1. PaO2/FiO2<200 (<300 means acute lung injury). 2. Bilateral alveolar infiltrates on CXR

EM - Pulm Flashcards by Kienan W

when is it considered bronchiolitis?

under 2 years old

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MCC of bronchiolitis

RSV (Respiratory Syncytial Virus, idk)

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s/s of bronchiolitis

-increased RR
-retractions
-grunting
-cough
-expiratory wheeze

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diagnosis of bronchiolitis

mainly clinical

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treatment of bronchiolitis

-nasal suction
-hydration
Also, Ribavirin

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discharge criteria for bronchiolitis

-RR <60
-clear airway
-adequate oral intake

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MCC of acute bronchitis

viral

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s/s of bronchitis

-cough
-wheezing
-SOB
-dyspnea
-fatigue
-rhonchi that clears with cough

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diagnosis of bronchitis

clinical

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treatment of bronchitis

reassurance and symptomatic

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etiology of epiglottitis

Hib

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s/s of epiglottitis

-dysphagia
-drooling
-tripod position
-fever
-stridor
-odynophagia

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diagnosis of epiglottitis

visualization of erythematous epiglottis

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managment of epiglottitis

-maintain airway
-vanc + rocephin

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etiologies of ARDS

-sepsis
-aspiration pneumonia

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pathophys of ARDS

excess fluid leading to…
-impaired gas exchange
-decreased compliance
-increased pulmonary arterial pressure

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diagnosis of ARDS

PaO2/FiO2<200 (<300 means acute lung injury).
Bilateral alveolar infiltrates on CXR

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s/s of ARDS

-SOB
-tachypnea
-crackles
-retractions

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treatment of ARDS

-treat underlying cause
-supp oxygen
-PEEP

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s/s of asthma

-cough
-chest tightness
-SOB
-difficulty breathing
-wheezing

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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

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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

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treatment of asthma

SABA + ICS

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treatment of status asthmaticus

intubation, IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen

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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