RESP Flashcards
Pulmonary contusion if severe what is used?
mechanical ventilation with positive end-expiratory pressure
What are some DDxs to consider for Hemoptysis
(1) Tuberculosis
(2) Chronic Bronchitis
(3) Pneumonia
(4) Pulmonary AVM
What is a common life-saving intervention in emergency situations for ARDS?
Intubation, with subsequent mechanical ventilation
What is the confirmatory test for COPD
Spirometry
What is commonly prescribed to COPD patients for the following?
a) Treat an acute exacerbation
b) Treat acute bronchitis
c) Prevent acute exacerbation of acute bronchitis
Antibiotics
_______ is a pathological term that describes some of the structural changes sometimes associated with COPD. These changes include abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis
Emphysema
What is the most effective med for angioedema
Epinephrine topically, by inhalation, or parentally,
essentials of DX for What?
(1) Fatigue, weight loss, fever, night sweats, productive cough.
(2) Cough >2 to 3 weeks’ duration, lymphadenopathy.
(3) Risk factors: Household exposure, incarceration, drug use, travel to endemic area.
(4) Chest Radiograph: Pulmonary opacities.
(5) Acid-fast bacilli on smear of sputum or sputum culture positive to confirm Mycobacterium tuberculosis.
TB.
Physical/Clinical Findings for….
(1) Mucus membrane irritation of the upper airway (depending on the agent) and often require emergency treatment.
(2) Dyspnea
(3) Cough
(4) Possible wheezing
(5) Possible hypoxiaS
RAD
TB Labs
Acid fast bacilli light microscopy- Require ____ consecutive morning specimens. Most labs are normal in the setting of pulmonary TB.
3 consecutive morning specimens
initial steps in managing a patient with massive hemoptysis are to
- ensure adequate oxygenation
- determine if the bleeding is coming primarily from one lung and, if so, which side is the primary source.
True/False
Unless the patient has progressed to apnea unwitnessed, high-grade upper airway obstruction is usually obvious.
True
echocardiography:
Substantial proportion of patients has normal EFs with elevated atrial pressures due to _______
diastolic dysfunction
True/False
Patients with massive hemoptysis who have
significant shortness of breath, poor gas exchange, hemodynamic instability, or rapid ongoing hemoptysis should be intubated with a large bore endotracheal tube
True
True/False
Pulmonary edema
Rales are present in all lung fields, as are generalized wheezing and rhonchi
True
What is the purpose of proper positioning of a patient with massive hemoptysis?
To protect the nonbleeding lung, since spillage of blood into the nonbleeding lung may prevent gas exchange by blocking the airway with clot or filling the alveoli with blood.
PT presents with theses issues what do you suspect
- Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors.
- Bronchial breath sounds or rales are frequent auscultatory findings.
- Parenchymal infiltrate on chest radiograph.
- Occurs outside of the hospital or less than 48 hours after admission in a patient who is not hospitalized or residing in a long-term care facility.
Pneumonia - Community acquired, bacterial, and viral
What is the Dosing for Isoniazid?
5 mg/kg/dose (usual dose: 300 mg) once daily.
Note:
The preferred frequency of administration is once daily during the intensive and continuation phases; however, 5-days per week administration by directly observed therapy (DOT) is an acceptable alternative.
Would you give morphine with opioid-induced pulmonary edema?
NO, Give naloxone
Disposition for Pleuritis
If the patient is hypoxic
MEDEVAC
these clinical symptoms and signs suggestive of what kind of injury?
(a) Dyspnea
(b) Subcutaneous emphysema of the neck or upper thoracic region.
(c) Hoarseness
(d) Hemoptysis
(e) Hypoxia
(f) Persistent pneumothorax despite appropriate tube thoracotomy.
Tracheobronchial injury
How should you position a patient with massive hemoptysis
-immediately placed into a position in which the presumed bleeding lung is in the dependent position
In full-blown pulmonary edema, the patient should be placed in a sitting position with legs dangling over the side of the bed. How does this help?
Facilitates respiration and reduces venous return.
Stable patients with suspected trauma to the trachea or bronchi should undergo what?
immediate bronchoscopy.
Physical findings of what?
-Significant traumatic mechanism and presence of other associated thoracic and extra thoracic injuries should raise suspicion for pulmonary contusion.
-The most important sign is hypoxia.
(a) The degree of hypoxemia directly correlates with the size of the contusion.
- Large contusions will lead to significant
respiratory distress.
-Dyspnea
-Hemoptysis
-Tachycardia
Pulmonary contusion
What is the main goal in treatment of pleuritis?
detect and treat the underlying lesion or cause
True/False
Patients who have lost consciousness but otherwise appear well, can be sent home.
False
should be examined and observed.
When negative intrathoracic pressure is generated on inspiration, the flail segment moves ______, thus reducing tidal volume.
- inward
- outward
inward
Disposition of hemothorax
MEDEVAC
True/False
Operational environment requires the IDC to rely on history and physical exam for recognition and early treatment of suspected PE.
True… good luck
What is the questionnaire used by used by sleep apnea screeners?
STOP BANG Questionnaire
PE Findings for what?
1) Fever or hypothermia
2) Tachypnea
3) Tachycardia
4) Mild arterial oxygen desaturation.
5) Many patients will often appear acutely ill.
6) Chest examination is often remarkable for altered breath sounds and rales.
7) Dullness to percussion may be present if a par pneumonic pleural effusion is
present.
Pneumonia
If patient is in acute distress, remains unstable, has dyspnea, persistent hypoxia (O2 Sats 95%) then……
MO call with MEDEVAC is warranted
Can an idc manage this asthma patient?
- Frequent asthma-related healthcare utilization.
- More than two courses of oral prednisone therapy in the past 12 months.
- Presence of social or psychological issues interfering with asthma management.
No refer
What is the complication(s) from Pleuritis
Atelectasis, respiratory splinting secondary to pain, or pneumonia
Dullness with decreased fremitus may indicate _______ or _______.
pleural thickening or effusion
You wana give O2 for your RADS pt if their Sat drops below what?
95%
These clinical risk factors are for what?
(a) Advancing age
(b) Male Gender
(c) Obesity
(d) Craniofacial morphology or upper airway soft tissue abnormalities.
(e) Additional factors identified in some studies include smoking, nasal congestion,
menopause, and family history.
Chronic Obstructive Sleep Apnea
If less invasive methods fail, immediate…………………………………….. is required
cricothyrotomy or tracheostomy
Physical findings of what issue?
(a) Pronounced stridorous respirations.
(b) Retractions of the supraclavicular and suprasternal areas of the chest indicate that
there is significant obstruction.
(c) Patients with complete airway obstruction will not be able to breathe or speak.
(d) Patients may have a visible swelling or mass in the neck.
(e) The tongue may be swollen, as may other structures in the mouth.
ARDS
What intervention is necessary for a PE patient when anticoagulation or thrombolytic therapy is contraindicated?
surgical intervention to remove the clot
Although not specific for PE, the ECG may show
ST and T wave abnormalities
______occurs when a segment of the chest does not have bony contiguity with the rest of the thoracic cage.
Flail chest
Injury to the vessel wall can be due to….
1) Prior episodes of thrombosis
2) Orthopedic surgery
3) Trauma
What test is used to evaluate COPD
Spirometry
What are Lifestyle modifications for treating COPD
1) STOP SMOKING
2) Elimination of exposure to products of combustion
3) Vaccination
4) Patient Education: use of inhaler
5) Nutrition and Self-Management
What would you suspect from these issues..
a) Constitutional symptoms such as fever, weight loss, and malaise.
b) Cough with expectoration of foul- smelling purulent sputum .
c) Absence of productive cough does not rule out such an infection.
d) Dentition is often poor.
e) Patients are rarely edentulous; if so, an obstructing bronchial lesion is usually present.
anaerobic pleuropulmonary infection
What are the Diuretics used for PE
Furosemide (Lasix), 20 - 80mg IV/IM/PO
-increase by 20 - 40 mg q6- 8h until desired response is achieved max 600mg/day.
Bumetanide (Bumex), 1 mg IV/PO
What are some examples of SABAs?
ALBUTEROL levalbuterol bitolterol pirbuterol terbutaline
Physical findings for what?
(1) may cause localized pain, crepitus, pain with inspiration, and dyspnea.
(2) May cause pneumothorax or Hemothorax.
(3) Mortality increases with the number of ribs involved.
(4) The pain associated with rib fractures may lead to hypoventilation, atelectasis, retained secretions, and pneumonia.
Rib Fx
What type of meds should you give for hemoptysis
Meds to treat underlying illness
Tx for pneumothorax
Ensure intact airway
-If the airway is not intact, provide suctioning and
intubation if necessary
O2
For a large pneumothorax or unstable patients, re-expansion of the lung is necessary
-Chest tube
Treat symptomatically for cough and chest pain
Disposition for Flail chest patients
MEDEVAC
X-rays are usually obtained to identify ____, not specifically for rib fractures
complications
What can be used to evaluate for hemothorax at bedside quickly
Ultrasound
It patient is in no acute distress, without dyspnea, has normal vital signs and is otherwise stable then….
possible referral to pulmonology and PFT
when is chest imaging indicated for asthma
pneumonia
another disorder mimicking asthma
a complication such as pneumothorax is suspected
_______ or the expectoration of blood, can range from blood-streaking of sputum to
the presence of gross blood from below the vocal cords or within the lungs.
Hemoptysis
Essentials of Diagnosis of what?
(1) Daytime somnolence or fatigue.
(2) History of loud snoring with witnessed apneic events.
(3) Overnight polysomnography demonstrating apneic episodes with hypoxemia.
Chronic obstructive sleep apnea
When would you admit a pneumonia pt?
1) Failure of outpatient therapy, including inability to maintain oral intake and medications.
2) Exacerbations of underlying disease that would benefit from hospitalization.
3) Complications of pneumonia arise
(such as hypoxemia, pleural effusion, sepsis,
and encephalopathy)
True/False
Left-sided bronchial injuries occur more commonly and are typically more severe, while almost 80% occur within 2 cm of the carina.
False
Right-sided injuries are more common and more severe
When is intubation indicated?
acute respiratory failure
What type of imaging may confirm the diagnosis and detect associated lung diseases. It can also be used to help assess severity and response to therapy over time.
Chest Radiography
what is the most common complication of pulmonary contusion?
Pneumonia
What meds would you give for Bronchitis
-NSIADS
-Acetaminophen (Tylenol)
-325-1000 mg PO q 4-6 h, max 4 grams/24 h
Cough suppressants/Antitussives
-Benzonatate, 100-200mg TID
SABA
Albuterol MDI 2 - 4 puffs q4-6h prn.
Would you suspect Rads if you patient has a chronic resp issues
not really,
Rads is an acute reaction to an exposure to a causal agent
Disposition for pneumothorax
MEDEVAC
True/false
Labs are contributory to dx for Flail chest
False
Noncontributory – Dx made based on history and physical exam
True/False
Uncomplicated pneumonia can usually be treated on an outpatient basis with antibiotics and supportive care.
True
acute respiratory failure is defined as?
insufficient oxygenation, insufficient ventilation, or both
What other med should you give a pt with INH and what labs should they have done?
Vitamin B6- 50mg daily with INH dose
Liver Function Test should be performed prior to
initiating and then situational depending on patients response to INH therapy
_____ imaging will reveal most pneumothoraces
Chest X-ray
Differential Diagnosis for PE – Must consider causes of chest pain and dyspnea
(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych
Physical exam findings for what?
(1) Onset often is abrupt, and one or more of the DVT risk factors is almost always present.
(2) Dyspnea, cough, anxiety, and chest pain occur in varying combinations.
(3) Hemoptysis, tachycardia, and tachypnea are common.
(4) Low grade fever, hypotension, cyanosis, DVT signs, and pleural friction rub may be present.
Pulmonary edema
Venous stasis increases with….
- Immobility
- Hyper viscosity
- Increased central venous pressure (pregnancy, low cardiac output)
What are some DDxs for PE
(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych
What labs/rads would you order for pt with suspected hemoptysis
CBC
CXR followed by a CT scan
If respiratory distress remains severe what interventions would you consider?
endotracheal intubation and mechanical ventilation may be necessary.
What meds is highly effective in pulmonary edema and may be helpful in less severe decompensations when the patient is uncomfortable for PE?
Morphine
ARDS Immediate first steps
Upper airway obstruction is most often due to soft tissue swelling secondary to……..
infection or angioedema.
The most common bacterial pathogen identified in most studies of community acquired pneumonia is
Streptococcus pneumonia
True/False
Morphine increases venous capacitance, lowering la pressure, and relieves anxiety, which can reduce the efficiency of ventilation
True
Vast majority of COPD patients will have an hx of what
Smoking
Presentation of RADS is different from that of true occupational asthma, because it is …….
an acute single event without a significant latency period
Disposition of Pulmonary Contusion
MEDEVAC
What is the most common cause of ARDS in adults?
Laryngeal edema from thermal injury or angioedema
Can an idc manage this Asthma patient?
- Frequent asthma-related healthcare utilization.
- More than two courses of oral prednisone therapy in the past 12 months.
- Presence of social or psychological issues interfering with asthma management.
No refer
Tx for PE
True/False
Patients can be left on room air, there is no need to monitor the O2 as there is only fluid in the lungs.
FALSE
Oxygen is delivered by mask to obtain adequate oxygenation. Monitor O2 Sat.
What are some Tx for OSA
(1) CPAP
(2) Weight loss.
(3) Oral appliances.
(4) Upper airway surgery.
Your pt who has a predisposition to venous thrombosis, especially in the lower extremities. presents with these issues. What do you suspect?
(1) Acute onset of dyspnea, pleuritic chest pain,
tachypnea, and tachycardia.
(2) Elevated rapid D-dimer, characteristic defects on ventilation-perfusion lung scan, helical CT scan, or pulmonary angiogram.
Pulmonary Embolism
What antibiotic is used for suspected aspiration
pneumonia?
Amoxicillin-potassium clavulanate 875/125 mg BID or 500/125 mg TID x 7 days
Essentials of diagnosis for Bronchitis
Cough associated with midline burning chest pain, fever, and dyspnea
Disposition for Pleuritis
If the underlying disease requires hospital treatment or if parenteral analgesics are required for pain control
MEDEVAC
All patients who have asthma must have access to what class of medication?
Shot acting Beta-agonists
SABAs
Tracheobronchial injuries are usually the result of _____ and _____.
motor vehicle accidents and crush injuries.
Symptoms and signs of….
Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors
acute lung infection
What are some CXR findings for PE
(a) Pulmonary vascular redistribution..
(b) Blurriness of vascular outlines
(c) Increased interstitial markings.
(d) Butterfly pattern of distribution of alveolar edema.
Treatment for Rib FX
Young, healthy patients with isolated rib fractures without evidence of other serious underlying injury.
(a) Pain medication.
(b) Deep breathing exercises.
(c) Incentive spirometry.
What is defined as inflammation of the tracheobronchial tree
Acute Bronchitis
What is the mainstay of TX for Pulmonary contusion?
supportive care.
- Oxygen
- Chest physiotherapy
Tx for Hemothorax
(a) Ensure patient has an intact airway.
(b) Oxygen to correct hypoxia.
(c) If the airway is not intact, provide suctioning and intubation if necessary.
(d) Tube thoracotomy with a 36 or 40 French chest tube.
Oral corticosteroids and bronchodilators commenced within how many months have had the most favorable outcomes.
first 3months
When should you hospitalize ARDS pt
only if symptoms develop or persist
or
if significant aspiration is suspected
True/False
Treatment for tracheobronchial injury can include Cricothyroidotomy if needed
True
What is Virchow’s Triad
- Venous stasis
- Injury to the vessel wall
- Hypercoagulability
What is characterized by episodic wheezing, shortness of breath, chest tightness, and cough.
Asthma
TB Physical Findings
Crackles may be present throughout _____ or may be heard only after a short cough
- inspiration
- exhalation
inspiration
Flail chest pt
Indications for early ventilation would include……
marked hypoxia
inadequate breathing
PE will develop within 50-60% of patients with ________
proximal deep vein thrombosis
Patient presents with these issues what would you suspect?
- “Pink Puffer”
- Major complaint is dyspnea.
- over age 50
- Cough is rare, may have scant thin clear sputum
- Thin
- Uncomfortable appearing with accessory muscle use
- Chest is quiet without adventitious lung sounds
Emphysema
________ are injuries of the lung parenchyma with hemorrhage and edema without associated laceration.
Pulmonary contusions
What does the STOP stand for in the STOP BANG OSA questionnaire?
(a) S (Snore): Yes or No
(b) T (Tired):
1) Do you feel fatigued during the day?
2) Do you wake up feeling like you haven’t slept?
(c) O (Obstruction):
1) Have you been told you stop breathing at night?
2) Do you gasp for air or choke while sleeping?
(d) P (Pressure):
1) Do you have blood pressure or on medications of high blood pressure?
_______ coupled with the use of forceps is the best method of removing obstructing foreign bodies
Direct laryngoscopy
What med and dose would you use for PE
Lovenox 1 mg/kg subcutaneously q 12 hours
RADS are very responsive to β2 agonists
Rads are less responsive to B2 agonists
These issues with asthma; what is the action to take
1) Atypical presentation or uncertain diagnosis of asthma, particularly if additional diagnostic testing is required (bronchoprovocation challenge, allergy skin testing, rhinoscopy, consideration of occupational exposure).
2) Complicating comorbid problems, such as rhinosinusitis, tobacco use, multiple environmental allergies, suspected allergic bronchopulmonary mycosis.
3) Occupational asthma.
4) Uncontrolled symptoms despite a moderate-dose inhaled corticosteroid and a LABA.
REFER
What is the most common emboli for PE
thrombi
In the young otherwise healthy patient, pleuritis is caused by _______ or _______
viral respiratory illness or pneumonia
Essentials of Diagnosis for what?
(1) Clear rhinorrhea, hyposmia, and nasal congestion
(2) Associated Symptoms: Malaise, headache, and cough
(3) Erythematous, engorged nasal mucosa on examination without intranasal purulence.
(4) Symptoms last <4 weeks and typically < 10 days
(5) Symptoms are self-limited.
Upper Respiratory Infection
What would you suspect?
Your pt has Onset of symptoms that simulate asthma with cough, wheeze, and dyspnea within 24 hours after exposure with persistence for at least 3 months.
RADS
During severe asthma exacerbations, airflow may be too limited to produce wheezing, and the only diagnostic clue on auscultation may be _____________.
globally reduced breath sounds with prolonged expiration.
Essentials of Diagnosis for Pneumothorax
Absent or decreased breath sounds, hyper resonance to percussion on affected side
What action would you take:
If patient is stable, not in any acute distress, with normal vital signs and you suspect COPD in a patient with no previous COPD dx
consult with MO, referral for PFT’ s and pulmonology referral
These are PE for What?
(a) Pleuritic chest pain, tachypnea, tachycardia.
(b) Chest pain ranging from minimal to severe and dyspnea occur in almost all patients.
Pneumothorax
Essentials of DX for what issue
(1) Episodic or chronic symptoms of wheezing, dyspnea, or cough.
(2) Symptoms frequently worse at night or in the early morning.
(3) Prolonged expiration and diffuse wheezes on physical examination.
(4) Limitation of airflow on pulmonary function testing or positive Broncho provocation challenge.
(5) Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy.
Asthma
True/false
Most likely, the IDC will not definitively diagnose a pulmonary embolism
True….. =[
These issues usually cause what?
(a) Trauma to the larynx.
(b) Foreign body aspiration.
(c) Laryngospasm
(d) Laryngeal edema from thermal injury or angioedema
(e) Infections
(f) Acute allergic laryngitis.
ARDS
A pt with one or more of these issues would be considered for what Dx?
(1) Acute onset or worsening of dyspnea at rest.
(2) Tachycardia, diaphoresis, cyanosis.
(3) Pulmonary rales, rhonchi; expiratory wheezing.
(4) Radiograph shows interstitial and alveolar edema with or without cardiomegaly.
(5) Arterial hypoxemia.
Pulmonary Edema
Should you Medivac one of these patients?
YES
Treatment regimens for pulmonary tuberculosis and tuberculous meningitis
- initial 2-month phase of a 4-drug regimen followed by a continuation phase
- continuation phase of an additional 4 to 7 months of rifampin and isoniazid for pulmonary tuberculosis
- continuation phase of an additional 7 to 10 months of rifampin and isoniazid for tuberculous meningitis
Treatment of asthma exacerbations:
What is the action to take if your patient has a poor reaction to a SABA, IE PEF < 50% predicted or
personal best and have symptoms of respiratory distress
refer to emergency room/evac
What does the BANG stand for in the STOP BANG OSA questionnaire?
B (BMI): - Is your BMI>28 A (Age): - Are you older then 50 N (Neck): - For males is you neck> 17 inches, For females is your neck>16 inches G (Gender): - Are you a male
True/False
COPD is preventable, manageable and reversible
False
Irreversible damage is done
Colds usually persist for ______ in the normal host, although clinical illness may last as long as ______ in up to 25 percent of patients, particularly smokers.
3 to 10 days
two weeks
______ is the screening tool of choice for the detection of rib fractures,
CXR
Rib Fx
What can help prevent hypoventilation and atelectasis?
Continuous body positioning and oscillation therapy
PE findings of what?
(1) The two major symptoms of this are MSK chest pain and respiratory distress.
(2) Tachypnea with shallow respirations secondary to pain will be seen.
(3) Paradoxical chest wall movement may not be seen in a conscious patient due to splinting of the chest wall.
(4) Crepitus is often present.
(5) When fatigue or underlying pulmonary injury develops, frank respiratory failure may supervene.
flail chest
Most common presentation of Pulmonary edema in developed countries is one of acute or subacute deterioration of
chronic heart failure
True/False
Disposition of PE patients
In most cases, pulmonary edema responds slowly to therapy
FALSE
responds rapidly
ARDS Immediate first steps
Foreign bodies such as meat may be removed by
Heimlich maneuver
What is the max dose for furosemide?
600mg/day
Risk factors for pulmonary embolism are the same as for deep vein thrombosis What is the triad called?
Virchow’s Triad
instructions for Patients with easy, uncomplicated removal of an obstructing foreign body
(a) Eat more slowly.
(b) Chew more thoroughly.
(c) Swallow more carefully.
What are the meds used to treat symptoms for URI
- Acetaminophen 325mg 1-2 tablets po q4-6h prn fever or pain
- Pseudoephedrine
- Immediate release: 60 mg every 4 to 6 hours
- extended release: 120 mg every 12 hours or 240 mg every 24 hours
- Oxymetazoline (Afrin) nasal
- 12 Hour Nasal Relief Spray: 0.05% (15 mL, 30 mL), Intranasal: Instill 2 to 3 sprays into each nostril twice daily for 3 days
Rib FX
_____ is paramount in facilitating adequate ventilation
Pain control
What is a complication for PE
Bronchospasm
may occur in response to pulmonary edema and may itself exacerbate hypoxemia and dyspnea.
What is the first line therapy for asthma management?
Inhaled corticosteroids
Stable or unstable?
1) RR <24/min, HR 60-120/min, BP normal, O2 Sat >90%.
2) Able to speak in sentences.
3) Obtain chest X-ray in 3-6 hours and compare with arrival Chest X-ray.
Stable
What would you use to treat pneumonia?
- Antipyretics,
- cough suppressants as needed.
- Maintain hydration and oral intake
- Empiric antibiotic options for patients with community-acquired pneumonia who do not require hospitalization
“Pink Puffer” is _____ predominant
Emphysema
what are some ddx for TB
(1) Pneumonia
(2) Cystic Fibrosis
(3) Chronic Bronchitis
What is the adverse effects of INH
> 10%: Hepatic, toxicity, increased serum transaminases
The Pt presents with theses issues during PE what do you suspect.
(1) Pleuritic chest pain may produce a sense of dyspnea.
(2) Pain is usually localized, sharp, and fleeting.
(3) It is made worse by coughing, moving, and breathing.
(4) Friction rub may be present on lung auscultation.
- If present, rub may lessen or disappear when effusion occurs.
(5) Pain may refer to the ipsilateral shoulder.
(6) Fever, Myalgia’s, headache, nasal congestion, or flu-like symptoms may also be present.
Pleuritis
What are the important parts of a CBC to consider when treating hemoptysis
- hemoglobin and hematocrit (to assess the magnitude and chronicity of bleeding),
- white blood cell count and differential (evidence for infection)
True/false
Clots that form pulmonary emboli are most commonly from the femoral or pelvic venous beds
True
CXR for COPD might reveal what?
-nonspecific peribronchial and perivascular markings
(dirty lungs) seen with bronchitis predominant
-may show hyperinflation and flattening of the diaphragm in half the cases. (Emphysema)
ARDS Immediate first steps
Obstructing liquids and particulate matter can be removed with…….
rigid suction device with a blunt tip (Yankauer).
PT presents with these issues what would you suspect?
(1) Patients complain of cough, fever, and constitutional symptoms.
(a) Cough is initially dry but can become productive.
(b) Often associated with midline chest pain or burning.
(2) Hemoptysis, wheezing, and rales may be present.
(3) Rhonchi that clears with coughing is a characteristic finding.
(4) The presence of rales is more characteristic of pneumonic consolidation or other condition involving the pulmonary parenchyma.
(5) Cigarette smoking is a cause or contributing factor in many cases.
Bronchitis
_____ benign, self-limited syndrome representing a group of diseases caused by members of several families of viruses.
Common Cold/ URI
What is the first line Tx for flail chest?
Supplemental oxygen
What are the mainstays of treatment for the patient with multiple rib fractures
Rapid mobilization
respiratory support
pain management
What are some complications of OSA
(1) Motor vehicle crashes.
(2) Cardiovascular morbidity.
(3) Metabolic syndrome and type 2 diabetes
(4) Nonalcoholic fatty liver disease.
Clearing of pulmonary infiltrates in patients with community- acquired pneumonia can take __ weeks or longer.
6
What meds are used to treat TB
Isoniazid
Rifampin
What is the first line diagnostic study when OSA is suspected?
In-laboratory polysomnography
What drugs are used to bust clots
Streptokinase, urokinase, and recombinant tissue plasminogen activator
Can you do Arterial Blood gasses for acute exacerbations on ship?
No they are obtained at higher levels of care that have capability
Your pt presents with these issues acutely what do you suspect?
(a) Severe dyspnea
(b) Production of pink, frothy sputum.
(c) Diaphoresis
(d) Cyanosis.
Pulmonary edema
What are some Med choices for pleuritis
Analgesic / Antipyretic / Non-Steroidal Anti-Inflammatory Drugs (NSAID).
-Acetaminophen 325-1000 mg PO q 4-6 max 4g/24h
-Aspirin 160-325 mg daily
-Nsiads
Codeine - T3 300/30mg 1-2 tabs q4h.
Morphine 2-8 mg intravenously may be repeated after 2-4 hours
The reference standard for PE diagnosis is….
pulmonary angiography
Does lovenox bust the clot?
no
If you answer is YES to ___ or more questions (categories) then you are high risk of having OSA and require referral for a sleep study.
three
What are the Empiric antibiotic options for tx pneumonia?
Macrolides
->Azithromycin, 500 mg orally as a first dose and then 250 mg once a day for 4 days, or 500 mg daily for 3 days.
Tetracyclines
-Doxycycline 100mg BID for 7 days.
Fluoroquinolones
-Levofloxacin 500 mg orally once a day for 7 days
-Moxifloxacin 400 mg orally once a day for 7 days.
True/False
For OSA you should subscribe Ambien 1 tablet 50mg every evening for two weeks to your patients to help them sleep.
False
No Meds are indicated for OSA specifically… Treat the underlying causes
The most common and characteristic initial symptoms are ______, _______, ______
Cough is common and tends to appear after
the onset of _________
nasal discharge
nasal obstruction
dry or “scratchy throat”.
nasal discharge and obstruction
What cause of ARDS happens more frequently in children than adults?
Aspiration of foreign bodies
______ are the most common injury sustained in blunt thoracic trauma
Rib Fx
What action would you take:
Exacerbation is if there is SOB, dyspnea or a
lot of wheezing
add Oral Steroids in addition to the Albuterol
Prednisone
What action would you take:
If patient is unstable, experiencing an acute exacerbation, has any acute distress or has any concerning abnormal vital signs,
discuss with MO and MEDEVAC
Essentials of diagnosis for what?
(a) History of/or predisposition to aspiration.
(b) Indolent symptoms, including fever, weight loss, malaise.
(c) Poor dentition.
(d) Foul-smelling purulent sputum (in many patients).
Aspiration Pneumonia and Lung Abscess
Typical causes of acute cardiogenic pulmonary edema:
- Acute myocardial infarction or severe ischemia
- Exacerbation of chronic heart failure.
- Acute volume overload of the LV (Valvular regurgitation).
- Mitral stenosis
Essentials of Diagnosis for Hemothorax
Decreased breath sounds, dullness to percussion on affected side. Respiratory distress and hypotension.
What can cause digital clubbing?
lung cancer, bronchiectasis, pulmonary fibrosis
________therapy may be required for some patients, such as those with right heart dysfunction, hemodynamic compromise, or cardiogenic shock
Thrombolytic therapy
What can you use for pain controll for Flail chest?
IV Morphine 2-8 mg
IV Fentanyl 50-100 mcg 1-2h prn
How would you tx a bronchospasm that occurred in response to PE
Beta-adrenergic agonists or intravenous aminophylline
Patient presents with these issues what would you suspect?
- Blue Bloater
- Productive cough for three months at a time within 2 years
- Major c/o is productive chronic cough with mucopurulent sputum
- Frequent exacerbations due to chest infections
- mild dyspnea
- In their 30s and 40s
Chronic bronchitis
Patients with OSA often report a family history of ____ or _______.
snoring or OSA
What is a complication for pneumothorax
Tension pneumothorax
Hypercoagulability can be caused by
1) Medications (OCP, hormone replacement)
2) Inherited gene defects
All patients in respiratory distress with suspected tracheobronchial injury should be…….
endotracheal intubated
Physical findings for what?
(a) Respiratory distress, tachypnea, variable degrees of hypoxia.
(b) Dullness to percussion, decreased breath sounds on affected side.
(c) Hypotension and flattened neck veins depending on degree of blood loss.
(d) Pulse pressure narrow.
(e) Smaller illnesses may be difficult to detect in supine patients because of gravity.
Hemothorax
Essentials of Diagnosis for what?
(1) Sudden onset of intermittent (fleeting) pain in the chest wall.
(2) Usually follows an injury or illness.
(3) Pain worsened by coughing, sneezing, deep breathing, or movement.
Pleuritis
