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Emergency Medicine > Pulmonary > Flashcards

Pulmonary Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

pimp question for pulmonary embolism

A

S1Q3T3

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2
Q

virchow triad

A

hemostasis
hypercoagulable state
endothelial injury

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3
Q

PERC Criteria

A 
over age 50 
HR > 100 
SaO2 < 95% 
unilateral leg swelling 
hemoptysis 
recent surgery or trauma 
history of DVT or PE 
hormone use
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4
Q

WELLS criteria

A 
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
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5
Q

what lab value will be grossly high in PE?

A

D-Dimer

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6
Q

two diagnostic tests for PE

A

CTPA

V/Q scan

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7
Q

Treatment for PE or DVT

A

systemic anticoagulation

fibrinolysis

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8
Q

subjective perception or experience of uncomfortable breathing

A

dyspnea

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9
Q

abnormal collection of blooed between parietal and visceral pleura → usually 5-10 L of serous fluid is normal

A

pleural effusion

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10
Q

Values for Exudative Pleural Effusion:
Pleural fluid protein: serum
pleural fluid LDH: serum LDH
Pleural fluid LDH ____ of UNL serum LDH

A

PF fluid:serum protein → > 0.5
PF:serum LDH → > 0.6
PF LDH > 2/3 UNL of serum LDH

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11
Q

Exudative pleural effusions are associated with

A

infection, malignancy, inflammation

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12
Q

Transudate pleural effusions are associated with

A

CHF, cirrhosis/ascites, nephrotic syndrome

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13
Q

Definitive diagnosis and treatment for pleural effusion

A

Thoracentesis → cell sount, protein, LDH, glucose

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14
Q

with thoracentesis, you should only withdrawal

A

1.5 L

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15
Q

when would you consider thoracentesis for pleural effusion?

A

if in destress → defer if in no distress

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16
Q

infected pleural effusion

A

empyema

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17
Q

what is required with empyema if purulent or a Gram (+) organism?

A

chest tube

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18
Q

What empyema cases can be discharged?

A

known cause/recurrent accumulations

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19
Q

when would get get blood cultures on patient with pneumonia?

A

admitting to hospital or ICU

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20
Q

organisms that cause CAP

A

S. pneumoniae, H. influenza, M. catarrhalis

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21
Q

organisms that cause HAP

A

S. aureus, MRSA, K. pneumonia, P. aeruginosa, E. coli

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22
Q

Atypicals that cause pneumonia

A

Legionella, M. pneumoniae, chlamydia

23
Q

Outpatient treatment for CAP

A

azithromycin
levofloxacin
doxycycline

24
Q

Inpatient treatment for CAP

A

IV levofloxacin

macrolide + B lactam

25
Q

Treatment for HCAP

A

antipseudomonal cephalosporin +
antipseudomonal FQ or AG +
linezolid or vancomycin (MRSA coverage)

26
Q

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

A

HCAP criteria

27
Q

CURB 65 score

A 
determine inpatient vs outpatient treatment 
confusion 
BUN > 19 
RR > 30 
BP < 90/<60
Age > 65
28
Q

Other scoring system to determine pneumonia severity

A

PORT score

29
Q

no clinically aparent lung disease → spontaneously free air enters the potential space between visceral and parietal pleura

A

primary pneumothorax

30
Q

Two causes of primary pneumothorax

A

spontaneous

penetration/trauma

31
Q

risk factors for primary pneumothorax

A

smoker, male, MVP, Marfan, atmospheric pressure changes

32
Q

Pneumothorax that occur in patients with underlying lung disease

A

secondary pneumothorax

33
Q

pressure in the chest cavity increases → great vessels and heart are compressed and you see contralateral shift

A

tension pneumothorax

34
Q

Findings of tension pneumothorax

A

hypoxia and shock

tracheal deviation, hyperresonance, hypotension, dyspnea

35
Q

classic finding of pneumothorax

A

tachycardia

36
Q

classic finding in traumatic pneumothorax

A

decreased breath sounds

37
Q

what to look for in US of suspected pneumothorax?

A

lung sliding

38
Q

Initial test for pneumothorax

A

upright PA CXR

39
Q

Highly sensitive for pneumothorax

A

CT

40
Q

Treatment for tension pneumothorax

A

chest tube ASAP

41
Q

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?

A

at 4 hours

recheck in 24 horus

42
Q

treatment for large, recurrent hemothorax or bilater pneumothorax

A

tube thoracostomy

43
Q

Where do you go in for needle decompression of tension pneumothorax?

A

2nd/3rd ICS midclavicular

4th/5h ICS anterior axillary line

44
Q

dypnea, wheezing, cough + prolonged expiration + accessory muscle use

A

asthma

45
Q

hyperresonance + decreased breath sounds + silent chest + tachycardia + wheezing + prolong expiration

A

asthma

46
Q

What do you use to trend an asthmatics response to therapy?

A

PFTs

47
Q

Standard ED therapy for asthma

A

inhaled B2 agonist → Albuterol
ipratropium bromide
oxygenation
relieve inflammation → corticosteroids

48
Q

side effects of albuterol

A

tremor, nervousness, anxiety, palpitations, tachycardia

49
Q

severe asthma attack that doesn’t respond to standard therapy

A

status asthmaticus

50
Q

hypoxia + tachycardia + tachypnea + accessory muscles +/- wheezing

A

status asthmaticus

51
Q

Treatment status asthamticus

A 
Magnesium 
NIPPV
Ketamine (only for Status Asthmaticus) 
Epinephrine
mechanical ventilation (lets patient rest)
52
Q

When can you DC an asthmatic patient?

A

FEV1 > 70%

53
Q

when do you admit asthmatic patient?

A

persistent symptoms + FEV1 or PEF <40% predicted

54
Q

what do you give asthmatic patient being discharged with FEV1 or PEF <70%

A

prednisone (5-10 day)
dexamethasone (2 day)
single dose methylprednisolone

Emergency Medicine (6 decks)

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