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MJ- Disciplines Exam 3 > Respiratory emergencies- Tx and Dx > Flashcards

Respiratory emergencies- Tx and Dx Flashcards

1
Q

What organism is Bullous Myringitis caused by and how do you tx it?

A

Mycoplasma pneumoniae

Macrolide

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2
Q

What is the dx

A

PNA w/ lobar infiltrates

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3
Q

Dx?

A

Lobar infiltrates:

RLL PNA

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4
Q

Dx?

A

Lobar infiltrates:

PNA of the lingula of the left upper lobe

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5
Q

What are the 7 things you do to tx PNA

A
  1. —IV fluids
  2. —Antipyretics
  3. —Oxygen
  4. —Bronchodilator
  5. —Antibiotic(s)
  6. —Cough suppressant with expectorant
  7. —Steroids (if COPD or recurrent PNAs)
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6
Q

What abx should be giving for HCAP?

A
  • Cefepime OR Ceftazidime OR Piperacillin-tazobactam
  • Ciprofloxacin OR Levofloxacin
  • Vancomycin
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7
Q

What is the diagnostic test of choice for PNA?

A

CXR

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8
Q
A
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9
Q

How is altitude acclimatization tx?

A

Descent

Acetazolamide (helps correct resp alkalosis by causing bicarbonate diuresis)

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10
Q

How is acute mountain sickness treated? (5)

A
  1. Halt further ascent until sxs resolve (go back down)
  2. Oxygen (0.5-1L/min)
  3. Acetazolamide
  4. Aspirin, Tylenol, Motrin
  5. Dexamethasone
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11
Q

How can someone prevent acute mountain sickness? (5 things, 2 are meds)

A
  1. Gradual ascent
  2. Avoid overexertion, alcohol, respiratory depressants
  3. Eat high carb meals
  4. Acetazolamide (24hrs before ascent)
  5. Dexamethasone
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12
Q

What 4 things are used to tx high altitude cerebral edema?

A
  1. —Oxygen
  2. —Descent/Evacuation
  3. —Dexamethasone
  4. —Loop diuretics (Furosemide, Bumetanide)
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13
Q

What 4 things are important in tx of High altitude pulmonary edema?

A
  1. —Recognition
  2. —**Immediate descent is TOC**
  3. —Oxygen (may take 72hrs to resolve)
  4. —Nifedipine

“IRON”

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14
Q

What is shown here?

A

Cardiomegaly

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15
Q

What are the arrows pointing to?

A

**Kerley B lines= CHF

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16
Q

What is seen in the picture on the right and what condition is this finding characteristic of?

A

Kerley B lines

CHF

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17
Q

Is ultrasound or CXR better at diagnosing CHF?

A

Ultrasound (presence of B lines 94% sensitive)

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18
Q

What is shown in the following ultrasound report and what condition is this sensitive for?

A

A and B lines –> CHF

(B lines= columns: means there is fluid in lungs)

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19
Q

What is the tx plan for CHF?

A
  1. Adequate oxygenation and ventilation
  2. Nitroglycerin (reduces preload/BP)
  3. Morphine Sulfate (decreases preload/anxiolysis)
  4. Diuretic (Furosemide MC, Bumetanide can also be used)
  5. +/- Dobutamine (Not commonly used)

“MONDD”

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20
Q

What 4 things should you AVOID giving to patients w/ CHF?

A
  1. CCBs (can cause pulm edema and cardiogenic shock)
  2. NSAIDs (inhibit diuretics)
  3. Anti-arrhythmics

“CAN”

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21
Q

You have a pt that presents w/ pleuritic CP, SOB and hemoptysis

–> what is the most likely dx?

A

Triad for Pulmonary Embolism

22
Q

What is the diagnostic test of choice for Pulmonary embolism?

A

CT

23
Q

What is the name of the classic sign seen on this CXR and what condition is this indicative of?

A

Hampton’s Hump= Pulmonary Emboli

24
Q

The following classic CXR sign is seen in what condition?

A

Pulmonary Embolism

25
Q

What are 3 classic signs that might be seen on CXR in a pt w/ a pulmonary embolism?

A
  1. Hampton’s hump (triangular infiltrate)
  2. Westermark’s sign (dilated pulm vessels proximal to embolus w/ sharply demarcated cutoff)
  3. Fleischner sign (distended central pulm aa)
26
Q

The following CT results show what condition? Which side is more severe?

A

Pulmonary embolism

Right= saddle PE (usually fatal)

27
Q

How do you tx a pt w/ a PE?

A
  1. Anticoagulation
    • Heparin
    • Coumadin
    • Lovenox
    • Rivaroxaban (Xeralto)
    • if anticoag CI: vena caval filter
  2. +/- Thrombolytics for massive PE if not contraindicated (major bleed w/in 6 mo, recent surgery, suspected aneurysm, etc)
    • Streptokinase
    • Urokinase
    • Alteplase (Activase) tPA–> only one FDA approved
  3. +/- embolectomy (if massive PE w/ CI to fibrinolysis)
  4. +/- catheter directed thrombolysis (if CI to fibrinolysis)
28
Q

How would you tx a pt w/ a massive PE?

A
  1. Anticoagulation
    • Heparin, Coumadin, Lovenox, Rivaroxaban
    • Venal caval filter if CI to anticoag
  2. Thrombolytics
    • Streptokinase
    • Urokinase
    • Alteplase (Activase) tPA--> only one FDA approved
  3. +/- Embolectomy if CI to fibrinolysis
  4. +/- Catheter directed thrombolysis if there are contraindications to the other treatments
29
Q

How do you tx a massive PE with contraindications to fibrionlysis or unstable after fibrinolysis?

A
  1. Anticoagulation
  2. Embolectomy
30
Q

What is Catheter directed thrombolysis used to tx and what meds are used?

A

Massive PE

  1. —Alteplase infused over 4 hours
  2. —Begin heparin infusion (no bolus) after alteplase completed
31
Q

How do you tx asthma/COPD in the ED?

A
  1. Beta agonist- Albuterol
    • ​via MDI or nebulizer (both have equal efficacy but prob use nebulizer in ED b/c easier)
  2. Ipratropium Bromide (given w/ albuterol)
  3. Corticosteroids ​
    • Dexamethazone, Methylprednisolone, Prednisone
    • high dose steroids not recommended
  4. Magnesium sulfate (for severe exacerbations)
  5. Heliox (MCly used in peds but not usually recommended)
  6. +/- Ketamine (conscious sedation)
  7. +/- Epinephrine (studies show no better than albuterol)
32
Q

Would you give a beta agonist continuously or intermitently in a severe asthma/COPD exacerbation seen in the ED?

A

continuous

33
Q

What med is no longer recommended in the tx of asthma/COPD exacerbations?

A

Theophylline

(b/c of narrow therapeutic window and many side effects)

34
Q

instead of using a beta agonist, Ipratroprium bromide and corticosteroids to tx asthma/COPD in the ED, what else can be used?

A

Non-invasive ventilation:

BiPAP- bilevel positive airway pressure (pt usually comes in on CPAP and is switched over to BiPAP b/c this is more physiologically normal)

(for moderate-severe dyspnea but no need for intubation)

35
Q

When should FB aspiration ALWAYS be considered?

A

In kids w/ unilateral wheezing and persistent sxs that don’t respond to bronchodilators

36
Q

What does the following CXR show?

(this is very subtle and probably won’t be on the exam)

A

Hyperexpansion of the R lung due to FB aspiration

37
Q

Where is this FB? Why?

A

Esophageal FB in the Thoracic inlet =

  • Thoracic inlet b/c at the level of the clavicles, site of anatomical change from skeletal to smooth mm, also transition of cricopharyngeum mm
  • Esophageal b/c coin is flat, and posterior to trachea (black line on right pic)

(test question)

38
Q

Where is this FB?

A

Esophageal FB

(b/c can see trachea/black line to the left)

39
Q

Where is this FB

(this is tricky, prob won’t be question)

A

Esophageal FB (b/c below bifurcation of the trachea)

Thoracic inlet, mid or GE junction

40
Q

Where is this FB located?

A

Right mainstem bronchi

41
Q

What is concerning about this FB?

A

It is a button battery! Can cause necrosis and burn hole through structure

MUST BE REMOVED

42
Q

How do you tx FB aspiration in a conscious patient?

A

Ask “are you choking” and “may I help you”

if pt can answer then let them cough, if can’t then perform the heimlich maneuver

43
Q

How do you tx a FB aspiration in an infant/child?

A

place infant stomach down across your forearm and give 5 quick, forceful blows on the infants back w/ the heel of your hand

44
Q

How do you tx a FB aspiration in an unconscious patient? What should you not do?

A
  • CPR
  • Magil forceps removal

(do NOT perform blind finger sweep)

45
Q

Your patient presents for evaluation of an elevated temperature and productive cough. 134/80, 50, 24, 102.4, 92% RA. Labs are significant for leukocytosis of 16k and sodium of 127. Based on this presentation, what etiologic agent do you suspect? How do you tx?

A

Legionella

tx w/ Macrolide (Azithromycin)

46
Q

What is the tx of choice for high altitude pulmonary edema?

A

Immediate descent

47
Q

—You are evaluating a 56 year old male with history of colon cancer, on chemotherapy, who presents for evaluation of shortness of breath. 90/40, 123, 28, 87% RA, 101.1. You give IV fluids, O2, monitor and obtain the following CXR.

How do you tx (in general)?

A
  • Antibiotics
  • Antipyretic
  • Nebulized treatments
48
Q

You are evaluating a 56 year old male with history of colon cancer, on chemotherapy, who presents w/ SOB. Vitals: 90/40, 123, 28, 87% RA, 101.1. You give IV fluids, O2 and monitor. CXR is negative. What is your next step?

A

Order CT

CT shows BI PE so give anticoagulation

49
Q

how do you tx someone ORALLY with CAP caused by Strep pneumo, H. influenza, Moraxella catarrhalis, Bordetella pertussis, Legionella, Mycoplasma pneumniae and chlamydia?

A

Levofloxacin

OR
Quinolone

OR

Doxy

OR

Macrolide

50
Q

How do you tx someone IV for CAP that is caused by Strep pneumo, H. influenza, Moraxella catarrhalis, Bordetella pertussis, Legionella, Mycoplasma pneumoniae, Chlamydia

A

Levo or Moxi or Doxy or Tigecycline

OR

Ceftriaxone + Doxy or Azithromycin

MJ- Disciplines Exam 3 (11 decks)

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