Module 2- Respiratory Flashcards
Cough
most common symptom for which patients seek attention, adversely affects person and work interaction, sleep and causes discomfort
Cough Symptoms
Acute-less than 3 weeks,
persistent- 3-8 weeks
Chronic- >8 weeks
Post-infection cough lasting 3-8 weeks also called a subacute cough
Acute Cough
due to VRI- fever, nasal congestion and sore throat help dx
Dyspnea- more serious disease,
Prominent natural cough= Asthma
persistent with phlegm= CPOD
posttussive emesis/inspiratory whoop= pertussis
Persistent and chronic Cough
Pertussis should be considered in adults/teens with severe cough more than 3 weeks
ACE inhibitors
Asthma, GERD, postnasal drip,
dyspnea not likely
Excessive mucous with chronic cough = COPD
Dry eyes with chronic cough= Sjogren Syndrome
Chronic dry may be idiopathic pulmonary fibrosis
Physical Exam for Cough
Vital sign abn? (fever, tachy, tachypnea- PNA)
airspace consolidation? (crackles, decreased, - CPNA)
Purulent Sputum- Bacterial infections in structural lung disease
Wheezing/Rhonchi- bronchitis
Chronic cough- COPD vs HF vs sinusitis
Treatment for acute cough
Target underlying issue
Flu- oseltamivir/sanamivir
Mycoplasma/Chlamydophlia-erythomycin/zithromax
bronchitis w/ wheezing- inhaled agonist therapy
Persistent and Chronic Cough tx
evaluation and management require multiple visits and trials
Pertusis- Macrolide abx early, tx does not help the cough if tx pass 7-10 of onset
Empiric therapy for nasal drip, asthma, GERD
When empiric fails- consider other causes
When to refer with cough
Failure to control cough following empiric tx trials
recurrent symptoms
When to admit with cough
High risk TB with noncompliance with precautions
Urgent bronch due to foreign body
smoke/toxic inhalational injury
gas exchange impaired by cough
high risk for barotrauma- pneumothorax
Community-acquired pneumonia- CAP Risk Factors
advanced age, alcoholism, tobacco, comorbid medical conditions (asthma/COPD), immunosuppression
CAP definition
Occurs when a defect in pulmonary defense system- cough reflex, mycocilary clearance system, immune response- or when a large infectious incoculum or a virulent pathogen overwhelms immune response
INFECTED Parenchyma
CAP Pathogenesis
30-60% of cases fail to identify cause
Bacterial: S. Pneumoniae, H. Flu, M Pneumoniae, C, pneumoniae, S aureus, Klebsiella, Legionella
Viruses- Corona, Flu, adenovirus, parainfluenza, respiratory syncytial
Signs and Symptoms of CAP
Acute/subacute fever, cough w or w/out sputum, dyspnea, Chest pain, Headache, fatigue,
Common physical findings: hypothermia, tachypnea, tachy, desaturation, crackles, bronchial breath sounds, dullness to percussion, AMS- esp with elderly
Diagnostic testing- CAP
Typically not required for ambulatory patients, empirical treatment almost always works
Xray is Gold standard
Lab work- WBC
leukocytosis
COVID/FLU
Sputum gram stain
Urinary antigen test s. pneumonia and legionella species
Treatment of Viral CAP
start within 48 hours of illness
*oesltamtivir 75mg x5 days
*Baloxavir 40-79 kg 40 mg x1 and >80kg 80mg x1
*IV Peramivir 600mg x1
*Zanamivir 10mg 2 inh BID x5 days- (don’t use with asthma=bronchospasm)
Outpatient management of Bacterial CAP
Healthy with no risk factors for MRSA/pseudomonas
*amoxicillin- 1g TID
*doxy 100mg BID x 5 days
*Macrolidies- Zithromax- 500mg x1 day then 250mg/x4 days
Clarthromycin 500mg BID x 5 days
Cormorbid medical conditions
*Macrolide or doxy plus oral beta-lactam
*mono-therapy with fluoroquinolone
*Moxifloxacin 400mg/d, Gemifloxacin 320mg/day, levofaxacin 750mg/d
Indications of Hospitalization for CAP
Severe illness- Resp compromised
inability to take oral fluids
poor compliance with medications
Substance abuse
cognitive impairment- Always
poor living situation or social support
inadequate finical resources
Prevention of CAP
Vaccine- Pneumovax 23 & Prevanr-13
Flu vaccine
Covid Vaccine
Anaerobic Pneumonia
history of aspiration, poor dentition, foul smelling purulent sputum, infiltrate in dependent lung zone- body position at time of aspiration determine zones of lungs,
Anaerobic PNA Path
Prevotella melanginigenica, peptostreptococcus, fusobacterium, neucleatum, and Bacteroids
Clinical signs of Anaerobic PNA
Constitutional symptoms and cough with expectoration of foul smelling sputum.
Dentition is poor
Imaging- lung abscess & necrotizing pneumonia & empyema
Anaerobic PNA- Treatment
Betalactam/lactamase inhibitor combined with carbapenem or clindamycin. Second line is penicillin and metronidazole and typically for 3 weeks
Thoracic surgery referral for large/non-resolving abscesses
Pulmonary Venous Thromboembolism
VTE- referred to as PE
can be caused by air, amniotic fluid, fat, foreign bodies, parasite eggs, septic emboli, tumor cells,
most common from venous system in the deep veins of lower extremities
Sign & Symptoms of VTE
depend on size and preexisting cardiopulmonary status,
dyspnea and pain (pleuritic chest pain), hemoptysis, syncope, tachy, tachypnea, hypoxia