final Flashcards
What are symptoms of a Pulmonary embolism?
• Chest pain
• Tachycardia
• Often have an area that is red, hot and swollen
o From DVT
If a patient is experiencing tachycardia, hypoxia and has no lung history and has normal breath sounds what should I think the issue is?
• Think circulatory
What are risk factors for DVT’s and PE’s?
- Sedentary job
- Been sedentary for an extended time like long road trip
- Vessel wall injury- from trauma, surgery or central venous catheters
- Hypercoagulability from malignancy or birth control
What are hemodynamic effects of a PE?
- Obstructs blood flow to the lungs
- Can cause acute pulmonary hypertension
- Big embolism can cause systemic hypotension
How does a PE cause Hypoxemia?
- Bronchoconstriction and atelectasis
- More blood is forced to go to less healthy area of the lungs
- Increase in dead space ventilation. There is airflow but there isn’t perfusion to bring the O2 throughout the body
What is the best way to diagnose a PE?
• Chest CT angiogram
How can a D-dimer test be used to help diagnose (or exclude) a PE?
- A negative d-dimer test combined with a low clinical suspecison of a PE rules out a PE
- A positive d-dimer is non-specific- can be a PE or DVT and required more testing
In general terms, How do we treat a PE?
- Stable patient- anticoagulants (blood thinner)
* Unstable patient- thrombolytic followed by anticoagulants
What are SCD’s and what do they do?
- Sequential compression devices
* They wrap around the patients legs and help prevent a DVT from forming
What are the 5 classes of Pulmonary Hypertension (WHO)
- Pulmonary arterial hypertension
a. Direct damage to small arteries - Pulmonary hypertension due to left heart disease
a. Left ventricular failure (heart doesn’t squeeze well)
b. Heart valve disease - Pulmonary hypertension due to lung disease and/or hypoxemia (chronic lung dz)
a. Via destruction of pulmonary vasculature
i. COPD or fibrosis
b. Via hypoxemic pulmonary artery vasoconstriction
i. Sleep apnea
ii. Severe lung dz - Chronic thromboembolic pulmonary hypertension
- Pulmonary hypertension from rare causes
What are symptoms of Pulmonary hypertension?
- The #1 symptom is slow progressive dyspnea
* Fatigue, chest pain
How do we diagnose pulmonary hypertension?
• Echocardiogram
What is an invasive way we can monitor pressures in the arteries?
• PA catheter
How do we treat pulmonary hypertension?
- IV and oral meds to relax (vasodilate) pulmonary arteries
- Inhaled vasodilators
- Chronic O2 therapy
- Surgical removal of old PE
- Treatment of underlying left heart dz, lung dz or sleep apnea
What is Asthma?
- Reactive airway dz
- Clinical syndrome of airway obstruction, inflammation and hyper-responsiveness
- EPISODIC wheezing, SOB, chest tightness and/or cough
What causes asthma?
- Mast cells in the aireways releasing histamine
* Smooth muscle constriction and vascular congestion and leakage
What are some asthma triggers?
- Allergens
- Respiratory infection
- Stress
How is asthma diagnosed?
• PFT may be normal or show obstruction
• Must be reversible. Shown by:
o Increase in FEV1 or FVC by 12% AND 200ml following a bronchodilator
o 15% or more variation in PEFR
What would a CXR in an asthma patient look like?
- Usually normal
* Sometimes will see hyperinflation or atelectasis
What is a controller medication?
- A medication that lessens the impact of daily symptoms but does not treat acute symptoms
- Decreases severity and frequency of symptoms
What is a mast cell?
- A mast cell is a cell that contains histamine
* When a mast cell becomes degranulated(explodes) it releases the histamine into the body
What is a mast cell stabilizer?
• A medication that helps stabilize mast cells so they do not degranulate and cause asthma symptoms
What are leukotriene inhibitors?
- They block the hyperactive response
* Singular
What is the MOA of Omalizumab?
• Binds to the free IgE antibodies to prevent them from binding to mast cells which then release histamine
What is Bronchial Thermoplasty?
• Heat is applied to the bronchial walls to impair smooth muscle contractility
How can you tell the difference between a pleural effusion and a pneumothorax on a CXR?
- A pleural effusion is water in the pleural space. It will be white with a meniscus sign
- A pneumo will be black
What happens in the lungs when some one has a pleural effusion?
- Some of the fluid pushes up causing collapse of the adjacent lung
- 2/3 of the fluid pushes down on the diaphragm and out on the chest wall causing an increased WOB
What are symptoms of Pleural Effusions?
- Dyspnea
- Pain
- Cough
What are signs of a pleural effusion?
- Dull percussion
- Diminished or absent breath sounds
- Extrapulmonary findings—CHF, joint dz
How do we treat a pleural effusion?
• Thoracentesis or chest tubes
What is the difference between an exudative and transudative effusion?
• Exudative- inflammatory
o CHF- anything that may upset the pleural lining
o cancer
• Transudative- non-inflammatory
What is VATS and why is it use?
- Video-assisted thoracoscopy
* Used to directly visualize inside the pleural space
What is pleurodesis?
- When the parietal and visceral pleurae is fused together
* Most often used for large recurrent effusions from cancer
What is compression atelectasis?
- Mediastinum shifts away from the involved side
* effusion
What is resorption (obstruction) atelectasis?
- Mediastinum/heart shifts toward the involved side
- Gas distal (away from center) to obstruction of airway is resorbed—distal lung collapses
- Mucus plug, cancer, foreign body
What is a pneumothorax?
• Air in the pleural space
What is a spontaneous pneumothorax?
- Primary- in otherwise healthy individuals
* Secondary- underlying lung dz
What is a traumatic pneumothorax?
• Blunt or penetrating trauma—stabbed or surgery error
What are symptoms of a pneumothorax?
- Pleuritic chest pain
* Dyspnea
What are exam findings of someone with a pneumothorax?
- Hyperresonance to percussion. (air makes it sound like drum)
- Decreased breath sounds
- Tracheal deviation
- Hemodynamic instability if it’s a tension pneumo
What is subcutaneous emphysema?
• Air that is trapped under the skin
Why do people get pneumonia?
• Micro aspiration of bacterias or virus
What is the difference between a typical and atypical pneumonia?
- Common (typical) has a normal CXR for pneumonia
* Atypical has a atypical CXR
What bacteria causes a common pneumonia?
- Streptococcus
* Hemophilus influenza
What bacteria cause an atypical pneumonia?
- Legionella
* Mycoplasma
What are two fungi that cause pneumonia in our area?
- Histoplasmosis
* Blastomycosis
What are common complications of pneumonia?
- Pleural effusion on the same side
- Abscess
- ARDS
What is an abscess?
- Cavity that fills with pus or fluid
* Happens if the pneumonia wasn’t treated properly or at all
What is the difference between pneumonia and bronchitis?
• Bronchitis is in the upper airways so it will not been seen in a CXR
What antigens can be detected in urine?
- Legionella
- Histoplasma
- Blastomyces
- Pneumococcal
What antigens can be detected in a nasal swab?
- Influenza
* RSV
What are some ways to get a lower respiratory sample
- Expectoration
- ETT suctioning
- Bronchoalveolar lavage
What are some ways to prevent pneumonias?
- Flu vaccine
- Pneumococcal vaccine
- Avoid sick
- Wash your hands
What else could suspected pneumonia be if we see the CXR?
- Lung CA
* ARDS
What do we give someone with a bacterial pneumonia?
• Antibiotics and supportive care
What are 5 common viruses?
- Influenza
- Parainfluenza
- RSV
- Adenovirus
- Corona virus
What is acute bronchitis?
• Cough with sputum productions
o No pneumonia on CXR
o Usually no hypoxemia, tachypnea (High RR)
• Can have chest pain and wheezing
• Does not typically respond to bronchodilators because it is in the upper airway
What are some clues in diagnosing viral pneumonia?
• Absent sputum production
• Sore throat, rhinitis, myalgias (muscle aches)
A bacterial infection will last longer than the 10-14 days that a viral infection lasts
