PULM 2 Flashcards
Patient comes to ED with an Asthma attack…you give them oxygen, dunebs and PO Steroids…
- What is the SpO2 goal for pregnant vs non pregnant?
Pregnant (SpO2 > 95%)
Non-Pregnant (SpO2 >90%)
Patient comes into the ED with an Asthma attack…You give them oxygen, duonebs and PO Steroids…
You continue to monitor them in the ED…
In what situation would you send them home and with what treatment?
Send home if:
- No O2 requirement
- No wheezing
- Peak Exp flow rate (PEFR) > 70%
TRX:
- Albuterol PRN
- PO steroids course
- Consider adding Inhaled Corticosteroids if not already on it based on history.
Patient comes into the ED with an Asthma attack…You give them oxygen, duonebs and PO Steroids…
You continue to monitor them in the ED…
In what situation would you admit to the medical floor?
Admit to floor if:
- Mild improvement (Cont O2 need + wheezing)
- Peak Exp Flow Rate 40-60% of baseline
TRX:
- O2
- Duonebs
- IV Steroids –> sent home on PO Steroids
- Consider Mg Sulfate or Terbutaline (IF SEVERE)
Patient comes into the ED with an Asthma attack…You give them oxygen, duonebs and PO Steroids…
You continue to monitor them in the ED…
In what situation would you admit to ICU?
What “severe symptoms” indicate a need for intubation?
Admit to ICU if:
- Severe symptoms
- PCO2 >42 on ABG
- PERF < 40%
Severe symptoms: Should prompt Intubation
- Accessor muscle use
- Cyanosis
- Diaphoretic
- Exhausted
- Marked tachypnea
- PaCO2 > 42
What is Allergic Bronchopulmonary Aspergillosis?
What two groups typically get ABPA?
What is the characteristic presentation?
DX?
TRX?
Exacerbated IgE and EgG mediated immune response to Aspergillus fungus in lungs.
Seen mostly in Asthmatics and Cystic Fibrosis.
Presents with:
- Fleeting infiltrated, fever + cough
- Recurrent asthma exacerbations
- Bronchiectasis
- EOSINOPHILIA
DX: + skin test for Aspergillosis, +ve IgG/IgE for Aspergillosis, EOSINOPHILIA > 500, + clinical picture.
TRX: Steroids + Voriconazole (or Itraconazole)
A patient presents with cardiac arrest…you start CPR, attach defib/monitor, and give O2….
How does management differ between:
- PEA/Asytole
- Vfib/Pulseless VT?
PEA/Asystole:
- CPR
- Epi Q 3-5 min
- check pulse Q 2 min –> no shock.
Vfib/Pulseless VT:
- First shock.
- CPR
- Epi Q3-5 min
- Check pulse q2 min –> SHOCK if no pulse.
Asbestosis can occur years (as much as 20 years) after exposure to Asbestos…
What are the 3 classic imaging findings?
Imaging:
- Pleural plaques
- Pleural thickening
- Basilar interstitial “ground glass” opacities.
Individuals with Asbestosis presents with what S/S?
What cancer are they at increased risk of?
TRX?
- Progressive dyspnea
- Basilar crackles
MESOTHELIOMA (among other lung CA)
TRX: Supportive, no good trx.
- Stop further damage to lungs from smoking.
- Pneumovax
You get a CXR and find a SOLITARY PULMONARY NODULE…
What is your first step in management?
Step 1 - See if there is a PRIOR XRAY. IF stable for 2-3 years –> NO further testing needed.
You get a CXR and find a SOLITARY PULMONARY NODULE and there is no prior XR to see if the lesion has changed over 2-3 years.
What is the next step in management?
What is the management of benign appearing lesion, intermediate suspicion, and highly suspicious lesion?
Chest CT:
Benign appearing–> follow up with serial CT
Intermediate suspicion –> PET or BX
Highly suspicious –> Surgical removal.
What are the 2 imaging findings of a solitary pulmonary nodule that are suggestive of a benign lesion, and therefore would only require serial CTs going forward to ensure no change…
What are the 3 patient characteristics that suggests low malignancy risk?
< 0.8 cm
Smooth margin
Non- smoker or quit > 15 years ago
no Lymphadenopathy
< 40 yo
(if these are present, then just follow up a solitary pulmonary nodule with serial CT)
What are the 2 imaging findings of a solitary pulmonary lesions that are suggest intermediate risk of malignancy, thereby requiring further testing with PET or BX?
What are the 2 patient characteristics that suggest intermediate risk of malignancy?
0.8-2.0 cm
Scalloped edges
Active smoker
40-60 yo
What are the 3 imaging findings of a solitary pulmonary lesion that are suggestive of HIGH malignancy risk, thereby necessitating surgical removal?
What are the 2 patient characteristics that suggest HIGH malignancy risk?
> 2 cm
Irregular magin
No calcification or irregular calcification (eccentric, stippled)
Active smoker
> 60 yo
What are the components of Modified Wells score for PE?
3 points for:
- Clinical signs of DVT
- PE is # 1 on differential
- 5 points for:
- Prior DVT/PE
- HR> 100
- Recent surgery or immobilization
1 point for:
- Hemoptysis
- Cancer
How does one use the WELLS SCORE to manage PE?
IF Wells > 4 points –> High likelihood of PE:
- Anti-coagulate immediately
- CT angiogram asap
IF Wells < 4 points –> unlikely PE
- D-dimer –> if > 500 get CT angiogram
