Step Up to Med - Pulmonary Flashcards
two types of chronic obstructive pulmonary disease
chronic bronchitis
emphysema
clinical diagnosis of chronic bronchitis
chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years
permanent enlargement of air spaces distal to the terminal bronchioles due to destruction of alveolar walls
emphysema
fourth leading cause of death in the US
COPD
two main risk factors for emphysema
tobacco smoke
alpha 1 antitrypsin deficiency
excess mucus production narrowing the airways with productive cough inflammation and scarring occurs with enlargement in mucous glands and smooth muscle hyperplasia leading to obstruction
chronic bronchitis
destruction of alveolar walls due to relative excess in proteases or relative deficiency of antiproteases in the lungs
emphysema
tobacco smoke and
number of activated PMNs and macrophages
alpha 1 antitrypsin
oxidative stress
increase
decrease
increase
definitive diagnostic test in COPD
pulmonary function testing (spirometry)
what are the critical spirometry findings in COPD
decrease FEV1/FVC ratio
increase TLC residual volume and FRC
GOLD staging is based on
FEV1
GOLD staging and FEV1
> 80% pred - mild
50-80 mod
30-50 sev
<30 very sev
CXR changes in COPD
hyperinflation
flattened diaphragm
enlarged retrosternal space
in what conditions is CXR useful in COPD
during acute exacerbation to R/O pulmonary causes such as PNA or PTX`
should be measured in patients with a personal or family historyt of premature emphysema less that 50 y.o
alpha 1 antitrypsin
the most important intervention for COPD’ers
smoking cessation
what is the effect of quitting smoking on the rate of decling of FEV1
decreases the RATE of decline to that of a normal person but WILL NOT reverse it
what are the three medications commonly employed in the treatment for COPD
ipratropium bromide
albuterol
corticosteroids
dhown to improve survival and QOL in patients with COPD AND chronic hypoxemia
oxygen therapy
requirements for home O2 (2)
PaO2 <55mHg on ABG
OR
O2 sat <88%
what two vaccinations are necessary for COPD’er
strep pneumo every 5-6 years, patients with severe disease before 65
anually get the flu vaccination
.increased dyspnea spuitum production and or cough in a patient with known COPD
acute exacerbation
where is the o2 saturation goal for a chronic COPD patient
90-93#
what type of steroids should be used for an acute COPD exacerbation
IV methylprednisone with prednisone taper once clinical improved
3 most common causes for acute exacerbations
infection
noncompliance
cardiac disease
what is one of the main long term complications of COPD
pulmonary HTN and cor pulmonale (long standing hypoxia in the pulmonary vasculature
airway inflammation
airway hyperresponsiveness
reversible airflow obstruction
asthma
T/F asthma can begin at any age
T
what is the typical clinical picture with extrinsic asthma
atopic, hay fever and eczema
asthma symptoms are typically worse at what time of the day
night
Sob wheezing tightness and cough
asthma
what testing is required for diagnosis of asthma
PFTs
what must be done in PFTs to confirm the diagnosis of asthma
administer PFTs before and after the administration of bronchodilators in order to show reversibility
increase of what magnitude following bronchodilators in PFTs regarding asthma diagnosis is considered reversible
12%
useful meassurement of airflow obstruction in asthma
peak flow
useful when asthma is suspected but PFTs are nondiagnostic
bronchoprovocation
what kind of medication is methacholine and what is it used for?
muscarinic agonist
bronchoprovocation in asthma
when is CXR helpful in asthma
severe cases to r/o other causes PNA PTX etc
when should ABGs be considered in a patient with asthma
severe respiratory distress
increasing levels of what on ABG are highly concerning for impending respiratory failure in an asthmatic
normal or elevated PaCO2
if PaCO2 is normal or increased in asthmatic
admit and consider intubation
acute asthma exacerbation first step
inhaled broncho dilators typically nebulized or MDI
monitor peak flows and clinically for improvement
what should be done in acute asthma exacerbation following trial on inhaled albuterol through nebulizer
IV steroids
third line agent in acute asthma exacerbation in the hospital
IV magnesium
reduces bronchospasm
what are the 3 adjunct therapies to consider on top of albuterol steroids and mag in an acute asthmatic
oxygen therapy
ABX
intubation if all else fails
permanent abnormal dilation and destruction of bronchial walls with chronic inflammation airway collapse and ciliary loss dysfunction leading to impaired clearance of secretions
bronchiectasis
airway obstruction
immunodeficiency
allergic bronchopulmonary aspergillosis
mycobacterium infections recurrent should raise concern for
bronchiectasis
most common cause for bronchiectasis
CF
rare congenital cause for bronchiectasis
kartagener syndrome
chronic cough with large amounts of mucopurulent foul smelling sputum
dyspnea
hemoptysis
recurrent or persistent PNA
bronchiectasis
diagnostic study of choice in bronchiectasis
high resolution CT
acute exacerbation of bronchiectasis requires what initial treatment
ABX
bronchial hygeine steps in bronchiectasis
hydration
bronchodilators
chest physiotherapy
excessively thick viscous secretions in the respiratory tract, exocrine pancreas, sweat glands, intestines, genitourinary tract
CF
treatment for CF
pancreatic enzyme replacement fat soluble vitamin supplements chest physical therapy vaccinations treatment of infections inhaled rhDNase (breaks down the DNA in respiratory mucus that clogs the airways)
most common lung cancer
Nonsmall cell lung cancers
biggest risk for lung CA
smoking
lowest association with smoking of all the lung cancers
adenocarcinoma
common in shipbuilding and construction industry, car mechanics, painting
increasing lung CA risk
asbestos
high levels found in basements
increase riskl for lung CA
radon
cough hemoptysis obstruction wheezing dyspnea recurrent PNA
most associated with what lung CA
squamous cell CA
anorexia
weight loss
weakness
associated prognosis with lung CA
bad (progressive at this point)
SVC synbdrome most commonly occurs in what type of lung CA
SCLC
facial fullness
facial and arm edema
dilated veins over anterior chest arms and face
JVD
SVC syndrome
nerve that courses through the mediastinum and can be injured by lung cancer if destructive
phrenic nerve
hoarseness secondary to lung cancer
recurrent laryngeal nerve injury
Apical tumor involved C8 and T1-T2 nerve roots
causing shoulder pain radiating down the arm
superior sulcus tumors
superior sulcus tumors almost always of what type
squamous cell
what syndrome can be involved with superior sulcus tumors
horners syndrome
why is the prognosis so poor associated with malignant pleural effusion
equivalent to distant metastasis
SIADH occurs with what pulmonary cancers
small cell lung cancer
ectopic ACTH secretion occurs with what lung cancers
small cell lung cancers
PTH like hormone secreting lung cancer
squamous cell carcinoma
hypertrophic pulmonary osteoarthropathy occurs in what two types of lung cancer
adenocarcinoma and squamous cell
proximal muscle weakness fatigability diminished deep tendon reflexes paresthesias in lung cancer setting
lambert eaten syndrome
loss of normal angle between the fingernail and nail bed due to thickening of subungual soft tissue
digital clubbing
digital clubbing usually iindicates
lung ca
most important radiologic study for the diagnosis of lung cancer
CXR
CXR criteria associated with benign lung tumor
stable over a 2 year period
useful test for staging of lung carcinoma
CT scan
cytologic exam of sputum in lung cancer useful for what type
central tumors
useful for diagnosing central visualized tumors but not peripheral lesions
fiberoptic bronchoscopy
best management for NSCLC
Surgery
treatment used as an adjunct following surgery for NSCLC
radiation
what is the treatment for management for SCLC
radiation and chemotherapy
50% chance of malignancy for solitary nodule if the patient is over the age of ____
50
T/F smoking has no effect on the chance of malignancy of a solitary pulmonary nodule
F (smoking definitely increases malignancy chance)
cutoff for large malignancy of pulmonary nodule
2cm
borders indicative of malignancy
irregular
type of calcifcation that indicates malignancyu in solitary pulmonary nodule
asymmetric calcification
dense calcification suggests
benign pulm nodule
enlarging pulmonary nodule suggests
malignancy
follow up of pulm nodule on xray with no old xray or new nodule
CT
low probability nodules management in pulmonary nodules
serial CT scan
intermediate probability nodule 1 cm or larger
PET scan
PET scan positive in pulmonary nodule
biopsy
high probability nodule follow up
biopsy
most common cause of mediastinal mass in older patients
metastatic cancer
most common cause of anterior mediastinum
FOUR T's thymoma teratoma thymoma terrible lymphoma
middle mediastinum most common causes (5)
lung cancer lymphoma aneurysm cysts morgagni hernia
posterior mediastinum most common causes (5)
neurogenic tumors esophageal masses enteric cysts aneurysms bochdalek hernia
most common symptoms of mediastinal structures
compressive symptoms
what kind of pneumonia is common with mediastinal structure
postobstructive PNA
what are the three neuronal type injuries associated with mediastinal masses
hoarseness with recurrent laryngeal nerve injury
horner syndrome from sympathetic ganglia
diaphragmatic paralysis 2/2 phrenic nerve injury
what is the test of choice with mediastinal masses
CT scan
lights criteria (3)
Protein (pleural)/Protein (serum) >0.5\
LDH (p)/LDH(s) >0.6
LDH> two thirds the upper limit of normal serum LDH
most common cause of pleural effusion
CHF
most common malignancy leading to pleural effusion
lung
Dullness to percussion
decreased breath sounds over the effusion
decreased tactile fremitus
pleural effusion
blunting of costophrenic angle
sign of what on CXR
pleural effusion
at least what volume of fluid can accumulate before pleural effusion can be detected
250ml
when is thoracentesis useful in pleural effusion
not obvious etiology
what is the complication associated with thoracentesis
PTX
treatment for transudative effusions
diuretics and sodium restriction
therapeutic thoracentesis
what is the treatment for exudative pleural effusions
treat underlying disease
uncomplicated parapneumonic effusions
ABX alone
complicated effusions parapneumonic
chest tube
intrapleural injection of thrombolytics if loculated
potential surgical lysis of adhesions
exudative pleural effusions if left untreated can lead to
empyema
most cases of empyema occur secondary to
bacterial PNA
two recommended tests for empyema
CXR and CT
treatment for empyema
ABX and thoracentesis
if empyema is severe and persistent regardless of drainage and ABX what can be done
rib resection and drainage open
air in the normally airless pleural space
PTX
two major categories of pneumothorax
spontaneous and traumatic pneumothoraces
traumatic pneumothoraces are most commonly 2/2
iatrogenic
primary spontaneous pneumothoraces are usually secondary to what cause
subpleural blebs in tall lean young men
T/F primary spontaneous pneumothorax has a high recurrence
T
secondary spontaneous pneumothorax is usually 2/2
COPD
or less commonly asthma ILD neoplasms CF TB
ipsilateral chest pain usually sudden dyspnea cough decreased breath sounds hyperresonance decreased or absent tactile fremitus on affected side mediastinal shift
pneumothorax
small PTX and patient asymptomatic
observation (resolve spontaneously in ~10 days)
PTX larger or patient is symptomatic
administer supplemental oxygen
needle aspiration or chest tube insertion
what is the treatment of secondary spontaneous pneumothorax
chest tube drainage
accumulation of air within the pleural space suich that tissues surrounding the opening into the pleural cavity act as valves allowing air to enter but not to escape
tension pneumothorax
accumulation of air in the pleural space and shift of mediastinum to the contralateral side
tension PTX
mechanical ventilation with barotrauma
CPR
trauma
lead to what type of PTX typically
tension PTX
hypotension distended neck veins shift of trachea decreased breath sounds on one side hyperresonance to percussion
tension PTX
what is the risk with tension PTX
hemodynamic compromise and shock
what is the immediate treatment for tension PTX
needle decompression
malignant mesothelioma usually secondary to what exposure
asbestos
blood effusion common with what malignancy
malignant mesothelioma
defined as an inflammatory process involving the alveolar wall that can lead to irreversible fibrosis, distortion of lung architecture and impaired gas exchange
ILD
four environmental lung diseases
coal workers pneumoconiosis
silicosis
asbestosis
berylliosis
what are the four ILDs associated with granulomas
sarcoidosis
histiocytosis X
wegener granulomatosis
churg strauss syndrome
alveolar filling disease as ILD (3)
goodpastures
idiopathic pulmonary hemosiderosis
alveolar proteinosis
ILD hypersensitivity lung diseases (2)
hypersensitivity pneumonitis
eosinophilic pneumonitis
drug induced ILD 2/2 (5)
amiodarone nitrofurantoin bleomycin phenytoin illicit drugs
ILD associated with connective tissue disorders (4)
rheumatoid arthritis
scleroderma
SLE
mixed connective tissue disease
what are the 3 random ILDs
idiopathic pulmonary fibrosis
cryptogenic organizing pneumonia
radiation pneumonitis
digital clubbing is common with what type of ILD
idiopathic pulmonary fibrosis
rales at the base
signf of pulmonary HTN and cyanosis in advanced disease
fatigue
dyspnea cough
ILD
which diagnostic test shows the extent of fibrosis in ILD better than other tests
CT
FEV1/FVC ratio
FEV1
FVC
DLCO
in ILD
increased
decreased
decreased
decreased
if the CT is not diagnostic for ILD what should be done
biopsy
what are the two disease in ILD that benefit from UA
goodpastures and wegeners granulomatosis
chronic systemic granulomatous disease characterized by noncaseating granulomas often involving multiple organ systems
african american female
<40years old
sarcoidosis
erythema nodosum
plaques subcutaneous nodules maculopapular eruptions
in what ILD
sarcoidosis
anterior uveitis common with what ILD
sarcoidosis
what are the two main disturbances of the heart associated with sarcoidosis
arrhythmias
conduction disturbances such as heart block
bell palsy can be seen with what ILD
sarcoidosis
bilateral hilar adenopathy is the hallmark of this disease
sarcoidosis
elevated in serum in about 50% to 80% of sarcoidosis patients
ACE enzyme
hypercalciuria and hypercalcemia are common in what ILD
sarcoidosis
definitive diagnosis in sarcoidosis
transbronchial biopsy
what can be found in transbronchial biopsy diagnostic for sarcoidosis
noncaseating granulomas
what is the least favorable CXR presentation of sarcoidosis
diffuse parenchymal infiltrates without hilar adenopathy
what is the most common disease course for sarcoidosis
resolve within 2 years
what is the treatment of choice for sarcoidosis
systemic corticosteroids
symptomatic patients active lung disease pulmonary function deterioration conduction disturbances severe skin or eye involvement
in sarcoidosis
systemic corticosteroids
used in sarcoidosis with patients that are refractory to systemic corticosteroids
methotrexate
chronic insterstitial poneumonia caused by abnormal proliferation of histiocytes
histiocytosis X
what are the three forms of histiocytosis X
eosinophilic granulomas
letterer Siwe
Hand Shuller Christian syndrome
sponstaneous pneumothorax lytic bone lesions diabetes insipidus CXR shjowing honeycomb appearance CT scan shows cystic lesions
histiocytosis X
what is the treatment for histiocytosis X
corticosteroids
lung transplant may be necessary
characterized as a ILD with necrotizing granulomatous vasculitis
wegener granulomatosis
lungs
kidneys
upper airway
sometimes other organs with ILD
wegener granulomatosis
gold standard for diagnosis of wegener granulomatosis
tissue biopsy
ILD with biopsy positive c-antineutrophilic cytoplasmic antibodies
wegener granulomatosis
treatment for granulomatosis with polyangiitis
immunosuppressive agents and glucocorticoids
granulomatous vasculitis is seen in patients with asthma
churg strauss syndrome
pulmonary infiltrates rash eosinophilia systemic vasculitis skin muscle nerve lesions significant blood eosinophilia P ANCA +
churg strauss
what is the treatment for churg strauss
systemic glucocorticoids
some patients may develop complicated pneumoconiosis characterized by fibrosis 2/2 carbon and silica
coal workers pneumoconiosis
diffuse interstitial fibrosis of the lung caused by inhalation of asbestos fibers
asberstosis
increased risk of bronchogenic carcinoma and malignant mesothelioma
asbestos
CXR showing hazy infilktrates with bilateral linear opacitis and may show pleural plaques
asbestosis
localized and nodular peribronchial fibrosis
can be acute or chronic
silicosis
ILD associated with increased risk of TB
mining stone cutting and glass manufacturin
silicosis
acute disease is a diffuse pneumonitis caused by massive exposure lymphocyte proliferation test is usefulk granulomas skin lesions hgypercalcemia
berylliosis
ILD with presence of serum IgG and IgA to the inhaled antigen is a halmmark finding
acute form has flu like features
CXR during the acute phase shows pulmonary infiltrates
hypersensitivity pneumonitis
fever and peripheral eosinophilia are features
eosinophilic pneumonia may be acute or chronic
CXR showing peripheral pulmonary infiltrates
eosinophilic pneumonia
autoimmune disease caused by IgG antibodies directed against glomerular and alveolar basement membranes
goodpasture syndrome
hemorrhagic pneumonitis and glomerulonephritis
ultimate renal failure is a complication of proliferative glomerulonephritis
hemoptysis and dyspnea
goodpasture
serologic evidence of antiglomerular basement mambrane antibodies
goodpastures
three treatments for goodpastures
corticosteroids
cyclophosphamide
plasmapharesis
accumulation of surfactant like protein and phospholipids in the alveoli
pulmonary alveolar proteinosis
CXR of ground glass appearance with bilateral alveolar infiltrates that resemble bat shape
patients at increased risk of infection and should not be given corticosteroids
alveolar proteinosis
what are the two treatments for alveolar proteinosis
lung lavage and GCSF
what tests must be down for idiopathic pulmonary fibrosis
CXR
open lung biopsy
exclude other ILDs
treatment for idiopathic pulmonary fibrosis
supplemental oxygen
corticosteroids
lung transplant
inflammatory lung disease with similar clinical and radiographic features to infectious pneumonia
associated with viral infections medications connective tissue disease but most cases are idiopathic
bilateral patchy infiltrates on CXR
cryptogenic organizing pneumonitis
what is the treatment for cryptogenic organizing pneumonitis
steroids
occurs in 5 to 15% of patients who undergo thoracic treatment for lung cancer breast cancer lymphoma or thymoma low grade fever cough chest fullness dyspnea pleuritic chest pain hemoptysis acute respiratory distress normal CXR CT with diffuse infiltrates
radiation pneumonitis
what is the treatment of choice for radiation pneumonitis
corticosteroids
CNS causes for respiratory failure
drug overdose
stroke
trauma
neuromuscular disease associated with respiratory failure
MS
GBS
ALS
upper airway causes for respiratory failure
obstruction
stenosis
spasms
paraylsis
thorax and pleura causes for respiratory failure
kyphoscoliosis
flail chest
hemothorax
cardiovascular system and blood
causes for respiratory failrue
CHF
valvular diseases
PE
anemia
lower airways and alveoli causes for respiratory failure
asthma
copd
PNA
acute respiratory distress syndrome
hypoxemic respiratory failure
O2 sat
FiO2
<90% despite 60% FiO2
what is the major pathophysiologic cause for hypoxemic respiratory failure
VQ mismatch
intrapulmonary shunting
hypercapnic respiratory failure is 2/2 what two causes
decrease in minute ventilation or increase in physiologic dead space
caused by a defect in either alveolar ventilation or perfusion
typically leads to hypoxia without hypercapnia
most common mechanism of hypoxemia
responsive to supplemental oxygen
V/Q mismatch
little or no ventilation in perfused areas
venous blood is shunted into the arterial circulation without being oxygenated represents one end of the spectrum in V/Q mismatch
shunting
atelectasis or fluid buildup in alveoli, direct right to left intracardiac blood flow in congenital heart diseases
type of respiratory failure
shunting
sepsis
DKA
hyperthermia
results in what type of respiratory failure
hypercapnia
this type of lung disease causes hypoxemia without hypercapnia
diffusion impairment
inability to speak in complete sentences use of accessory muscles of respiration tachypnea tachycardia cyanosis impaired mentation
respiratory failure
3 main causes for hypoxemia
V/Q mismatch
intrapulmonary shunting
hypoventilation
main cause for hypercapnia
hypoventilation
acid base disturbance with hypercapnia
respiratory acidosis
why should the lowest concentration of oxygen that provides sufficient oxygentation be used
to avoid oxygen toxicity 2/2 oxygen free radicals
what is the problem of using O2 in patients with COPD patients
can lead to V/Q mismatch, the haldane effect and loss of respiratory drive
should be given to a patient that is conscious and has possible impending respiratory failure with administration of oxygen
NPPV
diffuse inflammatory process involving both lungs
neutrophil activation in the systemic of pulmonary circulations is the primary mechanism
ARDS
acute onset
bilateral infiltrates on chest imaging
pulmonary edema not explained by fluid overload or CHD
PaO2/FiO2<300
ARDS
key pathophysiologic event in ARDS
massive intrapulmonary shunting of blood
why is high PEEP required in ARDS
prop open the airways
what is the difference between ARDS and severe cardiogenic pulmonary edema
cause for edema
in ARDS it is an increase of pulmonary capillary permeability
in cardiogenic pulmonary edema the increase in pulmonary hydrostatic pressure
what is the most common risk factor for ARDS
sepsis
GI risk for ARDS
aspiration of GERD
dyspnea
tachypnea
tachycardia increased work of breathing
progressive hypoxemia
ARDS
most useful parameter in differentiating ARDS from cardiogenic pulmonary edema
PCWP
if PCWP is low and there is an enormous pulmonary infiltrate
ARDS
if PCWP is greater tyhan 18 and massive pulmonary infiltrates
cardiogenic pulmonary edema
O2 saturation should be kept above what level in treatment of ARDS
90%
most important aspect of ARDSnet parameters for ventilatory settings in the setting of ARDS
high PEEP
low TV
what is the goal CVP in ARDS
4 to 6
what type of feeding is preferred to treat ARDS
tube feedings
what are the two main complications associated with mechanical ventilation
barotrauma
nosocomial
what are the two main goals of mechanical ventilation in respiratory failure
maintain alveolar ventilation
restore hypoxemia
test to assess response to initiation of mechanical ventilation
ABG
initial mode used in most patient with respiratory failure
AC
use for pressure support
weaning trials
settings of ventilation that affect minute ventilation
RR and TV
initial tidal volume typically used in most cases
4-8mL/kg
normal initial rate set in mech vent
10 to 12
settings that affect PaO2
FiO2
PEEP
initial FiO2 setting
100 and quickly titrate down
what is the normal PEEP
5cm H2O
all mechanically ventilated patients should be on what medication
PPI
mean pulmonary arterial pressure greater than 25 mm Hg at rest
Pulmonary HTN
what are the 5 main reasons for pulmonary HTN
passive due to overflow from left heart disease
hyperkinetic due to left to right shunting
obstruction (PE and Pulmonary artery stenosis)
pulmonary vascular obliteration from collagen vascular disease
pulmonary vasoconstriction
pulmonary HTN in young woman
thickening of pulmonary arteriolar walls
familial or idiopathic veno occlyussive
pulmonary arterial hypertension
dyspnea on exertion fatigue chest pain syncope loud pulmonic component of the second heart sound and subtle lift of sternum, signs of right heart failure
pulmonary artery hypertension
ECG in PAH
right axis deviation
CXR showing enlarged pulmonary artyeries with or without clear lung fields based on the cause of pulmonary hypertension
PAH
echocardiogram showing dilated pulmonary artery
dilation/hypertrophy of RA and RV
abnormal movement of IV septum
PAH
Right heart catheterization results of PAH
increased pulmonary artery pressure
sildenafil
oral CCBs
prostacyclins (epoprostenol)
endothelin receptor antagonists (bosentan)
used in what group of PAH
group 1
right ventricular hypertrophy with eventual RV failure resulting from pulmonary HTN secondary to pulmonary disease
cor pulmonale
cor pulmonale most commonly secondary to
COPD
decrease in execise tolerance
cyanosis and digital clubbing
signs of right ventricular failure hepatomegaly edema JVD
parasternal lift
cor pulmonale
most common DVTs that embolize to the lungs
iliofemoral
if a severe acute PE occurred what could occur as a result
cor pulmonale
what type of pathophysiology leads to the tachypnea associated with PE
increase in dead space in increase in hypoxemia and hypercarbia
recurrent small sub clinical PE’s can lead to
pulmonary arterial hypertension
most common symptoms of PE
dyspnea
most common sign of PE
tachypnea
T/F ABG levels are diagnostic for PE
F (not)
what are the CXR levels normally in PE
normal
what are the two CXR signs that are rarely seen with PE
hamptom hymp
westermark sign
positive venous duplex warrants what treatment in PE
anticoagulation
test of choice now in PE
CT angiography
test that is useful if there is contraindication to CTA
VQ scan
high probability VQ scan treatment
heparin
major contraindication for CTA
renal insufficiency
consider this test when risk of anticoagulation is high testing is equivocal or if the patient is hemodynamically unstable and embolectomy may be required
pulmonary angiography
when should patients be given anticoagulation if the clinical suspicion is high for PE
before testing
contraindications to heparin treatment
active bleeding
uncontrolled HTN
recent stroke
HIT
how long should anticoagulation be continued following acute treatment in PE
3-6 months
patients with massive PE and hemodynamic instability
thrombolytics
most common lung involved due to aspiration
RIght due to anatomy
predisposing factors for aspiration
reduced consciousness alcoholism extubation excessive vomiting tube feeding anesthesia surgery neuromuscular disease esophageal disorders
what is the difference mainly between aspiration pneumonia and aspiration pneumonitis
aspiration PNA takes days to develop
what organisms should be covered in aspiration PNA
anaerobics
low pulse ox
hypercarbia suspected or to evaluate for acid base abnormalities
ABG
five top diagnoses that cause hemoptysis
bronchitis lung cancer TB bronchiectasis pneumonia
fever night sweats weight loss and hemoptysis
TB
fevers and chills and history of HIV and hemoptysis
PNA or TB
risk factors for coagulation and hemoptysis
PE
acute renal failure or hematuria and hemoptysis
goodpasture
CXR is normal if there is a significant clinical suspicion for lung carcinoma
fiberoptic bronchoscopy
