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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?

23
Q

Disposition for OSA?

24
Q

Treatment for OSA?

A

Sleep study
Weight loss
Mechanical devices

25
What is pleuritis?
Infection of the pleural membrane
26
What are the hallmarks for pleuritis?
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
Labs/rads for Pleuritis?
CXR to rule out causes like pnuemothorax or pleural effusions
28
Treatment for pleuritis?
Treat symptoms Nsaids Morphine if severe
29
Complications of pleuritis?
Can lead to; Hypoxia CO2 buildup End Organ damage
30
Disposition for pleuritis?
MEDEVAC IF..... | Unstable (hypoxia) or pain uncontrolled
31
Likely causes of pleuritis?
Young adults - viral illness or pneumonia Trauma to chest wall
32
Hallmarks of Pulmonary Edema?
Severe dyspnea that worsens at rest * Cyanosis * Pink frothy sputum Adventitious lung sounds (crackles, rhonchi, wheeze) Shitty O2 sats
33
Labs/Rads for Pulmonary Edema?
``` CBC UA EKG Ultrasound CXR ```
34
What may the chest xray see for pulmonary edema?
Cardiomegaly Intersitial edema Alveolar edema
35
Causes of Pulmonary edema?
``` MI Heart failure A-fib Volume overload in Left ventricle Increased salts ```
36
Treatment for Severe Pulmonary Edema?
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
Non-cardiac related causes for Pulmonary Edema?
* High altitude * Meds * Shock * Sepsis
38
Disposition for pulmonary edema?
Medevac
39
What causes Pulmonary embolism?
An embolism that lodges itself in the pulmonary circulation. Thrombi are the most common
40
Hallmarks of Pulmonary Embolism?
Mhx of venous thromboses specially in lower extremities ACUTE chest pain and dyspnea * Hemoptysis * Low fever * Pleural rub Virchow's triad
41
What triad is associated as hallmarks for deep vein thromboses diseases and Pulmonary edema?
Virchow's Triad * Venous stasis * Injury to vessel wall * Hypercoagulability
42
What can cause hypercoaguability?
WOMEN: Birth control Contraceptives Hormones * Genes
43
How can you differentiate between pulmonary embolism and pulmonary edema?
Pulmonary Embolism: * Won't hear crackles, rhonchi, wheezing * Will hear friction rub possibly * Virchows Triad/ DVT signs
44
What in the condition of pulmonary embolism allows air to enter the pulmonary venous system?
Low pulmonary venous pressure: * Hypovolemia Increased Airway pressure: * Positive pressure ventilation * Tension pneumo
45
Where do most clots come from with regards to pulmonary emboli?
Femoral or Pelvic venous beds
46
What percentage of patients will develop a Pulmonary embolism with proximal DVT?
50-60%
47
What % of patients with symptomatic PE actually have lower DVT?
50-70%
48
What can causes to injury of a vessel wall?
Prior thrombosis Surgery Trauma
49
Can IDCs make a definitive diagnosis of Pulmonary embolism?
Nope
50
What is the standard for diagnosis radiology regarding Pulmonary embolism?
angiography
51
What will a CXR show for pulmonary embolism?
Actelectasis Infiltrates Effusions
52
Treatment for Pulmonary embolism?
O2 Lovenox Thrombolytic therapy * R heart dysfunction * Hemodynamic compromise * Cardiogenic shock
53
Disposition of pulmonary embolism?
MEDEVAC

MDT's (14 decks)

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