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

What kind of sounds will you hear with stethoscope in a PTX?

A

-hyperresonance

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