Review pulmonary Flashcards
outpatient CAP
S. pneumoniae, Mycoplasma pneumoniae, H. influenza, Chlamydia pneumoniae, RSV
inpatient CAP
S. pneumoniae, M. pneumoniae, C. pneumoniae, H. influenza, legionella, aspiration, RSV
inpatient ICU CAP
S. pneumoniae, S. aureus, legionella, gram-negative, H. influenza
CAP-alcoholics
anaerobes, Klebsiella pneumoniae
COPD/smoking CAP
H. influenza, psuedomonas aeruginosa,
Lung abscess CAP
CAP-MRSA, oral anaerobes, fungal pneumoniae, M. TB, atypical myocobacteria
HIV/AIDS CAP
M. TB, pneumocystsis jiroveci, cryptococcus, histoplasmosis, aspergillus, atypical myocobacteia, H. influenza, Pseudomonas aeruginosa
influenza CAP
influenza, S. pneumoniae, S. aureus, H. influenza
cough CAP
bordetella pertusis
Category 1 (outpatient, no cardiopulm disease)
S. pneumoniae, M. pneumoniae, RSV
Antibiotics: macrolide plus doxycycline
category 2 outpatient, cardiopulm disease or risk factors: COPD, DM
S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae
antibiotics: fluoroqionolone or beta-lactam + macrolide or doxycycline
category 3 inpatient, non-ICU
S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae
antibiotics: beta-lactam + macrolide, or fluoroquinolone
category 4A (inpatient ICU)
S. pneumoniae, legionella, H. infleunza
antibiotics: beta-lactam + macrolide OR fluoroquinolone
category 4B (inpatient ICU, RF for pseudomonas ) and consider MRSA risk factor
S. pneumoniae, legionella, H. infleunza, pseudomonas aeruginosa, CA-MRSA
antibiotics: anti-pseudomonal beta-lactam + aminoglycoside AND atypical coverage PLUS vancomycin or Linezolid
Light’s criteria for exudate
pleural fluid protein/Serum Protein: >.5 (3)
Pleural fluid LDH/Serum LDH: >.6 (200)
Pleural fluid LDH/upper limit normal serum LDH: >.66 (>2/3) (0-240)
light’s criteria for transudate
pleural fluid protein/Serum Protein: <.66 (2/3) (0-240)
pediatrics CAP: <1 month
G group B strep E. coli L. monocytogenes CMV HSV
pediatrics CAP: 1-3 months
virus
S. pneumoniae
afrebile pneumonitis pathogens
S. aureus
pediatrics CAP: 3months- 5 years
virus
S. pneumoniae
S. aureus
pediatrics CAP: school age
virus
M. pneumoniae
S. pneumoniae
C. pneuomoniae
HAP
penumoniae that develops <48 hours after admission that as not present on admission
VAP
pneumoniae that develops >48 hours after endotracheal intubation
HCAP
hospitalized for >1 day within 90days of admission
long-term nursing facilities
recent IV abx chemotherapy or wound care within 30 days
attended hospital or hemodialysis clinic
A-a gradient exceeds expectations?
diffusion impairment is present
a sat of 90% expect PaO2
60
normal PaO2 is approx
5X FiO2
on room air (21% FiO2) normal PaO2
is approx 100
normal PaO2: FiO2 on RA 100/.21= 475
every 1 liter is about 3% increase
ARDS severity: mild
PaO2/FiO2: 200-300
ARDS severity: moderate
PaO2/FiO2: 100-200
ARDS severity: severe
PaO2/FiO2: <100
what could an increased V/Q mean
PE
what could a decreased V/Q mean
Shunt
emphysema (non-functional alveoli)
fibrosis (poor diffusion of air)
secretions (blocks diffusion of air)
extrapulmonary shunt
right to left cardiac shunts
example: T of F
intra-pulmonary shunt
blood is transported through the lungs without taking part in gas exchange
example: atelectasis, pneumoniae, hepatopulmonary syndrome, AVM
diagnostic FEV1/FVC ratio
less than 70%
chronic respiratory failure is defined by
PaO250 mmHg while breathing air at sea level
stage I Mild COPD
FEV1/FVC 80%
stage II moderate COPD
FEV1/FVC <.7, FEV1 50-79%
stage III severe COPD
FEV1/FVC <.7, FEV1 30-49%
stage IV very severe COPD
FEV1/FVC <50% with chronic respiratory failure present
