Pulmonary Flashcards
Viral URI - Tx
- Nasal steroids: Proven benefit w/ allergic rhinitis
- Decongestants ONLY if Eustachian tube dysfunction
- Macrolide ABX have no effect on URI s/s
- Zinc: inhibits rhinovirus replication
Acute Bacterial Rhinosinusitis
- Persistent s/s of ARS >10d with NO improvement
- Onset with severe Sx (temp >102 and purulent nasal discharge or facial pain) lasting 3+ days
- Onset with worsening symptoms following a viral URI that lasted 5+ days and was initially improving
Who to refer to ENT?
1) Multiple recurrent episodes of ABRS (3+/year)
2) Chronic rhinosinusitis (w/ or w/o polyps or asthma) with recurrent exacerbations
3) Patients with allergic rhinitis who may be candidates for immunotherapy
Acute Bronchitis
- Cough generally persists 2-3wk; airway hyperreactivity may last 5-6wk
- Only “need” ABX if pertussis
- CXR after wk of coughing
- NSAIDs and ipratropium inhaled
- No ASA if suspecting influenza
- Evidence equivocal re/OTC cough meds and codeine
ABX in Bronchitis
- reductions in cough in 0.6d
- Azithromycin no better than low-dose Vc
Antibiotic abuse
- 25% of pt’s have self-treated URI with “Left-over” ABX from previous illness
- ABX therapy causes long-term resistance in gut flora
Pneumonia: Facts
- Disease of lung parenchyma
- Caused by mmicroaspiration of oropharyngeal contents
- Follow-up CXR in patients >40yr
- Healthcare-associated PNA: If hospitalized w/in 3mo; Cover pseudomonas and/or MRSA
- CXR may be negative in dehydrated patient
- Review CURB-65
Pneumovax
- > 65yr
- 2-64 w/chronic illnesses, smoking, and asplenia
- 1x @ 65yr
Pulmonary Embolus
- 30% mortality
- Massive: die within 1-2hr (cardiogenic shock)
- Submassive: saddle, no hypotension, 5% mortality
- Come in multiples
- Common complication of DVT (>50%)
PE: Assessment
- PESI Score (+1 for each):
- > 80 yo
- Hx of Ca
- Chronic cardiopulmonary Dz
- HR >110
- SBP >100
- SaO2 <90%
- 0=low risk; 1+=high risk
PE: Treatment
- No significant differences in outcome when treated out- vs. inpatient
- Low risk = class I or II
- Treat with Lovenox 1mg/kg SC BID and warfarin 5mg q pm
- Check INR in 3-4d (Goal 2-3)
- Also BLE duplex ultrasound
Pneumothorax
- Nasal O2
- Observe for 6hr and repeat CXR
- Assess for hypotension (tension pneumo)
- ED for pneumocath or chest tube if clinically unstable or size >2-3cm or >30%
- Smoking cessation
- No flying for 2wk
Mechanisms of Asthma
- Airway smooth muscle constriction
- Airway edema from inflammatory cells
- Mucous hypersecretion
- Airway hyper-responsiveness - an exaggerated bronchoconstrictor response to stimuli
See Charts
on Slides
4 Essentials of Asthma Care (EPR-3)
1) Assessment and monitoring asthma severity and asthma control
2) Education for a partnership in care
3) Control of factors contributing to asthma severity
4) pharmacologic treatment
Asthma: Assessment & Monitoring
- For periodic monitoring of asthma control to guide decisions for maintaining or adjusting therapy:
- Patients should monitor control in ongoing manner and be taught how to recognize inadequate control
- Either symptoms or peak flows; benefits similar
- Daily peak flows for moderate or severe persistent asthma, or Hx of severe exacerbations or poor perception of airway obstruction or worsening asthma
Asthma: Assessing the level of control
- Asthma better or worse since last visit
- Has your asthma awakened you in night or early morning?
- Have you needed or used more albuterol than usual?
- Have you had any urgent medical care recently?
- Are you able to do activities without cough, chest tightness, or SOB?
- What is your peak flow, personal best, vs. predictive?
- Access to meds daycare/school/work?
