Pulmonary Flashcards
pimp question for pulmonary embolism
S1Q3T3
virchow triad
hemostasis
hypercoagulable state
endothelial injury
PERC Criteria
over age 50 HR > 100 SaO2 < 95% unilateral leg swelling hemoptysis recent surgery or trauma history of DVT or PE hormone use
WELLS criteria
clinical S & Sx of DVT PE is likely diagnosis HR > 100 immobilization (3 days or surgery in 4 wks) prior PE or DVT hemoptysis malignancy
what lab value will be grossly high in PE?
D-Dimer
two diagnostic tests for PE
CTPA
V/Q scan
Treatment for PE or DVT
systemic anticoagulation
fibrinolysis
subjective perception or experience of uncomfortable breathing
dyspnea
abnormal collection of blooed between parietal and visceral pleura → usually 5-10 L of serous fluid is normal
pleural effusion
Values for Exudative Pleural Effusion:
Pleural fluid protein: serum
pleural fluid LDH: serum LDH
Pleural fluid LDH ____ of UNL serum LDH
PF fluid:serum protein → > 0.5
PF:serum LDH → > 0.6
PF LDH > 2/3 UNL of serum LDH
Exudative pleural effusions are associated with
infection, malignancy, inflammation
Transudate pleural effusions are associated with
CHF, cirrhosis/ascites, nephrotic syndrome
Definitive diagnosis and treatment for pleural effusion
Thoracentesis → cell sount, protein, LDH, glucose
with thoracentesis, you should only withdrawal
1.5 L
when would you consider thoracentesis for pleural effusion?
if in destress → defer if in no distress
infected pleural effusion
empyema
what is required with empyema if purulent or a Gram (+) organism?
chest tube
What empyema cases can be discharged?
known cause/recurrent accumulations
when would get get blood cultures on patient with pneumonia?
admitting to hospital or ICU
organisms that cause CAP
S. pneumoniae, H. influenza, M. catarrhalis
organisms that cause HAP
S. aureus, MRSA, K. pneumonia, P. aeruginosa, E. coli
Atypicals that cause pneumonia
Legionella, M. pneumoniae, chlamydia
Outpatient treatment for CAP
azithromycin
levofloxacin
doxycycline
Inpatient treatment for CAP
IV levofloxacin
macrolide + B lactam
Treatment for HCAP
antipseudomonal cephalosporin +
antipseudomonal FQ or AG +
linezolid or vancomycin (MRSA coverage)
IV therapy/wound care/IV chemo within 30 days
live in nursing home or long term care facility
hospitalized > 2 days within last 90 days
been to hospital or dialysis clinic in last 30 days
HCAP criteria
CURB 65 score
determine inpatient vs outpatient treatment confusion BUN > 19 RR > 30 BP < 90/<60 Age > 65
Other scoring system to determine pneumonia severity
PORT score
no clinically aparent lung disease → spontaneously free air enters the potential space between visceral and parietal pleura
primary pneumothorax
Two causes of primary pneumothorax
spontaneous
penetration/trauma
risk factors for primary pneumothorax
smoker, male, MVP, Marfan, atmospheric pressure changes
Pneumothorax that occur in patients with underlying lung disease
secondary pneumothorax
pressure in the chest cavity increases → great vessels and heart are compressed and you see contralateral shift
tension pneumothorax
Findings of tension pneumothorax
hypoxia and shock
tracheal deviation, hyperresonance, hypotension, dyspnea
classic finding of pneumothorax
tachycardia
classic finding in traumatic pneumothorax
decreased breath sounds
what to look for in US of suspected pneumothorax?
lung sliding
Initial test for pneumothorax
upright PA CXR
Highly sensitive for pneumothorax
CT
Treatment for tension pneumothorax
chest tube ASAP
How often do you repeat CXR for pneumothorax?
If you see improvement onf CXR and you discharge your patient when should you follow up on them?
at 4 hours
recheck in 24 horus
treatment for large, recurrent hemothorax or bilater pneumothorax
tube thoracostomy
Where do you go in for needle decompression of tension pneumothorax?
2nd/3rd ICS midclavicular
4th/5h ICS anterior axillary line
dypnea, wheezing, cough + prolonged expiration + accessory muscle use
asthma
hyperresonance + decreased breath sounds + silent chest + tachycardia + wheezing + prolong expiration
asthma
What do you use to trend an asthmatics response to therapy?
PFTs
Standard ED therapy for asthma
inhaled B2 agonist → Albuterol
ipratropium bromide
oxygenation
relieve inflammation → corticosteroids
side effects of albuterol
tremor, nervousness, anxiety, palpitations, tachycardia
severe asthma attack that doesn’t respond to standard therapy
status asthmaticus
hypoxia + tachycardia + tachypnea + accessory muscles +/- wheezing
status asthmaticus
Treatment status asthamticus
Magnesium NIPPV Ketamine (only for Status Asthmaticus) Epinephrine mechanical ventilation (lets patient rest)
When can you DC an asthmatic patient?
FEV1 > 70%
when do you admit asthmatic patient?
persistent symptoms + FEV1 or PEF <40% predicted
what do you give asthmatic patient being discharged with FEV1 or PEF <70%
prednisone (5-10 day)
dexamethasone (2 day)
single dose methylprednisolone
