Respiratory MDT Flashcards
ACUTE - <3months
- Cough with midline burning chest pain
- Cough starts dry then progresses to productive
- Fever
- Dyspnea
- Hemoptysis (possible)
- Wheezing (possible)
- Crackles/Rales (possible)
RHONCI THAT CLEARS WITH COUGHING
Smokers
Acute Bronchitis
How to differentiate between pnuemonia and bronchitis?
Chest x-ray will show lower lobe infiltrate
- blood in the nose
- respiratory distress
- adventitious lung sounds
- clubbing of the fingers (cancer)
- skin rash
- bruits/murmurs that increase with inhalation
- smoking
- cough
- fever
Hempotysis
Immediate tx for hemoptysis?
- Adequate O2
PATIENT POSITION
* on the affected side (protect non-effected lung from spillover blood)
PATENT AIRWAY
(DEFINITIVE AIRWAY)
* Large bore ET tube 8 or greater for interventional and diagnostic bronchoscopy
- acute/subacute Fever
- cough with or without sputum
- dyspnea
- tachypnea
- tachycardia
- ill appearing
- diminished O2 sats
Sounds:
* crackles/rales
DULLNESS TO PERCUSSION
Smell
* Foul smelling productive cough suggests anaerobic infection
- constitutional symptoms
Pnuemonia
Labs for hemoptysis?
CBC - hct/hb , wbc
- Secondary to penetrating injury most common
- Decreased breath sounds on affected side
- Dullness to percussion on affected side
- Respiratory distress
- Hypotension
- Tachypnea
- Hypoxia
- Flattened neck veins
- Narrow pulse pressure
Hemothorax
Tx for hemothorax?
Airway
O2
Suctioning
Chest tube thoracostomy 36fr – 40fr
- Diminished breath sounds
- Hyper resonance on affected side
- Decreased chest movement on affected side
- Chest pain
- Tachypnea
- Tachycardia
- Dyspnea
- Guarding
Pnuemothorax
Treatment for worsening pnuemothorax?
14 guage 3.25 inch over the needle catheter
2nd intercostal space mid clavicular line over the top of the rib
- Tracheal deviation away from distress
- Resp distress
- Tachypnea
- Tachycardia
- Hyperresonance to percuss
- Decreased or absent breath sounds
- Neck veins may be distended
Tension Pneumothorax
- Cough >3 months w/ 2 consecutive years
* Productive Chronic Cough
Chronic Bronchitis
- Over distention of the lungs (Barrell chest)
- Decreased intensity of breath and heart sounds
- Prolonged expiratory phase
- Wheezing – airway obstruction
- Dyspnea
- Chronic cough
- Pursed lips, accessory muscle use, retractions
Emphysema/ COPD
- Dyspnea with exertion
- Wheezing
- Breathlessness
- Chest tightness
- Cough (night or early morning)
- Airway can become inflamed and constricted
Asthma
Daytime somnolence
Loud snoring with apneic events
never feel rested
- Obese
- Large neck
- fat old white guy
Obstructive sleep apnea
Disposition for OSA?
retain
- sudden onset of intermittent chest pain, localized
- fleeting pain
- Dyspnea
- possible friction rub on auscultation
- HX of injury/illness
** Chest pain worsens with coughing, deep breathing, sneezing ***
- PAIN REFERRED TO IPSILATERAL SHOULDER
Pleuritis - Possibly caused by COVID-19, or the flu
Disposition of pleuritis?
MEDEVAC if unstable or need cxr to identify issues
Complaint:
* Acute or worsening dyspnea at rest
(SEVERE DYSPNEA)
Presentation
- Tachycardia
- Cyanosis
- Diaphoresis
- Pink frothy sputum (fluid leaking from vasculature into the lungs)
Auscultation
- Crackles/Rales
- Rhonchi
- Expiratory Wheezing
Pulmonary Edema
Predisposition of venous thrombosis (especially lower extremities)
Fam hx of thromboses
- ACUTE dyspnea (always PE as differential)
- ACUTE Pleuritic chest pain
- Tachycardia, Tachypnea
- Cough
- Anxiety
- Hemoptysis
- Low fever
- Hypotension
- Cyanosis
- Pleural friction rub
- A-fib
VIRCHOW’s TRIAD
Pulmonary Embolism
Tx for Pulmonary Embolism?
Lovenox
- Crepitus
- Localized pain
- Pain with inspiration
- Dyspnea
- Shallow/Fast breathing
Obvious trauma or history of trauma
Rib fracture
Tx for rib fracture?
Stable Patient:
Incentive Spirometry
Pain Meds
Deep breathing exercises
- Segment of chest is floating
Pain (worse than rib fracture)
Respiratory Distress
Crepitus
- Tachypnea with shallow respirations secondary to pain
- Paradoxical movement
Flail chest
