Inservice Deck 3 - respiratory

Question 1

30 year old female with history of multiple PEs goes into PEA. What tx is indicated?

Answer 1

thrombolytics

PE with CV collapse

Question 2

what are indications to give thrombolytics for a PE?

Answer 2

hypotension, syncope with hemodynamic compromise, hypoxemic or depleted cardiopulmonary reserves. Consider with right heart strain on EKG, or RV dysfunction on ECHO, as this may progress to hemodynamic compromise. Tx is not related to size of PE on CT

Question 3

next step in management or diagnosis in patient with right sided stab wound who has 2 chest tubes placed, yet has continued ptx and large air leak?

Answer 3

tracheobronchial injury

• diagnose with bronchoscopy

Question 4

exacerbation of asthma tx differ in pregnancy?

Answer 4

NO! Tx - steroids, albuterol, anticholinergics

Question 5

In a COPD patient with respiratory distress, nonpalpable pulses, and decreased breath sounds on 1 side, what immediate therapy is needed?

Answer 5

needle decompression/tube thoracostomy

Question 6

patient with long term pulmonary HTN develops signs/sx of CHF. What is the cause?

Answer 6

cor pulmonale

leading to right sided heart failure

Question 7

near drowning victim is found pulseless, apneic. What should the initial treatment be, heimlich, CPR etc? how should airway be opened?

Answer 7

jaw thrust maneuver, start CPR

Question 8

what is the most favorable narcotic for pain in severe asthmatic?

Answer 8

fentanyl - less histamine release than morphine/dilaudid

ketamine also bronchodilator

Question 9

patient has cocaine use and develops sudden onset of pain, but has stable vitals; what is tx plan? CXR shows pneumomediastinum

Answer 9

observe

• most resolve spontaneously, can have palpable crepitus on exam

Question 10

patient presents wqith difficulty breathing and is found to have a primary simple PTX of approx 20%. Tx and disposition/

Answer 10

100% O2, watch for 6 hours, repeat CXR

Question 11

most common cause of hemoptysis in adults?

Answer 11

bronchitis

Question 12

what is the definition of massive hemoptysis?

Answer 12

600 ml in 24 hours, or an amount that interferes with respirations

Question 13

patient presents with left lung tumor presents with hemoptysis and difficulty breathing. How do you position patient and what should one do next?

Answer 13

left affected side down

call pulmonology for bronch

give oxygen, suction

Question 14

previously healthy 30 year old with no comorbidities presents with pneumonia and CXR shows lung abscess. What is most likely etiology?

Answer 14

staph aureus

Question 15

18 year old healthy male presents with flu like symptoms, myalgias, and cough. CXR shows diffuse interstitial infiltrate. what is most likely etiology and tx?

Answer 15

mycoplasma

cxr looks worse than the pt

tx - doxy or macrolides

Question 16

d-dimer is most useful for its specificity?

Answer 16

false - high sensitivity in low risk pts helps rule out low risk patients

Question 17

what should be done next for a patient with non-cardiogenic pulmonary edema in significant respiratory distress, but alert and tolerating secretions?

Answer 17

CPAP/BIPAP

Question 18

HIV + patient with CD4 > 200 has sx consistent with PNA, with single lobar infiltrate on xray. Etiology?

Answer 18

strep pneumo

Question 19

intubate pt with asthma exacerbation becomes more difficult to ventilate. CXR shows no PTX. What is occurring and what should be done next?

Answer 19

Auto-PEEP. Decrease vent frequency, decrease I:E ratio

Question 20

alcoholic with currant jelly sputum has?

Answer 20

klebsiella PNA

Question 21

next step in patient with peanut aspiration with intermittent stridor and negative CXR?

Answer 21

bronchoscopy

Question 22

50 year old otherwise healthy male presents to the ED in august with PNA and abd pain. Most likely cause?

Answer 22

legionnaires disease

associated with hyponatremia, bradycardia, hepatomegaly