vascular pulm conditions, pleural diseases Flashcards
what are the ekg findings in PE?
tachycardia, S1T- s wave in lead I and inverted T in lead III
What is the treatment for PE?
-O2 supplementation, IV fluids or pressors as needed, anticoagulation for 3-6 months; IVC filter placement if anticoagulation is contraindicated
consider thrombolysis if pt has no cardiac contraindications, trauma, surgery
What should you do if spiral CT or V/Q scan is equivocal for PE?
angiography
What are the causes of pulmonary HTN?
PE, valvular disease, left to right shunt, COPD, idiopathic
What is the treatment for pulmonary HTN?
extra O2, vasodilators for idiopathic and pulmonary causes to decrease pulmonary vascular resistance, anticogulation if pt has idiopathic, embolic, or cadiac cause
How does pulmonary capillary wedge pressure help distinguish ARDS from cardiac causes of pulmonary edema?
ARDS: wedge pressure 18
What EKG changes are seen with pulmonary edema?
T-wave abnormalities, QT prolongation. may occur suddently
What is the tx for pulmonary edema?
diuretics, salt restriction, treatment of underlying cause, O2, vasodilators; nesiritide may help
What are causes of low glucose in fluid of pleural effusion?
TB, malignancy, autoimmune disease
Whenis the pH of pleural fluid low?
empyema, TB, malignancy
If there are high triglycerides in the pleural fluid, what is the probable source?
thoracic duct rupture
What is the treatment for empyema?
chest tube?
What are options for recurrent malignant effusions?
repeat thoracentesis, pleurodesis
What are key features of a exudate?
pleural:serum protein >0.5 or P:S LDH > 0.6 or total LDH >2/3 upper limit
What are the key historical features of a pneumothorax?
unilateral cest pain, dyspnea, decr chest wall movement, unilateral decr breathsounds, incr resonance to percussion, decr dectile fremitus
If hypotensive, JVD, or tracheal deviation, suspect tension pneumo
What is tx of pneumothorax?
15%: chest tube
If tension pneumo, immediate needle decompression (4-5 interspace at midaxillary line, or 2nd and 3rd interspace at midclavicular line) and chest tube placement
What are common causes of pneumothorax?
asthma, CF, HIV, emphysema, trauma, neoplasm, iatrogenic
What is a closed vs. open pneumothorax?
closed: internal rupture of resp system with intact chest wall- may be spontaneous, COPD, TB, trauma
open: open chest wall
What are the causes of hemothorax?
trauma, CA, TB, pulm infarct
What are some treatments for central sleep apnea?
resp stimulants (acetazolamide or theophylline), phrenic nerve pacemaking
What complications can arise from atelectasis?
if longer than 72 hrs, PNA
How long can someone be intubated before they should be converted to a traceostomy?
convert if >3 wks
