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CCFP-EM > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Differential for Wheeze

A

Pulm:
- Asthma
- COPDe
- Pneumonia
- Allergic or eosinophilic pneumonia
- Neoplasm
- Foreign Body

Upper Airway:
- Croup
- Laryngeal edema / neoplasm

Cardiac:
- CHF
- Valvular heart dusease

Other:
- GERD
- ARDS

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2
Q

Risk Factors for Asthma Death

A

Hx:
- Prev intubation / ICU
- Two hospitalizations in 1 year
- 3 ED visits in 1 year
- Use of more than 2 MDI cannisters/ mth
- Difficulty perceiving exacerbation

Social:
- Low SES
- inner city
- illicit drug use

Comorbidities:
- CV disease
- Other lung disease

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3
Q

Objective findings of severe Asthma

A

Pulse > 120
Pulsus paradoxus > 10
RR > 20
Accessory muscle use
PaO2 < 60 or PaCO2 > 40

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4
Q

Therapies for acute severe asthma

A

O2 > 90%, >95% in preggers and CV disease
Beta Agonists
Inhaled anti-cholinergic
Steroids
Epinephrine
MgSO4
Fluids
Ketamine
Heliox
Leukotriene receptor antagonists

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5
Q

Ventilation Strategy for severe asthma

A

BiPAP if fails then:
ETT
Low respiratory rate
High I:E ratio 1:4 - 1:5
Volume control 6-8 cc/kg
Minute ventilation 115/kg/min = ~7 L/min average adult (500 cc at 14 breaths)
- Turn off peak pressure
Paralysis
Low PEEP
FiO2 100% and titrate down

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6
Q

FEV1 for asthma guidelines

A

> 70%, can go home
40-70%, possibly go home, otherwise can admit
<40%, ICU

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7
Q

GOLD Criteria for COPDe

A

Change in baseline cough, dyspnea, sputum

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8
Q

Gold Classification

A

FEV1/FVC < 70%
and
Mild: FEV1 > 80%
Moderate: FEV1 50-80%
Severe: 30-50%
Very Severe: < 30%

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9
Q

Factors / Triggers of decompensation in COPD

A
  • Viral
  • Bacterial: H. Flu, Strep Pneumo, Moroxella, Pseudomonas
    Atypical: Chlamydia, Legionella
  • Air pollution
  • Other critical events: pneumothorax, PE, CHF, pneumonia, obesity, trauma, NM disease, non-compliance
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10
Q

COPDe mimics

A

Pneumonia
CHF
Asthma exacerbation
PE
Pneumothorax
Pleural effusion
Dysrhythmias

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11
Q

Clinical Features for AECOPD

A

Cough +/- purulence
Increased WOB or air hunger

Wheeze
altered LOC, irritable (hypercapnea +/- asterixis)
RHF with JVD and peripheral edema

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12
Q

ED Management of AECOPD

A

Severe:
O2 88-92%
Bag-valve or BiPAP or ETT
in-line beta-agonist and anticholinergic
IV corticosteroid
IV antibiotics

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13
Q

Inidications and Contraindications for PPV in AECOPD

A

Indications:
- Moderate to severe Dyspneas
- RR > 25
- Acidosis

Exclusion:
- Somnolence / Agitated
- Vomiting
- CV instability
- Respiratory Arrest
- Upper airway obstruction
- Craniofacial trauma
- Mask won’t fit.

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14
Q

ECG Findings of COPD

A

P pulmonale, peaked P in II, III and aVF
low voltage
Poor R-wave progression
Tachydysrhythmias: A.fib, MAT

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15
Q

Causes of URTI

A

Viral:
EBV, Adenovirus, Coronavirus, cocksackie, HIV, HMNV, Influenza, VZV
Bacterial:
GAS, H. Flu, gonorrhea, non group A strep, mycoplasma, n. meningiditis
Non-infectious: Kawasaki, SJS, thyroiditis
Trauma

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16
Q

When to given steroids in pharyngitis

A

Severe symptoms with inability to swallow, airway obstruction, PTA, post-tonsillectomy, EBV

17
Q

Causes of epiglottitis

A

H influenza B
Strep
Staph
Viruses
Burns

18
Q

Mgmt of epiglottitis

A

Consider intubation in acute onset < 6 hrs
IV abx: Ceftriaxone, Septra
Steroids
Racemic epi
Analgesia
Humidified O2
Observation

19
Q

Deep spaces of the neck and associated infection

A

Submandibular Space: Ludwig’s Angina
Parapharyngeal Space: Carotid / Jugular and CN. : Lemierre’s syndrome
Retropharyngeal Space: RPA
Danger space - posterior to retropharyngeal: Base of skull to diaphragm
The prevertebral Space.

20
Q

Mgmt and predisposition for rhinosinusitis

A

RF:
- Smoking, immune compromise, structure abnormality, polyps, tumors, trauma, overuse of decongestants. barotrauma, cocaine, instrumentation

Therapy: Flushes, local decongestants (no more than 5 days), 2nd gen antihistamines, Antibiotics if febrile or not getting better, high dose amox - 90 mg/kg = 1 g TID for 7-10 days. Septra or azithro 3 days + decongestants

21
Q

5 Suppurative and Non-suppurative complications of GABHS.

A

Supp:
Bacteremia
PTA
Otitis Media
Necrotizing fasciitis
Meningitis
Lemeirre’s

Non-supp:
Rheumatic fever
PANDAS (neuropsych)
PSGN
Scarlet fever
Strep toxic shock

22
Q

Lateral neck XR of epiglottitis

A

Obliteration of vallecula
Swelling fo arytendoids
Edema of prevertebral soft tissues
Edematous epiglottitis (thumb) - > 8 mm bad

23
Q

Pneumonia associative pathogens

A

EtOH: strep pneumo, anaerobes, gram negatives (klebsiella), Tb
COPD: Strep pneumo, H flu, moroxella
Nursing home: S. Pneumo, gram negatives, H flu, Staph Aureus, chlamydia
Poor Dental: Anaerobes
Bat: Histoplasma
Bird: Histoplamsa, Cryptococcus, Chlamydophilia
Farm animals and Cats: Coxiella burnetti (Q fever)
Sicke / Asplena: S pneumo, H flu
Rabbit: Tularemia (also in terrorism)

24
Q

Abx for Pneumonia based on disposition

A

Admit:
CAP - non-immune compromise: Ceftriaxone + Azithro
Severe ICU: Ceftriaxone _+ azithro + vanco
HCAP or bronchiectasis: Cefipine 2g + Cipro + vanco
PCP: Septra

24
Q

Pneumonias presenting with cavitary lesions

A

TB
Staph Aureus
Anaerobes
Aerobic gram negatives
Fungal disease

25
Q

DDx for pneumonia on CXR

A

Silicosis
Toxic Fumes
Radiations
Immunologic disease
Hypersensitivity pneumonitis

25
Q

Analysis of pleural effusions

A

Blood
Chyle
Transudative fluid (increased pressure or decreased oncotic pressure)
Exudate (parapneumonic effusion, empyema, subphrenic abscess)

25
Q

Light’s Criteria

A

Pleural:Serum protein > 0.5
Pleural: Serum LDH > 0.6
Pleural LDH > 0.66 ULN

26
Q

CURB65

A

Confusion
Urea > 20
RR > 30
BP < 90 /60
65 age

27
Q

Risk Factors for spontaneous PTX

A

Tall
Male
Smoker
Changes in air pressure
Marfan
FMHx

28
Q

8 Causes of secondary PTX

A

Airway Disease:
- COPD
- Asthma
- Cystic Fibrosis
Infections:
- Necrotizing bacterial
- PJP
- TB
ILD
Neoplasms
Connective tissue disease
Pulmonary infarction
Endometriosis - catamenial

29
Q

Signs of Tension Pneumo

A

Tachy > 120
Hypotensive
Hypoxia
Deviation of trachea away from PTX
JVD

30
Q

PTX size estimate on CXR

A

> 2 cm at level of HILUM ~ 50% collapse = LARGE

31
Q

Mgmt of primary and secondary PTX

A

Small: Conservative
Large: > 20%, can aspirate and reassess after 6 hrs for reaccumulation
- Pigtail if persistent
Cutoff of 3cm from apex.

32
Q

10 Causes of pleural effusion

A

Infection
CHF
PE
Malignancy / Neoplasm
Cirrhosis
Nephrotic Syndrome
Connective Tissue Disease
Abdo (Pancreatitis, esophageal rupture)

33
Q
A

CCFP-EM (20 decks)

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