Respiratory Flashcards
Define Dyspnea
SUBJECTIVE feeling of difficult, labored breathing
What is orthopnea MCly seen in?
CHF
Define hypoxemia
low ARTERIAL oxygen, Pa02 under 60 mmHg
Define stridor and causes for it
Upper airway, Inspiratory Causes: 1. FB 2. Croup 3. Epiglottis
Define wheezing and causes
Lower airway, expiratory Causes: 1. Asthma 2. COPD 3. FB 4. Cardiogenic pulmonary edema
Define Rales and causes
Lower airway, velcro sound
Causes:
CHF
Define Rhonchi/crackles and causes
Lower airway
Causes:
Pneumonia
Define Respiratory Distress or Failure
Inadequate oxygenation and/or ventilation
What organism is associated with bradycardia and hyponatremia in pneumonia?
Legionella
What organism is associated with bullies myringitis in pneumonia?
Mycoplasma pneumonia
Define CAP
PNA in patient who has not been hospitalized or resident of long-term care facility for 14 days prior to presentation
Define Hospital-acquired (nosocomial) and Ventilator-acquired PNA
PNA occurring > 48 hours after admission or intubation
MC cause of pneumonia
Streptococcus Pneumoniae
MC presentation in Streptococcus Pneumoniae
- Sudden onset fever
- Rigors
- Productive cough
- Dyspnea
CXR findings in Streptococcus Pneumoniae
- Lobar infiltrate
2. Para-pneumonic pleural effusion (25%)
What organism causes a secondary bacterial pneumonia following influenza?
S. aureus
Define high altitude illness
- Hypoxic environment
2. Partial pressure changes with elevation
@ what elevations do we see high altitude illness?
5,000 feet
MC @ 8,000-14,000 ft
Ventilation acclimization
Increased ventilation rate
Induces respiratory alkalosis
Blood acclimization
Increased red cell mass
Begins 2 hrs. after ascent
Fluid acclimization
- Peripheral venoconstriction- increases central blood volume
- ADH and aldosterone suppressed- Diuresis
Cardiovascular acclimization
- Decreased SV, Increased HR
- Pulmonary vessels constrict
- Increased cerebral blood flow
Sleep acclimization
Cheyne-stokes breathing
Acute mountain sickness sx’s
- Lightheaded
- HA-Worse with valsava or bending over
- Breathlessness with activity
- Weakness
- Irritability
- Nausea
What is the hallmark findings in Acute mountain sickness
Fluid retention
Pathophysiology of Acute mountain sickness
D/t hypobaric hypoxia
Cerebral blood flow increases–>brain enlarges–>vasogenic edema
Acute mountain sickness treatment
- Discontinue ascent
- Oxygen
- Acetazolamide
- ASA, Tylenol, Motrin
- Dexamethasone
Acute mountain sickness prevention
- Gradual onset
- Avoid overexertion
- Avoid alcohol
- High carb meal
- Acetazolamide
- Dexamethasone
High Altitude Cerebral Edema sx’s
- AMS
2. Neurologic sx’s: CN 3 & 6 Palsy- Eye is down and out
What is the most lethal high altitude illness
High Altitude Pulmonary Edema
High Altitude Pulmonary Edema etiology
Pulmonary HTN
High Altitude Pulmonary Edema sx’s
- Dry cough–>productive cough
- Increasing dyspnea
- Coma, death
What is the treatment of choice in High Altitude Pulmonary Edema
- Immediate descent
- Nifedipine
- Oxygen
What is the MC reason for admission in medicare pt’s?
CHF
What BNP value is suggestive of CHF?
200
EKG findings in CHF
LV hypertrophy
What imaging has both the highest sensitivity and specificity in CHF?
US
CXR findings in CHF
- Cardiomegaly
- Enlarged pulmonary artery
- Pleural effusions
- Kerley B lines
US findings in CHF
B lines
What does an echo evaluate in CHF?
- LV and valvular function
- Tamponade
- VSD
Pharmacologic treatment in CHF
- NTG-Reduce preload and BP
- Diuretic (Lasix)
- Morphine sulfate- Reduces preload
- Dobutamine-adjunct to NTG, use in hypotensive pt’s
What medications do you want to avoid in CHF?
- CCB
- NSAIDs
- Anti-arrhythmias
Virchows triad
- Venous stasis
- Vessel wall inflammation/injury
- Hypercoagulability
PE risk factors: MOIST CAMEL
M-Malginancy O-Obesity I-Immobilizations S-Surgery T-Trauma
C-CHF A-Age: 40+ M- Mobility (lack of) E-Estrogen excess L-Long bone fx S-Smoker
Triad of sx’s in PE
- Pleuritic CP
- Dyspnea
- Hemoptysis
CXR findings in PE
- Hampton’s Hump
- Westermark’s sign
- Fleischner sign
What is considered by most to the dx test of choice in PE
CT scan
What echo findings indicated a poor prognosis in PE
RV enlargement + RV dysfunction= large clot
MC EKG finding in PE
Sinus tachycardia
Followed by T wave inversion
“Classic” EKG findings in PE
S1Q3T3
Anticoagulation treatment in PE
- Heparin
- Coumadin
- Lovenox
- Rivaroxaban (Xeralto)- factor Xa inhibitor
Indications for thrombotic treatment in PE
Massive PE
Hemodynamically unstable
Asthma pathophysiology triad
- Airway inflammation
- Obstruction to airflow
- Bronchial hyperresponsiveness
Asthma clinical triad
- Dyspnea
- Wheezing
- Cough
COPD definition
Chronic irreversible disorder
Define Chronic Bronchitis
- Presence of chronic productive cough for 3 months in 2 successive years
- Clinical diagnosis
Define Emphysema
- Destruction of bronchioles and alveoli
2. Pathologic diagnosis
What does FEV1 measure?
Severity of pt’s airway restriction
What are the treatment goals in COPD?
- Reverse airflow obstruction
- Provide adequate oxygenation
- Relieve inflammation
What is the cornerstone of therapy in Asthma/COPD?
- Beta Agonist: Albuterol
2. Corticosteroids (high-dose): Prednisone, Methylprednisolone, Dexamethasone
Role of Epinephrine in COPD?
Acts as a bronchodilator
NOT beta selective
What location of the airway does Ipratropium Bromide (anti-cholinergic) primarily work at?
Large central area
What is Magnesium Sulfate reserved for?
Severe exacerbations
What is Heiolx reserved for?
Severe reactions in pediatrics
BiPAP indications
- Cooperative patient
- Dyspnea (moderate to severe)
- Tachypnea (>24 breaths per minute)
- Increased work of breathing
- Hypoxemia
BiPAP contraindications
- Need for emergent intubation
- Cardiac or respiratory arrest
- Inability to protect airway or clear secretions
- Decreased LOC
- Facial trauma or deformity
- Recent esophageal surgery
What age groups does FB aspiration MCly occur in?
< 1 year and >75 years of age
Adult risk factors in FB aspirations?
- Altered level of consciousness
- Impaired swallowing mechanism
- Stroke related dysphagia
- Alzheimer’s dementia
- Parkinson’s disease
Where is the MC location for FB? What’s significant about this location?
Thoracic inlet
- Site of anatomical change from skeletal to smooth muscle
- Cricopharyngeus muscle