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MDTs Flashcards

1
Q

What is COPD characterized by?

A
  • Issues with airway and alveolar structures limiting airflow
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2
Q

What causes parenchymal destruction?

A

Emphysema

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3
Q

Generalized Hallmarks for all COPD cases?

A
  • Can’t get enough air out
  • Chronic cough
  • Wheezing (airway obstruction)
  • Dyspnea
  • Signs of Resp distress

Barrell chest (very chronic onset)

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4
Q

What defines chronic bronchitis?

A

Productive cough x3 months in each of 2 successive years

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5
Q

What is emphysema?

A

Term to describe the structural changes associated with COPD

** NO FIBROSIS visible**

Enlargement of the airspaces distal to the terminal bronchioles and accompanied by destruction of airspace walls

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6
Q

What is asthma?

A

Chronic inflammatory disorder

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7
Q

What is the gold standard for diagnosis of COPD?

A

Spirometry is the gold standard

lower the value, the worse the obstruction

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8
Q

Tx meds for COPD?

A

SABA’s (albuterol)

Oral corticosteroid
Glucocorticoids

LABA’s

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9
Q

Disposition for COPD?

A

MEDEVAC if signs of instability

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10
Q

Differentials for COPD?

A

Heart failure
Trauma
Embolism

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11
Q

Is COPD reversible?

A

Nope

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12
Q

Is Asthma reversible

A

It can be

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13
Q

Hallmarks of chronic bronchitis?

A

Chronic PRODUCTIVE cough

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14
Q

What structures does chronic bronchitis involve?

A

Bronchioles and mucus buildup

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15
Q

Hallmarks of Emphysema?

A

Distention of lungs

Decreased lung sounds

Decreased heart sounds

Prolonged expiratory phase

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16
Q

Rads/Labs for COPD?

A

CXR may show severe emphysema

Arterial blood gases

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17
Q

Treatments for COPD and Asthma?

A

Short Term:
SABAs
Oral steroids

Maintenance:
Inhaled Steroids
LABAs

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18
Q

Disposition for COPD?

A

Maintain onboard unless unstable or unresponsive to treatment

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19
Q

Hallmarks of Obstructive Sleep Apnea?

A

Daytime somnolence or fatigue

Loud snoring with apneic events

Never feel rested

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20
Q

Obvious risk factors for obstructive sleep apnea?

A

Think of an old white American

  • Obese
  • Smoker
  • Older
  • Male
  • Upper airway issues causing obstruction
  • Sinus congestion
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21
Q

Questions asked to determine sleep study for OSA?

A 
STOPBANG
S - Snore
T - tired / somnolence
O - obstructions/ apneic
P - Pressure high for BP
B - BMI >28
A - Age >50
N - Neck >17"
G - gender (male)
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22
Q

How many questions do you need to answer yes on STOPBANG to be recommended for sleep study regarding OSA?

A

3 or more

23
Q

Disposition for OSA?

A

Maintain

24
Q

Treatment for OSA?

A

Sleep study
Weight loss
Mechanical devices

25
Q

What is pleuritis?

A

Infection of the pleural membrane

26
Q

What are the hallmarks for pleuritis?

A

Sudden onset chest pain that is FLEETING

  • exacerbated by cough, deep breathing, sneezing, and movement
  • Chest pain radiates to ipsilateral shoulder

Friction rub on auscultation

27
Q

Labs/rads for Pleuritis?

A

CXR to rule out causes like pnuemothorax or pleural effusions

28
Q

Treatment for pleuritis?

A

Treat symptoms
Nsaids

Morphine if severe

29
Q

Complications of pleuritis?

A

Can lead to;

Hypoxia
CO2 buildup
End Organ damage

30
Q

Disposition for pleuritis?

A

MEDEVAC IF…..

Unstable (hypoxia) or pain uncontrolled

31
Q

Likely causes of pleuritis?

A

Young adults - viral illness or pneumonia

Trauma to chest wall

32
Q

Hallmarks of Pulmonary Edema?

A

Severe dyspnea that worsens at rest

  • Cyanosis
  • Pink frothy sputum

Adventitious lung sounds (crackles, rhonchi, wheeze)

Shitty O2 sats

33
Q

Labs/Rads for Pulmonary Edema?

A 
CBC
UA
EKG
Ultrasound
CXR
34
Q

What may the chest xray see for pulmonary edema?

A

Cardiomegaly
Intersitial edema
Alveolar edema

35
Q

Causes of Pulmonary edema?

A 
MI
Heart failure
A-fib
Volume overload in Left ventricle
Increased salts
36
Q

Treatment for Severe Pulmonary Edema?

A

Sit with legs dangling (for reduction in venous return)

  • O2
  • ET Tube (if needed)
  • Morphine
  • Diuretics
  • Nitro (reduces BP and LV pressures)
  • Beta Agonists maybe
37
Q

Non-cardiac related causes for Pulmonary Edema?

A
  • High altitude
  • Meds
  • Shock
  • Sepsis
38
Q

Disposition for pulmonary edema?

A

Medevac

39
Q

What causes Pulmonary embolism?

A

An embolism that lodges itself in the pulmonary circulation.

Thrombi are the most common

40
Q

Hallmarks of Pulmonary Embolism?

A

Mhx of venous thromboses specially in lower extremities

ACUTE chest pain and dyspnea

  • Hemoptysis
  • Low fever
  • Pleural rub

Virchow’s triad

41
Q

What triad is associated as hallmarks for deep vein thromboses diseases and Pulmonary edema?

A

Virchow’s Triad

  • Venous stasis
  • Injury to vessel wall
  • Hypercoagulability
42
Q

What can cause hypercoaguability?

A

WOMEN:
Birth control
Contraceptives
Hormones

  • Genes
43
Q

How can you differentiate between pulmonary embolism and pulmonary edema?

A

Pulmonary Embolism:

  • Won’t hear crackles, rhonchi, wheezing
  • Will hear friction rub possibly
  • Virchows Triad/ DVT signs
44
Q

What in the condition of pulmonary embolism allows air to enter the pulmonary venous system?

A

Low pulmonary venous pressure:
* Hypovolemia

Increased Airway pressure:

  • Positive pressure ventilation
  • Tension pneumo
45
Q

Where do most clots come from with regards to pulmonary emboli?

A

Femoral or Pelvic venous beds

46
Q

What percentage of patients will develop a Pulmonary embolism with proximal DVT?

A

50-60%

47
Q

What % of patients with symptomatic PE actually have lower DVT?

A

50-70%

48
Q

What can causes to injury of a vessel wall?

A

Prior thrombosis
Surgery
Trauma

49
Q

Can IDCs make a definitive diagnosis of Pulmonary embolism?

A

Nope

50
Q

What is the standard for diagnosis radiology regarding Pulmonary embolism?

A

angiography

51
Q

What will a CXR show for pulmonary embolism?

A

Actelectasis
Infiltrates
Effusions

52
Q

Treatment for Pulmonary embolism?

A

O2
Lovenox

Thrombolytic therapy

  • R heart dysfunction
  • Hemodynamic compromise
  • Cardiogenic shock
53
Q

Disposition of pulmonary embolism?

A

MEDEVAC

MDT's (14 decks)

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