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EM - Exam 1 > Chest Pain and SOB > Flashcards

Chest Pain and SOB Flashcards

1
Q

Possible ddx of pleuritic chest pain and SOB (atraumatic)

A
  1. PE
  2. Spontaneous PTX
  3. PNA
  4. Pericarditis
  5. Pleurisy
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2
Q

Possible ddx of pleuritic chest pain and SOB (traumatic)

A
  1. Pericardial tamponade
  2. Pulmonary contusion
  3. Tension PTX
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3
Q

Possible ddx of reproducible chest pain

A
  1. Strain
  2. Costochondritis
  3. Fracture
  4. Infectious
  5. Zoster
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4
Q

Possible ddx of substernal chest pain

A
  1. MI/angina
  2. Dissecting TAA
  3. GI
  4. Pneuomediastinum
  5. Mediastinitis
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5
Q

Possible ddx of SOB

A
  1. Pericardial effusion
  2. Pleural effusion
  3. CHF
  4. Asthma/COPD
  5. Anemia
  6. Anxiety
  7. Sickle cell crisis
  8. ARDS
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6
Q

Clinical presentation of PE

A
  • Virchow’s triad
  • Impending doom
  • Tachy
  • Cyanosis
  • Leg edema/calf pain
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7
Q

Tests to diagnose PE and what they may show

A
  • Wells/PERC score
  • D dimer
  • EKG (S1Q3T3)
  • CXR (Fleischner, Westermark, Hampton)
  • CTA
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8
Q

Tx of PE

A
  • Coumadin
  • Factor Xa inhibitors
  • LMWH
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9
Q

Clinical presentation of spontaneous PTX

A
  • Tall/thin person
  • Decreased/absent BS
  • Tracheal shift
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10
Q

Tests to diagnose spontaneous PTX and what they may show

A
  • CXR (linear demarcation)

- Bedside U/S (absent sliding)

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11
Q

Tx of spontaneous PTX

A

Observation vs. chest tube vs. needle decompression

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12
Q

Presentation of PNA

A
  • Gradual onset
  • Fever
  • Cough
  • Rhonchi
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13
Q

Tests to diagnose PNA and what they may show

A
  • CBC (leukocytosis, neutropenia)
  • Blood/sputum culture
  • Flu test
  • CXR (infiltrate)
  • CT
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14
Q

Treatment of PNA

A
  • Abx
  • Antipyretics
  • IVF for sepsis
  • O2
  • Admit based on PORT score
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15
Q

Presentation of pericarditis

A
  • Viral prodrome
  • Pain relieved by sitting forward
  • Pericardial friction rub
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16
Q

Tests to diagnose pericarditis and what they may show

A
  • Mainly clinical diagnosis
  • EBV/HIV/Hep/Lyme (negative)
  • EKG (diffuse ST elevations or low voltage)
  • Echo
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17
Q

Treatment of pericarditis

A
  • NSAIDs
  • Colchicine
  • Steroids
  • Pericardiocentesis for effusion
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18
Q

Presentation of pleurisy

A
  • Viral illness (MC)
  • Trauma
  • Localized pains including w/deep inspiration
  • Pleural friction rub
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19
Q

Tests to diagnose pleurisy and what they may show

A
  • CXR (normal)

- Testing based on work up of suspected underlying etiology

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20
Q

Treatment of pleurisy

A
  • NSAIDs
  • Narcotics
  • Tx any underlying etiology other than viral
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21
Q

Presentation of pericardial tamponade

A
  • Recent surgery or penetrating injury
  • Pulsus paradoxus
  • Beck’s triad (JVD, hypotension, muffled heart sounds)
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22
Q

Tests to diagnose pericardial tamponade and what they may show?

A
  • CXR (water bottle heart)
  • U/S (effusion)
  • EKG (electrical alternans, low voltage)
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23
Q

Tx of pericardial tamponade

A
  • Pericardiocentesis

- May require dobutamine

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24
Q

Presentation of pulmonary contusion

A
  • Recent blunt trauma
  • Chest wall bruising or crepitus
  • Hypoxia
  • Tachypnea
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25
Q

Tests to diagnose pulmonary contusion and what they may show?

A
  • CXR (acute or delayed haziness)

- CT will show up earlier than CXR

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26
Q

Treatment of pulmonary contusion

A
  • Analgesics
  • O2 PRN
  • Incentive spirometer
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27
Q

Presentation of tension PTX

A
  • Penetrating injury
  • Decreased or absent BS
  • Tracheal shift
  • Absent chest rise
  • Significant distress
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28
Q

Test to diagnose tension PTX and what they may show?

A
  • CXR (linear demarcation, tracheal shift)

- U/S (lack of pleural sliding)

29
Q

Treatment of tension PTX

A
  • Needle decompression

- Chest tube

30
Q

Presentation of costochondritis

A
  • Sharp, parasternal, non-radiating pain

- Recent coughing/sneezing episodes

31
Q

Tests to diagnose costochondritis?

A

Generally nothing required

32
Q

Treatment of costochondritis

A
  • NSAIDs
  • Rest
  • Cough meds
33
Q

Treatment of Herpes Zoster

A
  • Antiviral
  • Steroid
  • Analgesics
34
Q

Presentation of aortic dissection

A
  • Tearing, ripping pain
  • PE may be WNL
  • Tachy
  • Decreased pulses
35
Q

Tests to diagnose aortic dissection and what they may show?

A
  • CXR (wide mediastinum)
  • US (aortic root)
  • CTA
36
Q

Treatment of aortic dissection

A

-BB until BP

37
Q

Presentation of pneumomediastinum

A
  • Radiating chest pain to neck/back/shoulders
  • Onset w/forceful coughing
  • PE may be WNL
  • Hamman sign (crepitus w/cardiac auscultation)
38
Q

Tests to diagnose pneumomediastinum and what they may show?

A

CXR (SQ air along hilum or into neck soft tissues)

39
Q

Treatment of pneumomediastinum

A
  • Usually no tx required

- Close FU

40
Q

Presentation of mediastinitis

A
  • Recent dental infection or post-surgery
  • Gradual, sharp pleuritic pain
  • PE may be WNL
  • Hamman sign (crepitus w/cardiac auscultation)
41
Q

Tests to diagnose mediastinitis and what they may show?

A
  • CBC (leukocytosis, bandemia)
  • CRP/ESR
  • Barium swallow
  • CT neck and chest
42
Q

Treatment of mediastinitis

A
  • ABCs
  • Abx
  • IVF
43
Q

Presentation of pleural effusion

A
  • Dullness to P/A
  • Pleural friction rub
  • Cough
  • Recent PNA, cancer, CHF
44
Q

Tests to diagnose pleural effusion and what they may show?

A

CXR (blunting of costophrenic angles)

45
Q

Treatment of pleural effusion

A
  • Spontaneous resolution
  • Diuresis
  • Thoracentesis
46
Q

Presentation of CHF

A
  • Crackles/rales
  • JVD
  • Pitting edema
  • Hypoxia
47
Q

Tests to diagnose CHF and what they may show?

A
  • CXR (Kerley B, cardiomegaly)
  • BNP
  • US (B lines)
48
Q

Treatment of CHF

A
  • Diuretics
  • NTG
  • CPAP
  • Dialysis
49
Q

Presentation of asthma/COPD

A
  • Wheezing, tightness
  • Anxious
  • Decreased air movement
50
Q

Tests to diagnose asthma/COPD and what they may show?

A
  • Peak flow

- CXR

51
Q

Treatment of asthma/COPD

A
  • Nebulizers
  • Steroids
  • Mg
  • Ativan
52
Q

Presentation of anemia

A
  • Fatigue
  • DOE
  • Cold intolerance
  • Pallor
  • Splenomegaly
53
Q

Tests to diagnose anemia and what they may show?

A
  • Low H/H
  • Increased BUN w/GIB
  • Reticulocyte ct in sickle cell
54
Q

Treatment of anemia

A
  • Blood transfusion

- Treat underlying disease

55
Q

Presentation of anxiety

A
  • Generally constant, non-exertional SOB
  • Recent trigger event
  • Hyperventilating
56
Q

Tests to diagnose anxiety

A
  • R/o other etiology

- DAU-8

57
Q

Treatment of anxiety

A
  • Anxiolytics

- Non rebreather w/o O2

58
Q

Presentation of sickle cell crisis

A

-Pain
-SOB, tachypnea
-Fever, cough
-Hypoxemia
(acute chest syndrome)

59
Q

Tests to diagnose sickle cell crisis and what they may show?

A
  • CBC (low reticulocyte count)

- Hgb electrophoresis (if new)

60
Q

Treatment of sickle cell crisis

A
  • Analgesics
  • O2
  • Transfusion for drop in Hgb
  • IVF
61
Q

Define ARDS

A

Respiratory failure 2/2 pulm or systemic insult WITHOUT evidence of heart failure

62
Q

Onset of ARDS

A

Within 12-48 hrs (but up to 1 wk) of triggering event

63
Q

Etiologies of ARDS

A
  • Sepsis
  • Aspiration or inhalation of harmful substances
  • Trauma/burns
  • PNA
64
Q

Pathophys of ARDS

A
  • Damage to capillary and alveolar endothelial cells
  • Causes increased vascular permeability and low surfactant
  • Results in pulm edema and alveolar collapse (hypoxemia)
65
Q

Presentation of ARDS

A
  • Rapid onset of significant tachypnea, retractions
  • Crackles
  • Hypoxemia refractory to O2
66
Q

What does CXR show in ARDS?

A
  • Diffuse bilat patchy infiltrates

- Air bronchograms

67
Q

Treatment of ARDS

A
  • Aggressive diagnosis and tx
  • Intubation usually and set ventilator to avoid O2 toxicity
  • Supportive (fluids, fever)
68
Q

How are steroids used in ARDS?

A

Not proven effective

69
Q

Preventive measures of ARDS

A

None have been identified

EM - Exam 1 (5 decks)

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