas exchange
-decreased compliance
-increased pulmonary arterial pressure
diagnosis of ARDS
- PaO2/FiO2<200 (<300 means acute lung injury).
- Bilateral alveolar infiltrates on CXR
s/s of ARDS
-SOB
-tachypnea
-crackles
-retractions
treatment of ARDS
-treat underlying cause
-supp oxygen
-PEEP
s/s of asthma
-cough
-chest tightness
-SOB
-difficulty breathing
-wheezing
diagnosis of asthma
-in children: 85% or lower FEV1/FVC and >12% improvement after bronchodilator
-in adults: 70% or lower FEV1/FVC and 12% improvement and >200mL
classification of asthma
-Mild Intermittant:
Symptoms < 2 times/week, exacerbations brief
-Mild Persistent:
Symptoms > 2 times/week; not every day - exacerbations may produce minor limitation to activities; Use of rescue inhaler > 2days/week, but not daily
-Moderate Persistent:
Daily symptoms and use of inhalers, exacerbations may last for days and produce some limitations to activities
-Severe Persistent:
continual symptoms - frequent exacerbations; Extremely limited activity tolerance
treatment of asthma
SABA + ICS
treatment of status asthmaticus
intubation, IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen
etiology of croup
Parainfluenza
clinical findings for croup
-barking cough
-inspiratory stridor
-prodromal URI sx
imaging of croup
steeple sign
management of croup
-mild: decadron (dexamethasone)
-moderate-severe: decadron, epi, supportive care
s/s of airway foreign body
-sudden coughing
-gagging, stridor, cyanosis
diagnosis of airway foreign body
-xray initially
-bronchoscopy definitive
management of airway foreign body
-BLS
-laryngoscopy
s/s of influenza
-fever
-HA
-fatigue
-body aches
-sore throat
-URI sx
diagnosis of influenza
NP swab
management of influenza
-supportive care
-tamiflu within 48 hours of sx
s/s of pertussis
-catarrhal: URI sx for 1-2 weeks
-paroxysmal stage: whoop like cough
-convalescent stage: chronic cough
diagnosis of pertussis
-clinical diagnosis
-confirmed with culture of nasal secretions
treatment of pertussis
Azithromycin
transudate vs exudate
-transudate: fluid that passes through a membrane which filters out all the cells and much protein which yields a watery solution
-exudate: fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation
etiology of transudates
-heart failure
-cirrhosis
-PE
etiology of exudates
-pneumonia
-cancer
s/s of pleural effusion
-dyspnea
-cough
-pleuritic cp
-diminished breath sounds
-dull to percussion
-sx of underlying cause
treatment of pleural effusion
-if small and likely benign: observe
-if large or atypical: thoracentesis followed by tube thoracostomy
-if recurrent: pleurodesis
how to determine if the fluid is transudative vs exudative
if one or more is present, its exudative
-pleural protein/serum protein >0.5
-pleural LDH/serum LDH >0.6
-pleural LDH> 148
etiology of primary spontaneous pneumothorax
tall, thin males who smoke
etiology of secondary pneumothorax
pre-existing pulmonary disease
MCC of tension pneumothorax
cardiopulmonary resuscitation
s/s of pneumothorax
-pleuritis CP
-tachypnea
-SOB
-diminished breath sounds
-decreased tactile fremitus
s/s of tension pneumothorax
-severe resp compromise
-tracheal deviation
-displacement of PMI
diagnosis of pneumothorax
chest x-ray
treatment of primary spontaneous pneumothorax
-small: supplemental oxygen and observe
-large: aspiration followed by chest tube
treatment of secondary pneumothorax
chest tube
treatment of tension pneumothorax
needle decompression
MCC of PE
DVT
risk factors for PE
virchows triad (stasis, injury, hypercoagulability)
s/s of PE
-dyspnea
-pleuritic CP
-cough
-hemoptysis
-tachypnea
diagnosis of PE
-wells criteria and PERC rules
-if low risk and no PERC: no testing
-if low risk and 1 PERC or intermediate risk: D-Dimer
-if high risk: CTA
-gold standard: pulmonary angiography
if CTA for PE has a CI …(Like preggo)
VQ scan
treatment of PE
-oxygen
-ventilatory support
-anticoagulation
which anticoagulant to use for PE
-unstable: UFH
-stable and cannot take oral: LMWH
-stable and can take oral: DOAC
5mm positives for TB skin test
-HIV
-recent contact with TB
-CXR findings that suggest TB
-organ transplant
-immunosuppressed
10mm positives for TB skin test
-people who have come from endemic areas
-drug users
-mycobacteriology lab workers
-people who live or work in high risk congregate settings
-certain medical conditions
-children under 5
-infants or children exposed to adults in high risk categories
15mm positives for TB skin test
no risk factors
s/s of tuberculosis
-fever
-chills
-night sweats
-weight loss
-cough
-hemoptysis
-chest pain
-fatigue
diagnosis of TB
sputum culture
treatment of latent TB
Isoniazid for 9 months
Treatment of active TB
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
