Pulmonary System Flashcards
0
Q
Empyema
A
- Infected pleural effusion
- Needs to be drained
- Usually drained with a chest tube
- Decortication if the empyema is solid
1
Q
Post-op Pneumonia
A
- Atypical= mycoplasma, legionella, chlamydia
- Hospital acquired= gram neg rods, staph, anaerobes
- Aspiration= anaerobes
- Sx: sudden onset, fever, productive cough, dyspnea, night sweats, pleuritic chest pain. Atypical= gradual onset, dry cough, HA, myalgia, sore throat, GI sx.
- PE: decreased bronchial breath sounds, rales, wheezes, dullness to percussion, egophony, tactile fremitus.
- Dx: PE, CXR, CBC, sputum gram stain/culture, nasopharyngeal aspiration, blood culture, ABG.
- Tx: IV Abx (extended spectrum cephalosporin or carbapenem, add aminoglycoside or FQ for coverage of resistant organisms).
- Complications: pleural effusion, empyema, lung abscess, necrotizing pneumonia, bacteremia.
2
Q
Pleural Effusion
A
- Fluid in the pleural space
- Caused by: infection, CHF, SLE/RA, pancreatitis, trauma, pulmonary embolism, renal disease, cirrhosis, malignancy, postpericardiotomy
- Sx: dyspnea, pleuritic chest pain, decreased breath sounds, dullness to percussion, egophony
- Dx: Thoracentesis
- Tx: pigtail catheter, thoracostomy
3
Q
Pneumothorax
A
- Collapse of lung with air in pleural space
- Tension PTX= dyspnea, JVD, tachypnea, anxiety, pleuritic chest pain, unilateral decreased or absent breath sounds, tracheal shift away from the affected side, hyperresonance on the affected side.
- CXR= air w/o lung markings is seen outside the white pleural line.
- Need to give pt supplemental O2-PTX is almost all Nitrogen so will increase the nitrogen gradient causing the PTX to resolve faster.
- Tx: Rapid thoracostomy incision-OR-needle thoracostomy in the 2nd intercostal space midclavicular line followed by tube thoracostomy(chest tube).
- Chest tube: 1) suction until PTX resolves 2) water seal for 24 hrs 3) remove chest tube if no PTX or air leak is present after 24hrs.
- Can occur after placement of central line-always need a CXR after placement.
- Spontaneous: atraumatic, occur in tall/thin, dx with CXR, tx with chest tube.
4
Q
Lung Neoplasms
A
-Nodules- seen on CXR
-Benign: 45-50yo, smoker, new/enlarged lesion, absent/irregular
calcification, irregular margins, >2cm
- Cancer= leading cause of cancer death in US
- Small cell(SCLC): highly correlated with cigarette exposure, central location, neuroendocrine origin, mets usually found on presentation in intrathoracic and extrathoracic sites (brain, liver, bone)
- Non-small cell(NSCLC): most common are adenocarcinoma, SCC, large cell carcinoma. Less likely to metastasize at early stage.
- Adenocarcinoma: Most common lung cancer, peripheral
- SCC: central location
- Large cell: least common
- Nodules: asx or have chronic cough, dyspnea, and SOB.
- Cancer: cough, hemoptysis, dyspnea, wheezing, pneumonia, chest pain, wt loss, possible abnormal resp exam.
- Dx: CXR or CT, FNA for peripheral lesions, bronchoscopy for central lesions
- Tx: Nodules= Surgical resection of nodules that are high risk for malignancy. Otherwise follow with CXR or CT every 3 mos for 1 yr, then every 6mos. SCLC=radiation and chemo. NSCLC= Surgical resection in early stages.
5
Q
Pulmonary Emboli
A
- DVT embolizes
- RFs: post op, trauma, paralysis, immobility, CHF, obesity, BCP/tamoxifen, cancer, advanced age, polycythemia, MI, HIT syndrome, hypercoagulable state.
- Sx: SOB, tachypnea, hypotension, chest pain, fever, loud pulmonic component of S2, hemoptysis.
- Labs: decreased PO2 and PCO2 due to hyperventilation
- Dx: CT angiogram, VQscan, pulmonary angiogram is TOC.
- CXR= Westermarks sign (cant see pulmonary vessels)
- EKG= flipped T waves or ST depression
- Tx: If stable= anticoagulation(heparin then coumadin) or Greenfield filter (placed in IVC via jugular vein). If unstable= thrombolytic therapy.
6
Q
Penetrating Lung Trauma
A
- Presentation: chest pain, hemoptysis, tenderness, bruising, back pain, difficulty breathing, deformed chest, fainting, trouble swallowing, abdominal pain.
- Dx: CXR, CT.
- Tx: Surgery, chest tube, intubation, mechanical ventilation
7
Q
Blunt Lung Trauma
A
- Most common cause is MVA
- More common in kids because less protection from chest wall
- Sx: pain, shock, respiratory distress, hemoptysis, sternal tenderness, subcutaneous emphysema
- Dx: CXR- large PTX or pneumomediastinum
- Tx: intubation, mechanical ventilation, chest tube.
8
Q
What kind of sounds will you hear with stethoscope in a PTX?
A
-hyperresonance