Reapiratory Flashcards
Lung Cancer Screening
Annual low-dose CT (LDCT) in adults 50-80 w/ 20 pack year hx who currently smoke or who have quit within 15 years
Signs of Respiratory Failure
Tachypnea, lack of wheezing, accessory muscle use, diaphoresis, exhaustion
Causes of Tachypnea
Pain, fever, physical exertion, PE, hyperthyroidism
Egophony
Presence of consolidation in the lungs
Will hear “bah” sounds instead of “eee”
Whispered Pectoriloquy
Instruct pt to whisper “99”
Consolidation if words are clearly heard on the lower lobes
Normal lung percussion sound
Resonance
Gold standard test for Asthma and COPD
PFT (pre- and post-bronchodilator)
FEV1/FVC
Proportion of person’s VC that the person is able to expire in 1 second
Most important for detecting airflow obstruction
Restrictive lung diseases
Pulmonary fibrosis
Pleural disease
Diaphragm obstruction
Obstructive lung disease
Asthma
COPD (chronic bronchitis, emphysema)
Bronchiectasis
Asthma lung findings
Wheezing with prolonged expiration
Medication triggers for asthma
ASA or NSAIDs
BB
ACEI
Certain eye drops
Goal frequency of SABA use
< 2 days a week
Tx for Exercise-Induced Bronchoconstriction (asthma)
Pre-medicate 5-20 min before exercise w/ 2 puffs of SABA
Emergency Management of Asthma exacerbation
Albuterol 0.5% solution by nebulizer every 20-30 minutes up to 3 doses
Albuterol w/spacer, 4-8 puffs every 20 minutes for 8 doses
Glucocorticoids for Asthma exacerbations
Pred 40-60 for 5-7 days
If it is also taking inhaled glucocorticoids, no need to taper PO dose lasting 3 weeks or less
Peek Expiratory Flow (PEF)
Based on height, age, sex (HAS)
Chronic Bronchitis
Coughing w/excessive mucous for 3 or more months for a minimum of 2 or more consecutive years
“Blue bloater” vs “pink puffer”
Blue = chronic bronchitis (chronic hypoxia)
Pink = emphysema (adequate O2 saturation)
COPD Diagnosis
Post-bronch FEV1/FVC < 0.7
Digital clubbing
Not typical in COPD
PNA initial testing
CBC w Diff
BUN/Cr
CXR
PNA Tx
5-7 days of tx
W/o CM Doxy or Macrolide or Amoxicillin
W/ CM Fluoroquinolone or Doxy or macrolide + beta-lactam (Augmentin or Cefuroxime)
PNA s/sx
Tachypnea, crackles or rales, consolidation (dullness on percussion, increased tactile fremitus, cough does not completely clear abnormal lung sounds), pleural friction rub (caused by pleurisy - pt reports sharp localized pain with deep breath/movement/cough)
CURB-65
PNA assessment
0-1 treat as OP
2 short hospital stay or monitor closely
CURB-65 Assessment Questions
Confusion of new onset
Blood urea nitrogen > 19
RR 30 BPM or more
BP < 90 systolic or < 60 diastolic
Age 65
Acute Bronchitis Symptoms
Cough with or w/o sputum
Absence of fever or tachypnea
Lasting > 5 days
Absence of asthma, COPD, or other airway disease
Acute Bronchitis Tx
Bronchodilator via MDI such as SAMA (ipatroprium bromide) or SABA (albuterol)
Pred 40 mg x 3-5 days
Asthma Dx
Airflow obstruction that is at least partially reversible
Increase in FEV1 12% and > 200 ml from baseline post beta2agonist
Spirometry is preferred test to diagnose
Peak flow meter primarily used for monitoring
SABA example
Albuterol
SAMA
Ipratropium bromide
What step is a daily inhaler added
Step 3
Following almost daily symptoms with nighttime awakening greater then 1 or more times a month
LAMA example
Triotropium bromide (Spiriva)
LABA example
Budesonide-formoterol (symbicort)
LABA example
Budesonide-formoterol (symbicort)
Asthma control questions
- Daytime asthma symptoms more than 2/week?
- Any nighttime awakening?
- Reliever therapy for symptoms more than 2/week?
- Any activity limitation
Scoring asthma control
1-2 positive responses = partly controlled
3-4 positive responses = uncontrolled
Asthma assessment
Measure FEV1 at diagnoses, after 3-6 months of controller therapy, then periodically
Asthma and pregnancy
Treat as you would any non-pregnant pt
Air trapping is seen
Acute Asthma flares
COPD
Tactile fremitus
Decreases w/ decreased tissue density
Palpitations vibration from when the pt is speaking
Asthma wheeze
Initially expiratory, then inspiratory
COPD Interventions
Smoking cessation
Advice on physical activity and Pulm rehab
Influenza, pneumococcal, RSV, COVID vaccine
COPD definition
Spirometry
FEV1: FVC < 0.70 post bronchodilation
GOLD Classification
Severity of COPD
1 mild FEV1 80 % or more
2 mod FEV1 50-80%
3 severe FEV1 30-50%
4 very severe FEV1 less than 30%
GOLD Classification
Severity of COPD
1 mild FEV1 80 % or more
2 mod FEV1 50-80%
3 severe FEV1 30-50%
4 very severe FEV1 less than 30%
Asthma diagnoses
Spirometry not required like with COPD
COPD First line tx
LABA or LAMA
W/ very occasional breathlessness SABA or SAMA
COPD Second Line Tx
LAMA + LABA
COPD w/hospitalization and greater than 2 exacerbations
LABA + LAMA
Add ICS if blood eosinophils are great or equal to 300
COPD exacerbation w/ antibiotics
5 day course
Pertussis TX
First line Macrolides x5-7 days
Second line Bactrim x 14 days
