Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STM: Exam 1 > Pulmonary Emergenices > Flashcards

Pulmonary Emergenices Flashcards

1
Q

Respiratory Parameters to Know

A

Dyspnea = difficult to breath
Tachypnea = fast (20+) breathes/min
Hypoxia: spO2 < 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Bronchitis
Etiology
Symptoms
Diagnosis
Treatment

A

Etiology
- inflammation in the large airways: cough without pneumonia, or chronic respiratory issues
- caused: VIRAL&raquo_space; bacterial (adenovirus, influenzia, rhinovirus,etc.) (h.flu or s. pneumoniae)
- happens fall/winter

Symptoms

first phase = fevers, muscle aches viral/cold like symptoms

second phase = cough!!! persistant cough for 1-3 weeks

Diagnosis
clincal: history and symptoms
- can get CXR to rule out pneumonia
- ensure you can differentiate from pertussis! the whooping cough: can do PCR test & azithryomycin to treat

Treatment = supportive
- cough suppressant: guaifenesin
- wheeze? albuterol
- NO abx. (unless 10+ days with comorbities: Azithromycin)
- somtimes steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pneumonia
Etiology
Symptoms
Diagnosis

A

Etiology
- infection of the alveoli usually due to aspiration of the pathogen
- or hematogenous spread: staph and strep
- most common cause of sepsis
- community acquired
- hospital acquired: infection after 48+ hours in hospital
- ventilator = after 48hours
- healthcare-assocaited = nursing home, etc. pts.

Risk Factors
- aspiration
- bacteremia
- debilitaion
- chronic disease, pulmonary disease

Symptoms
- cough
- fatigue
- fever
- dyspnea
- sputum
- chest pain pleuritic
- (URI symptoms usually first, then these)

Diagnosis
- clinical signs rails, consolidation, dull to percuss, rhonchi and wheezing
- Chest Xray- see infiltrates
- labs for WBC or sputum (not neede in ED)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pneumonia: Pneumococcal

A
  • elderly, under 2 or immunosuppressed

Symptoms
- bloody sputum
- rigors/fever
- dyspnea
- chest pain

CXR: lobar infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pneumonia: Staph Aureus

A

who
- chornic lung disease
- aspiration risk pts.:nursing home

Symptoms
- insidious onset
- low-fever
- sputum
- dyspnea

CXR
- extensive disease
- empyema
- multiple infiltrates
- effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pneumonia: Klebsiella

A

Who
-alcoholics
- eldery
- chornic lung disease

Symptoms
- acute onset:severe quick
- red current jelly sputum
- fever
- chest pain

CXR
- cavitations: necortotixing in lobar infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pneumonia: Pseudomonas

A

Who
- generally hospital pt.

Symptoms
- they’re SUPER sick
- systemic illness
- confusion
- cyanosis

CXR
- bilateral lower lobe infiltrtaes
- +/- empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pneumonia: H. flu

A

Who
- eldery
- immuncomp.
- sickle cell pt.

symptoms
- gradual onset
- sputum
- chest pain

CXR
- pleural effusions
- multilobal infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pneumonia: Legionella

A

Who
- transplant pt.

Symptoms
- can get to ARDS/organ failure
- N/V/D
- sinusitis, myocardidis, pyleonephritis

CXR
- patchy infiltrtates
- hilar adenopathy

labs can confrim that is legionella but rarely done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pneumonia: Treatment
Uncomplicated Outpatient

A

Uncomplicated Outpt.
first line = amoxicillin + macrolide
- amoxicillin + azyromycin
- amoxillin + clarithromycin

  • amoxicillin + (doxycycline)

PCN allergy = 3rd gen ceph (cefpodoxime/cefditoren)
PCN allergy SEVERE = florquinolone (levofloxicin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pneumonia: Treatment
Complicated Outpatient or someont who had abx. in the last 3 months

A

first line : fluroquinolone
- levofloxacin
- moxifloxicin

or

Augmentin + azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pneumonia: Treatment
Inpatient but not the ICU

A

first line = florquinolone (IV)
- levofloxacin
- moxifloxacin

or

ceftiaxone + azithrmycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pneumonia: Treatment
ICU

A

Multiple Drugs: by hospital

Ceftriaxone + Azirthromycin
or
Cefriaxone
Levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pneumonia: Treatment
Healthcare Associated

A

HC associated: think pseudmonas and MRSA coverage

3 drugs
cefepime + ciprofloxicin + vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disposition fro teh ER: who stasy and who goes for pneumonia

A

Pneumonia
- most can go home
- clinical picutre to guide you
- CURB-65 and PSI good score tools to justify your need to admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aspiration Pneumonia
Etiology
Diagnosis
Treatment

A

Etiology
- inhaled oropharyngeal contents
- common in nursing home pt.
- common in those with impaired breathing or swallowing function
- causes a severe and acute pneumonitis
- posterior portion of the upper lobes and anterior portion of lower lobes affected

Diagnosis
- unilateral or patchy consolidation: RLL is most common

Treatment
- CAP: unasyn, augmentin, moxi or levofloxicin
- HAP: vanco or zosyn
- most need to be admitted

17
Q

Acute Asthma
etiolgoy
symptoms
diagnosis in the ER

A

Etiology
- chronic inflammatory disorder: accumulation of inflammatory markers to teh airway vasoconstricts, thickens secretions and allows for edema to occur

Symptoms
- wheezing
- dyspnea
- cough
- sputum? fever? SOB? tight chest?

Diagnosis
- they probably alread have asthma dx.
- get their spO2
- if spO2 < 90 = get ABG
- get spirometry
- CXR if needed to rule out other things

18
Q

Acute Asthma
Treatment
Dispo

A

Treatment
- ipatropium & albuterol nebulizer in the ED
- steroids: solumederol

need to ask
- if taken steroid before
- last dose? and how often?

if significant symptoms = discahrge them with prednisone burst x 5 days

Dispo
- depends on symptoms
- can observe or admit
- most go home
- refill Rx and make sure htey have F/U

19
Q

what is Status Asthmaticus

A

Status Asthmaticus
- acute severe asthma attack that does NOT improve with bronchodilators or corticosteroids

Signs
- FEV 1 < 25% predicted
- ABG and spO2
- “youll know”

Treatment
- IV magnesium: 1-2 grams over 30 minutes
- CPAP/BIPAP
- intubate? use ketamine
- epinephrine only for refractory situations

sent to ICU

20
Q

COPD
Etiology
Symptoms of the Exacerbation in the ER

A

Etiology
- chronic bronchitis and emphysema as as result of decreased airflow and alveolar abnormalities
- lost elastic recoli, naorrowing of airways occurs and collpase of smaller airways makes gas exchange difficult
- mucous statsis and bacterial colonization
- remember: FEv1/FVC < 0.7

Exacerations
- commonly URI triggered
- V/Q mismatch : more SOB than baseline

Symptoms
- chronic and progressive dyspnea
- cough
- sputum production
- cyanosis (blue bloater)
- tachypnea
- hypoxemia
- wheezing
- HTN
-

21
Q

COPD
Diagnosis
Treatment
who goes to ICU

A

Diagnosis
- FEv1/FVC < 0.7 on spirometry + clinical symptoms
- ABG: respiratory acidosis (hold onto CO2)
- can get BNP, EKG and CRX to rule out others

Treatment
- adminster O2
- monitor on tele
- albuterol/ipratropium
- steroids: short term for the exacerbation
- can consider giving abx.

the ABG/SpO2 & PE will guide management
most go home: the older, sicker, comorb stay

ICU?
- severe dyspnea that need intubation or bipap
- AMS
- worsening hyoxpemia
- hemodynamic instable

22
Q

Pneumothorax

A

Etiology
- free air in the potential space
- spontaneous or secondary from a lung disease
- smokers, males marfans syndrome (spont.)
- primary = ruputred bleb lets air into the apex
- secondary = visceral pleura is damaged

Symptoms
- tachycardia
- decreased breath sounds
- sudden onset dyspnea
- ipsilateral chest pain
- hyperresonant to percussion
- decreased tactile fremitus

if tension pneumothorax
- hypotension
- trachea deviates away
- severe dyspnea
- these pts. will look much sicker

23
Q

PTX
diagnosis
treatment

A

Diagnosisi
- CXR: should be sufficient
- could get CT but CXR is good enough

Treatment
TENSION: immediate needle decompression and chest tubes (need decomp. in the 4th-5th ICS mid-axillary)
SPONTANEOUS: if first time & < 20% of the lung, normal VS: can observe 4 hours, repeat CXR and d/c with follow up
everyone else: consult surgery and clinically decide chest tube v. needle decomp.

stable pts. have normal VS, no hemothorax, and speak in full sentences

24
Q

Pulmonary Embolism
Etiology
symptoms
signs
diagnosis

A

Etiology
- clot in the pulmonary arteries
- most are a result of a DVT
- deep VT > superfisical
- can be provoked:but most comonig into the ED are unprovoked

Symptoms
- unexplained dyspnea
- pleuritic chest pain
- pain increased by cough or breathing
- pulmonary infarct: severe pain in that one areas 1-3 days after the emboli event

Signs
- tachycardia
- tachypnea
- decreased O2
- mild fever
- some have normal VS = hard to dx.
- unilateral limb swelling and wheezing are you best clue because thats DVT + PE involvment

Diagnosis
- signs of hypoxemia or dyspnea with clear lung sounds on PE suggest a PE

then get…
Wells criteria (sick + comorb.)
PERC (for healthy pt.)

(remember S1Q3T3 on EKG is a sign)
hamptons hump and westermark sign on CXR

25
Q

PE
DVT features to clue you in
tests to do
gold standard?

A

DVT Features
- unliateral LE pain, redness, swelling
- homans sign= not super reliable but its a thing

so now what

  • US: can rule out a DVT
  • D-Dimer; can exclude VTE
  • chest CT anigo: will rule out PE
  • V/Q: for your pregnant pt.
  • gold standard: pulmonary angiography to get the PE
26
Q

PE Treatment (but this is treatment for the DVT too)

A

STABLE and GOING HOME
- enoxaparin + coumadin
- or newer DOAC agents
- renal failure = have to us heparin (admit)

MODERATE to SEVERE (the PE is there od dx. use this or unstable)
- heparin, coumadin or enoxaprin
- admit to monitor them in coumadin prison (inpt.)

UNSTABLE
- surgical embolectomy or fibrinolysis (TPA)

27
Q

Airway Obstruction

A

CONSCIOUS pt.
- ask them to cough
- do the heimlich

UNCONSCIOUS pt.
- do chest compression
- only remove FB if you can see it: no blind sweeps
- ventilate if you can
- CPR

28
Q

ARDS
Etiology
berlin Criteria
Underlying Causes
Phases

A

Acute Respiratory Distress Syndrome
- severe dyspnea with rapid onset hyopxemia, diffuse pulmonary infiltrates and respiratory failure
- usually the result of a diffuse lung injury
- 100% of these pts. go to the ICU

Berlin Criteria
- onset within 1 week of clinical insult
- bilateral opacities on imaging not explained by lung/lobar collpar or nodes
- respiratory failure not due to cardiac failure or fluid overlaod
- PaO2/FiO2 ratio < 300 with PEEP > 5cm H20

Underlying Causes
- sepsis and bacterial pneumonia
- aspiration of gastric contents
- trauma
- drug OD
- too many trasnfusions (TRALI)

3 Phases
- Exudative: alvolar edema with lots of leukocytes
- Proliferative: inflammtion in the interstitium and early fibrosis of the lungs can start
- Fibrotic: 3 weeks after injur:y fiberotic changes & bullae formation or recovery

29
Q

ARDS
Treatment Managment

A

Treatment
______________________________
Initiate volume/pressure limited ventilation: give lungs a break
- TV: < 6, pplat < 30
- RR < 35

Oxygenate
- FiO2 < 0.6
- SpO2 88-95%

Minimized acidosis
- pH > 7.3
- RR < 35

Diuresis (offload)
- MAP > 65
- dont overdiuresis and then hypoperfuse!

30
Q

Endotracheal Tube Intubation
what is it

A

ET Tube: cornerstone of emergency airway management
- direct connection to the trachea allowinf for better oxygenation and ventilation

Key Tasks whild Intubating
- ensure ongoing cardiac rhythm monitoring is happening
- establish IV access and fluids
- try to normalize the pt. HR and BP and optimize their O2 prior to administering the sedating meds and starting

31
Q

ET Intubation
Mallampati Classification

A

Class I: good airway
Class II - III: ehh
Class IV: difficult airway: hard to visualize the posterior structures

32
Q

ET intubation
steps

A

Steps
- preoxygenate pt. = administer 100% O2 with 15 L/min for 3 minutes

Sizes of Et TUbes
8.0-8.5 = average adult man
7.5-8.0 - femlae adult

  1. clear oropharynx
  2. laryngoscope in left
  3. right hand to open mouth, operate and insert the ETT
  4. advnace and lift the blade into the oropharynx
  5. visualize and lift epiglottis
  6. see vocal cords
  7. advance ETT
  8. infalte ballon
  9. confirm placement
  10. secure tube with tape
33
Q

what is rapid sequence intubation

A

RSI is the usuing of induction agent and NM blockade to faciliate a tube placement

  • goal is to intubate with minimzing phsiologic perturbations
  • superoir to sedation and allows high success rate of intubation

Meds to Use
- pre treat: lidocaine, fetanyl
- induction: etomidate, propfol, ketamine
- parlytic agenet (for gag) : rocuronium, vercuronium, succinylchoine

STM: Exam 1 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions