Chest Discomfort Flashcards
(18 cards)
Describe the PE of someone with pleuritis/Pleurisy
Sharp inspratory pain, SOB/Dyspnea
Audible puelral friction rub
Occurs secondarily to another cause (Viral infection, bacterial, lung cancer, pneumothorax, RA, SLE, Chemo, Amioderone, Pericarditis)
Costochondritis presents how
Dull or sharp pain on inspiration or with moving
Reproducible pain with palpation
Management for chostochondritis
Topical analgesics
Local steroid injections
Tx for Pleurisy
NSAIDs
Antitussive
Thoracocentisis if fluid
Dx for pleurisy
CBC, cultures, CXR, EKG, Thoracocentisis
Hallmarks of ARDs
- Acute, diffuse, inflammatory lung injury
- Hypoxemia
- Bilateral opacities
- Alveolar Damage
- Noncardiogenic edema
Problem in acute respiratory failure type 1
Hypoxia
Failure of Oxygenation (PaO2 <60 mmHg, SpO2 <90%)
Problem in acute respiratory failure type 2
Hypercapnea
- Increased CO2 and acidosis
Primarily a failure of ventilation
Causes of type 1 respiratory failure
High altitude (Decreased O2 delivery)
Hypoventilation (RR low and TV low)
Low O2 and high CO2
Causes of type 1 respiratory failure
1) Won’t breath (Opiates, Benzos, Stroke)
2) Can’t breathe ( Chest wall deformities, Nerve issues, Muscle pathologies)
3) Can’t breathe enough ( Airway obstruction, COPD, Asthma )
V/Q mismatch causes
1) Airway– Mucus plug, COPD, asthma
2) Alveoli– Atelectasis, PNA, ARDS
3) Vessils– PE, vasoconstriction
Respiratory failure Dx
ABGs ( Low O2= type 1, Elevated CO2 and low O2, type 2)
CXR (image underlying cause)
Bronchoscopy (Mucus plug)
Type 1 respiratory failure treatment
Bronchodilators for COPD
Abx for PNA
Diuretics for edema
Suction for mucus plug
Thoracacentesis for effusion
Type 2 respiratory failure treatments
Treat underlying cause (Narcan for opioid overdose)
Increase RR or TV
CPAP, BiPAP, intubation
If a patient is still hypoxic in Respiratory failure despite having 60% + FiO2, what do you do
Add PEEP, remains in lungs at the end of exhalation, keep alveoli open for gas exchange.
What is PEEP
Positive End Expiratory pressure
Used WITH mechanical ventiliation
Maintains pressure above atmospheric level by exerting pressure that opposes passive emptying of the lung
What is the most common form of PEEP
BiPAP– deliver constant PEEP, also positive inspratory pressure. Increase tidal volume
CPAP does what
Continuous positive airway pressure, deliver constant PEEP. Prevents atelectasis. Improves oxygenation
