vascular pulm conditions, pleural diseases

Question 1

what are the ekg findings in PE?

Answer 1

tachycardia, S1T- s wave in lead I and inverted T in lead III

Question 2

What is the treatment for PE?

Answer 2

-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

Question 3

What should you do if spiral CT or V/Q scan is equivocal for PE?

Answer 3

angiography

Question 4

What are the causes of pulmonary HTN?

Answer 4

PE, valvular disease, left to right shunt, COPD, idiopathic

Question 5

What is the treatment for pulmonary HTN?

Answer 5

extra O2, vasodilators for idiopathic and pulmonary causes to decrease pulmonary vascular resistance, anticogulation if pt has idiopathic, embolic, or cadiac cause

Question 6

How does pulmonary capillary wedge pressure help distinguish ARDS from cardiac causes of pulmonary edema?

Answer 6

ARDS: wedge pressure 18

Question 7

What EKG changes are seen with pulmonary edema?

Answer 7

T-wave abnormalities, QT prolongation. may occur suddently

Question 8

What is the tx for pulmonary edema?

Answer 8

diuretics, salt restriction, treatment of underlying cause, O2, vasodilators; nesiritide may help

Question 9

What are causes of low glucose in fluid of pleural effusion?

Answer 9

TB, malignancy, autoimmune disease

Question 10

Whenis the pH of pleural fluid low?

Answer 10

empyema, TB, malignancy

Question 11

If there are high triglycerides in the pleural fluid, what is the probable source?

Answer 11

thoracic duct rupture

Question 12

What is the treatment for empyema?

Answer 12

chest tube?

Question 13

What are options for recurrent malignant effusions?

Answer 13

repeat thoracentesis, pleurodesis

Question 14

What are key features of a exudate?

Answer 14

pleural:serum protein >0.5 or P:S LDH > 0.6 or total LDH >2/3 upper limit

Question 15

What are the key historical features of a pneumothorax?

Answer 15

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

Question 16

What is tx of pneumothorax?

Answer 16

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

Question 17

What are common causes of pneumothorax?

Answer 17

asthma, CF, HIV, emphysema, trauma, neoplasm, iatrogenic

Question 18

What is a closed vs. open pneumothorax?

Answer 18

closed: internal rupture of resp system with intact chest wall- may be spontaneous, COPD, TB, trauma
open: open chest wall

Question 19

What are the causes of hemothorax?

Answer 19

trauma, CA, TB, pulm infarct

Question 20

What are some treatments for central sleep apnea?

Answer 20

resp stimulants (acetazolamide or theophylline), phrenic nerve pacemaking

Question 21

What complications can arise from atelectasis?

Answer 21

if longer than 72 hrs, PNA

Question 22

How long can someone be intubated before they should be converted to a traceostomy?

Answer 22

convert if >3 wks