SOB

Question 1

symptoms of SOB

Answer 1

pain
fever
cough
fatigue
vom/diarrhea
weight loss

Question 2

common causes of SOB

Answer 2

COPD exacerbation
MI, PE, CHF
pneumonia
anemia (men: norm. HGB: 14-16, women: HGB: 13-15)
maligancy
arrythmias
reactive airway disease (like bronchospasm)

Question 3

5 life-threatening conditions of SOB

Answer 3

status asthmaticus
acute MI
PE
tension pneumothorax
acute pulmonary edema (sim. to CHF, but happens FAST!)

Question 4

SOB dx (besides hx, hx, hx)

Answer 4

CXR (portable)
EKG
CT scan, MRI (diff: MRI-no radiation, good for preggos but time consuming)
V/Q scan (vent/perf scan)
labs
ABG
lower extrem. venous doppler (good alt. to CAT scan)

Question 5

complications of SOB

Answer 5

worsening condition
death/disab. due to underlying condition
med SEs

Question 6

med SEs

Answer 6

arrythmias (albuterol), bleeding (ASA,anticoags), elev. BP (albuterol, antichol, sympathomim.), hyperglycemia (steroids), allergic rxn (abx)

Question 7

SOB tx depends on…

Answer 7

cause

consider risk vs. benefits, poss. complications

Question 8

COPD tx
(bronchospasm, inflammation, mucous production)
typ. chronic, can have acute exacerbation

Answer 8

bronchodilators (albuterol-tachycardia, hypokalemia, zolfamax? $, less SEs)
anticholinergics
steroids
epinephrine (if necessary)
Mag sulfate
O2

Question 9

oxygen capacity depends on ???

Answer 9

HGB, CO

Question 10

MI tx

Answer 10

BOAT MAN (old school)

B-blockers
O2
Aspirin
TPA(thrombolytics) if necessary (less for MI, more for CVA)

Morphine
Anticoags
Nitro (SL, transderm, IV)

newer tx: Plavix (antiplatelet)
coronary angiogram

Question 11

status asthmaticus

Answer 11

(sev. resp. distress–>bronchospasm–>crash) take over airway!

Question 12

PE tx/dx

mostly from legs, R UE

Answer 12

anticoag (LMWH)
tPA if needed (criteria: worsening even with anticoag, clot is so big need to bust open)
pulm. angiogram (take catheter to clot, sm. doses clot busters (tPA), risk of bleeding)
tx underlying cause of PE (protein C/S def., stasis, OCT)

Question 13

tension pneumothorax tx
(air from outside, trauma)
(emphysema, emboli bust open)

Answer 13

needle decompression (2nd IC space)
chest tube placement (get air/fluid out from pleural space)
tx cause of pneumo

Question 14

acute pulm. edema/CHF

pump fails, fluid inc. pressure in pulm. vasculature, leaks out–>fluid in lungs

Answer 14

tx symps:
aspirin
nitro
diuresis (dec. lung flooding, BP, Lasix)
stabilize vitals
O2
BIPAP or intubation (high press O2 to push fluid out)
tx underlying cause of CHF

Question 15

PE risk factors

Answer 15

OCT and smoking!

Question 16

MRI vs CT

Answer 16

MRI-no radiation, good for preggos but time consuming

also those allergic to radiation fluid (also V/Q scan)

Question 17

SOB labs

Answer 17

CBC
Troponin
D-dimer (helps if negative (sens., good at ruling out) , not specific

Question 18

STEMI in DM pts:

Answer 18

SOB, blunted pain response NEED EKG
lateral wall
V1, V5 (2+ leads), inferior?

Question 19

most common EKG in PE

most common CXR

Answer 19

sinus tachycardia or S1Q3T3

normal

Question 20

pulmonary HTN causes

Answer 20

right sided heart pressure, dilation

saddle emboli

Question 21

CHF causes

Answer 21

uncont. HTN, MI, valvular heart disease, congenital HD, cardiomyopathies, arrythmia/irreg. heart rhythms (doesn’t allow heart to fill), toxic ingestion (cocaine)

Question 22

causes of CHF exacerbation

Answer 22

do not intubate my pt against med ADvice
diet
non-compliance w. meds
infection
MI
PE
arrhythmias
metab. abn
anemia
drugs

Question 23

multilobar pneumonia risk for..

Answer 23

CHF