Pulm Flashcards
dypsnea hypoxia hypercapnia wheezing cyanosis
these are all common problems found where?
ED
SUBJECTIVE FEELING OF DIFFICULT, LABORED OR UNCOMFORTABLE BREATHING?
dyspnea
6Ps of dyspnea?
possible FB Pulmonary bronchial constriction PE Pneumo pneumonia pump failure
MCC of dyspnea?
asthma/copd CHF ischemic Heart disease penumonia psychogenci
most immediately life threatening causes of dyspnea?
upper airway obstruction
tension penumo
PE, guillian barre, myastenia gravis
the goal for dyspnea is to what?
maintain PaO2 above 60mm Hg or O2 sat above 90% (goals may be lower in pts with COPD or chronic lung dx)
inadequate delivery of O2 to the tissues?
hypoxia
hypoxia is defined as PaO2 below what?
60 mm Hg `
dx of hypoxia:
clinical suspicion or what 2 other things?
ABG or pulse ox
PaCO2 above 45 mmHg and is exclusively due to alveolar hypoventiliation?
hypercapnia
chronic hypercapnia s/s?
tolerated large variations as seen in COPD
severe hypercapnia:above what PACO2? and s/s?
80mm Hg
coma, encephalopathy, seizures
dx of hypercapnia?
pulse ox
causes of hypercapnia?:
there is a shit ton
kyphoscolisis, morbid obesity
upper airway obstruction
depressed central respiratory drive: CNS dx (brainstem tumor), durgs (opioids, sedatives, anesthetics), tetnaus
MG/GB
botulism, organophosphate poisoning
intrinsic lung dx associated w/ increased dead space like COPD
tx of hypercapnia besides tx of underlying cause?
ABC!!!!!!!!!
O2 and ventiliation
musical, high pitches, adventitious lung sounds produced by the airflow through the central and lower airways?
wheezing
wheezing may result from what?
increased secretions
smooth muscle constrictions
muscular hypertrophy
peri bronchial inflammation
not all wheezing is what?
asthma
pts with severe airflow obstructions may actually have no wheezing but decreased what?
breath sounds
dx of wheezing?
PE (ausculation)
tx of wheezing?
UNDERLYING CAUSE
peripheral cyanosis:
poor perfusion in extremities
central cyanosis:
low PaO2 or abnormal hemoglobins
causes of peripheral cyanosis:
reduced CO
cold extremeites
misdistribution of blood flow
arterial/venous obstruction
causes of central cyanosis?
hypoxemia (high altitude, hypoventiliation, ventiliation perfusion mismatch, right to left shunt, av fistulas, intrapulmonary shunts)
hemoglobin abnormalities: (metheglobinemia, sulfhemoglobinemia, carboxyhemoglinemia)
tx of cyanosis:
TX UNDERLYING CAUSE
supplemental O2, get that sat above 90%
infx of the conducting airways of the lungs?
acute bronchitis
acute bronchitis is mainly causes by what?
viruses
cough lasting more than 5 days, sputum/purulent, afebrile, wheezing
acute bronchitis
work up for acute broncitis:
vitals and pulse ox
CXR to rule out pneumonia
NO FUCKING CULTURES
TX of acute bronchitis:
symptomatics/supportive (SABA/cough suppressants)
its viral so let it go away on its own
infection of the alveolar portion of the lung?
pneumonia
1 pathogen of pneumonia?
s penumo (kids under 5 is viral)
MC pathogen of atypical (walking) pneumonia?
mycoplasma
who is at risk for apritation pneumonia?
alcholics, hx of seizures, CVA, neuromuscular dx, intubated pts
big “chill” pneumonia is likely what?
strep pneumo
fever, cough, dyspnea, pleuritic chest pain, sputum production are s/s of what?
pneumonia
lobar pneumonia s/s:
consilidation, bronchial breath sounds, egophony, increased tactile/vocal fremitus, dullness to percussion
bronchopenumonia s/s:
rales/rhonchi without consilidation, pleural effusion, empyema!!!
interstitial pneumonia: s/s
rales, rhonchi, normal breath sounds
tests for pneumonia:
cxr initial
ct is best
cbc, electrolytes/cmp, abg/vbg, blood cultures
hospitalized over 48 hours within prior 90 days, those getting outpt dialysis, chemo, wound care or home IV AB therapy, residents in nursing/rehab
all criteria for what?
HAP
lung abscess:
pus in the lung
empyema:
pus in pleural space (seen in bronchopenumonia)
main cause of TB?
mycobacterium tuberculosis
slow growing aerobic rod with acid fast properties
myhcobacterium tuberculosis
MC place for TB?
high O2 or blood flow like the apical/posterior segments of the upper lobes
how is TB spread?
droplets
latent and actibe TB will both have a positive skin test?
yes!!
extrapulmonary TB: develops in 20% of cases, MC in who?
presentation?
children, immunocompromised
lymphadenitis with painless enlargement
miliary TB:
multisystem dx causes by what?
massive hematogenous dissemination
where is miliary tb mc?
young/immunocompromised
gold standard TB work up?
sputum
when would we admit a TB pt?
instability, hypoxia, dyspnea, unrelaibale pt, suspected or known MDR TB
ISOLATE PTS
