Pulmonary emergencies Flashcards
Signs and symptoms of anaphylaxis
Sx w/in 30 minutes of re-exposure Urticaria Laryngeal edema epiglottal edema hypotension seizures dyspnea Angioedema
Management of anaphylaxis
Maintain airway Pulse ox and cardiac monitor Epinephrine sub q or IV albuterol inhaler or nebulizer for bronchospasm Fluids for hypotension Antihistamines, corticosteroids
Angioedema:
MC cause
Patho:
Tx:
MC: ACE inhibitors
Accumulation of bradykinin leading to vasodilation, hypotension, angioedema
Tx: Airway, epineph, antihistamines, steroids
Definition of pnuemothorax?
abnormal collection of air in the pleural space
Spontaneous pneumothoraces occur most commonly in who?
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.
Most common physiologic cause of spontaneous pneumo?
Subpleural bleb resulting in free communication of air to the pleura space.
Signs of suspected pneumothorax?
Signs of progression to tension pneumo?
S: tachypnea, tachycardia, decreased breath sounds on affected side
Tension pneumo: hypotension, tracheal deviation, elevated JVD
Treatment of pneumothoraces?
<15% involvement of hemithorax: conservative treatment.
Large pneumos or with comorbidities: needle or tube thoracostomies.
Virchow’s triad
Venous stasis
Vessel injury
Hypercoagulable states
Common signs and symptoms of DVT
Pain in extremity Tenderness in extremity Discoloration of erythema in ext Palpable venous chord Homans sign Unilateral swelling
Treatments for DVT
LMW heparin
Oral factor Xa: rivaroxaban, apixaban
Unfractionated heparin
Definition of PE
Occlusion of pulmonary arteries by the embolization of thrombi, air, fat, or other particulate mater.
MC: DVT 95%
Most common ECG changes for PE
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
Treatment of PE?
Steps for stabilization…
plus treatement
ABCs first IV access O2 Cardiac monitoring CXR IV fluids and pressors if indicated. Thrombolytic therapy
Definition of asthma
Disease of the lower airways characterized by acute exacerbations.
Epidemiology of asthma
4-5% of the population
- Highest among african-american males
Pathogenesis of asthma
Chronic airway inflammation, heightened bronchial reactivity and mucus production
Symptoms of asthma
tachycardia, tachypnea, may be hypoxic
- wheezing and prolonged expiratory phase
- may appear over inflatted
- Pulsus paradoxus: SBP <10mmHg during inspiration
Diagnostic eval for asthma
Peak expiratory flow rates
Treatment of asthma
Reducing bronchorestriction and inflammation
- supplimental O2
- Beta2 agonist via neb or MDI
- aero antiChol (ipatropium bromide)
- prednisone 40-60mg
Definition of COPD
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.
Pathogenesis of emphysema?
Reduction in elastic recoil of the lung parechyma resulting in physiologic dead space.
- The airway colapses during expiration
pathogenesis of chronic bronchitits?
Hypertropy of the mucus producing glands of the lung. Plus airway inflammation and hypertrophy of the airway smooth muscle.
Classic history of acute exacerbations of COPD
Varying degrees of respiratory distress
- history of progressive dyspnea
- increased sputum production
- decreased exercise tolerance
- fever and change in sputum herald superimposed pneumonia.
Treatment for acute COPD ex?
- include supporting and monitoring measures.
- 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.
Definition of pneumonia
Infection of the lungs by bacteria, virus, or fungus.
Mortality percentages of PNA?
6th leading cause of death in the US
- most common infectious cause of death in US
Pneumonia typical bacteria? CAP
Strep. pneumoniae, Haemophilus influenzae Staphlococcus aureus Group A strep Moraxella catarrhalis
Atypical pneumonia bacteria? CAP
Legionella pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae
Viral causes of pneumonia?
Influenza A and B RSV: respiratory synctial virus Adenovirus Parainfluenza Cytomeglovirus Herpes simplex virus Varicella virus Hantavirus
Classic symptoms of pneumonia
Fever Chills Cough Sputum production Dyspnea Pleuritic chest pain
Signs of pneumonia
Tachycardia
Tachypneic
Febrile
Physical exam findings with PNA
Tactile fremitus (vibratory tremors felt on palpation)
Dullness to percussion
Egophony (e to a changes)
Rales (crackling sounds in the area of consolidation.
Diagnostic eval of PNA
CXR: consolidations or infiltrates in lobar pattern
CBC: elevated WBC with left shift (predominance of segmented neutrophils and bands)
Treatment of PNA, CAP
If limited resistance: macrolide
High resistances: Doxycycline
Other options: respiratory floroquinolone (levofloxacin, moxifloxacin)
Amoxicillin-clavulantate
Tuberculosis basics
Bacteria: Mycobacterium tuberculosis
Most common cause of infectious disease death world wide.
Lung are primary site of infection: 80%
What is scrofula?
A disease of glandular swellings, probably a form of tuberculosis
When is greater than 5mm of induration positive for TB test?
- HIV pos, or HIV risk factors
- Recent close contact with active TB
- Person with chest xray consistent with healed TB
When is greater than 10mm of induration positive for TB test?
- 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
When is greater than 15mm of induration positive for TB test?
In all other cases
This is for people considered low risk
Primary symptoms of TB?
Symptoms of postprimary TB?
Mild fever
Malaise
Post: Fever, chills, night sweats, weight loss, dyspnea, fatigue, cough, hemopptysis.
Physical exam findings of TB?
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)
What are classical radiographic findings for TB?
Hilar adenopathy: MC
Apical pleural scarring
cavitary lesions
