Respiratory Flashcards
COPD causes
Smoking Air pollution Second hand occupational alpha 1 antitrip chronic resp infx children
COPD presentation
few complaints, avoid exertion
resp: dyspnea, chronic cough morning sputum
ill: cough, sputum, wheezing, dyspnea
COPD two types describe
Chronic bronchitis: blue bloater, imbalance ventilation/perfusion (hypoxemia, polycythemia) PULMONARY HTN COR PULMONALE sputum 3 months for 2 years
Emphysema: pink puffer, pursed lip breathing, thin, tachycardic, hyperventilate
COPD PE
distant lung sounds, resonant on percussion prolonged expiration accessory muscle use clubbing neck vein distention during exp. tender liver (R sided heart failure)
COPD diagnosis
spirometry FEV1/FVC 80 2. mod 50-80 (SOB becomes problematic) 3. severe 30-50 (Impact QOL) 4. very severe
Treatment COPD
- bronchodilator prn SHORT ACTING (anticholinergic or beta2)
- LONG ACTING bronchodilator
- ICS + LA
- ICS + LA beta 2 + LA anticholinergic
Beta 2 agonist
Albuterol + levalbuterol
Formoterol (long acting)
Anticholinergics
PIUM
ICS
(ONE)
not monotherapy
STAGE 3 or 4 COPD
Oxygen therapy in COPD
PaO2 of 55 or less (O2 sat 88% or less)
Most common cause of COPD exacerbation and treatment
Resp tract infection (spneumo hflu chlamydia mcatarrhalis)
amox, doxy, bactrim, z pack, clarithro, levaquin
give abx: ^ SOB, ^ sputum volume, ^purulence
Complicated pneumonia ie smoker
levaquin
Community acquired pneumonia at risk
Old young Smokers, alcohol GERD Chronic disease institutionalized
CAP S/S
cough dyspnea fever hemoptysis pleuritic chest pain fatigue malaise
older adults change in mental status
CAP PE
crackles don't clear diminished breath sounds consolidation on percussion (dull) egophany bronchophany increased tactile fremitus INCREASED sound at based
pediatric CAP
FEVER** cough post tussive nausea vomiting
if anxious, drowsy delirious, splingting, laying with knees to chest O2
Gold standard dx pneumonia
Infiltrate on x ray (dense homogenous opacification on RUL)
Get x ray if HR>100, Temp>100 RR>20 or two of following:: crackles, decreased breath sounds, lack of asthma
Segmental pneumonia caused by
aspiration
Interstitial pneumonia caused by
idiopathic pulmonary fibrosis
Bronchopneumonia AKA
community acquired peumonia
CBC pneumonia
^ neutrophils
shift to left: bands or stabs infectious process
shift to right: increase mature cells
Bacterial organisms of pneumonia OUTPATIENT
Strep pneumo (gram +) green thick Mycoplasma H flu (gram - anareobic) Chlamydia Resp. viruses
Pneumonia inpatient
staph (+) , klebsiella (gram- upper lobe current jelly sputum) legionella (contaminated water), gram -**
Pneumonia treatment
CAP no comorbidity
CAP with comorbidity
if recent abx use
Macrolide (pneumo, flu+ atypical)
Doxy (klebsiella, mycoplasma,
Comorbidity: Resp fluoroquiniolone or macrolide
comorbidity and recent abx use: resp fluoroquinolone OR macrolide.doxy+ vantin or ceftin, high dose augmentin, rocephin
