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Emergency > Pulmonary emergencies > Flashcards

Pulmonary emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Signs and symptoms of anaphylaxis

A 
Sx w/in 30 minutes of re-exposure
Urticaria
Laryngeal edema
epiglottal edema
hypotension
seizures
dyspnea
Angioedema
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2
Q

Management of anaphylaxis

A 
Maintain airway
Pulse ox and cardiac monitor
Epinephrine sub q or IV
albuterol inhaler or nebulizer for bronchospasm
Fluids for hypotension
Antihistamines, corticosteroids
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3
Q

Angioedema:
MC cause
Patho:
Tx:

A

MC: ACE inhibitors
Accumulation of bradykinin leading to vasodilation, hypotension, angioedema
Tx: Airway, epineph, antihistamines, steroids

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4
Q

Definition of pnuemothorax?

A

abnormal collection of air in the pleural space

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5
Q

Spontaneous pneumothoraces occur most commonly in who?

A

Tall thin men in their 20-30’s

  • Smokers 20x more likely to develop a spontaneous pneumothorax
  • Recurrence is common, 20-50% of people suffering from a repeat pneumo.
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6
Q

Most common physiologic cause of spontaneous pneumo?

A

Subpleural bleb resulting in free communication of air to the pleura space.

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7
Q

Signs of suspected pneumothorax?

Signs of progression to tension pneumo?

A

S: tachypnea, tachycardia, decreased breath sounds on affected side

Tension pneumo: hypotension, tracheal deviation, elevated JVD

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8
Q

Treatment of pneumothoraces?

A

<15% involvement of hemithorax: conservative treatment.

Large pneumos or with comorbidities: needle or tube thoracostomies.

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9
Q

Virchow’s triad

A

Venous stasis
Vessel injury
Hypercoagulable states

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10
Q

Common signs and symptoms of DVT

A 
Pain in extremity
Tenderness in extremity
Discoloration of erythema in ext
Palpable venous chord
Homans sign
Unilateral swelling
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11
Q

Treatments for DVT

A

LMW heparin
Oral factor Xa: rivaroxaban, apixaban
Unfractionated heparin

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12
Q

Definition of PE

A

Occlusion of pulmonary arteries by the embolization of thrombi, air, fat, or other particulate mater.
MC: DVT 95%

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13
Q

Most common ECG changes for PE

A

Sinus tachycardia and nonspecific ST-T wave changes
Right sided heart strain:
- S wave lead 1, Q wave lead 3, T wave inversion lead 3.
- Right axis deviation
- New right bundle branch block
- T wave inversions in V1-V4

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14
Q

Treatment of PE?
Steps for stabilization…
plus treatement

A 
ABCs first
IV access
O2
Cardiac monitoring
CXR
IV fluids and pressors if indicated.
Thrombolytic therapy
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15
Q

Definition of asthma

A

Disease of the lower airways characterized by acute exacerbations.

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16
Q

Epidemiology of asthma

A

4-5% of the population

- Highest among african-american males

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17
Q

Pathogenesis of asthma

A

Chronic airway inflammation, heightened bronchial reactivity and mucus production

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18
Q

Symptoms of asthma

A

tachycardia, tachypnea, may be hypoxic

  • wheezing and prolonged expiratory phase
  • may appear over inflatted
  • Pulsus paradoxus: SBP <10mmHg during inspiration
19
Q

Diagnostic eval for asthma

A

Peak expiratory flow rates

20
Q

Treatment of asthma

A

Reducing bronchorestriction and inflammation

  • supplimental O2
  • Beta2 agonist via neb or MDI
  • aero antiChol (ipatropium bromide)
  • prednisone 40-60mg
21
Q

Definition of COPD

A

2 conditions:
Emphysema: dilation of air space destruction distal to the terminal bronchiol
Chronic bronchitis: excess mucus production and productive cough for at least 3 months a year for min of 2 years.

22
Q

Pathogenesis of emphysema?

A

Reduction in elastic recoil of the lung parechyma resulting in physiologic dead space.
- The airway colapses during expiration

23
Q

pathogenesis of chronic bronchitits?

A

Hypertropy of the mucus producing glands of the lung. Plus airway inflammation and hypertrophy of the airway smooth muscle.

24
Q

Classic history of acute exacerbations of COPD

A

Varying degrees of respiratory distress

  • history of progressive dyspnea
  • increased sputum production
  • decreased exercise tolerance
  • fever and change in sputum herald superimposed pneumonia.
25
Q

Treatment for acute COPD ex?

- include supporting and monitoring measures.

A
  • Supplemental O2
  • Beta2 agonist (careful with CAD pt.)
  • ipratropium bromide (antichol)
  • prednisone oral 60-80mg or IV methylprednisolone 60-120mg
  • Empiric antibiotic therapy for strep pneumo, H. flu, Moraxella c.
26
Q

Definition of pneumonia

A

Infection of the lungs by bacteria, virus, or fungus.

27
Q

Mortality percentages of PNA?

A

6th leading cause of death in the US

- most common infectious cause of death in US

28
Q

Pneumonia typical bacteria? CAP

A 
Strep. pneumoniae, 
Haemophilus influenzae
Staphlococcus aureus
Group A strep
Moraxella catarrhalis
29
Q

Atypical pneumonia bacteria? CAP

A

Legionella pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae

30
Q

Viral causes of pneumonia?

A 
Influenza A and B
RSV: respiratory synctial virus
Adenovirus
Parainfluenza
Cytomeglovirus
Herpes simplex virus
Varicella virus
Hantavirus
31
Q

Classic symptoms of pneumonia

A 
Fever
Chills
Cough
Sputum production
Dyspnea
Pleuritic chest pain
32
Q

Signs of pneumonia

A

Tachycardia
Tachypneic
Febrile

33
Q

Physical exam findings with PNA

A

Tactile fremitus (vibratory tremors felt on palpation)
Dullness to percussion
Egophony (e to a changes)
Rales (crackling sounds in the area of consolidation.

34
Q

Diagnostic eval of PNA

A

CXR: consolidations or infiltrates in lobar pattern
CBC: elevated WBC with left shift (predominance of segmented neutrophils and bands)

35
Q

Treatment of PNA, CAP

A

If limited resistance: macrolide
High resistances: Doxycycline
Other options: respiratory floroquinolone (levofloxacin, moxifloxacin)
Amoxicillin-clavulantate

36
Q

Tuberculosis basics

A

Bacteria: Mycobacterium tuberculosis
Most common cause of infectious disease death world wide.
Lung are primary site of infection: 80%

37
Q

What is scrofula?

A

A disease of glandular swellings, probably a form of tuberculosis

38
Q

When is greater than 5mm of induration positive for TB test?

A
  • HIV pos, or HIV risk factors
  • Recent close contact with active TB
  • Person with chest xray consistent with healed TB
39
Q

When is greater than 10mm of induration positive for TB test?

A
  • persons born in country with high TB rates
  • IV drug user
  • Low income population
  • Nursing home resident
  • Children under age of 4
  • Person with medical condition which puts them at increased risk
40
Q

When is greater than 15mm of induration positive for TB test?

A

In all other cases

This is for people considered low risk

41
Q

Primary symptoms of TB?

Symptoms of postprimary TB?

A

Mild fever
Malaise

Post: Fever, chills, night sweats, weight loss, dyspnea, fatigue, cough, hemopptysis.

42
Q

Physical exam findings of TB?

A

Fever, rarely hypoxia
Lungs: rales or signs of extrapulmonary effusion, cavitation suggested by amphora (hollow sound on ausculation similar to the sound made by blowing across the mouth of a bottle)

43
Q

What are classical radiographic findings for TB?

A

Hilar adenopathy: MC
Apical pleural scarring
cavitary lesions

Emergency (14 decks)

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