Flashcards in COPD/Pneumonia/Asthma Deck (67)
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1
PNE- Organism- Streptococcus Pneumonia
Most common, rust colored sputum
2
PNE- Organism- H. Influenzae
2nd Most common in smokers and COPD
3
PNE- Organism- Staph Aureus
Rarely in younger adults, mostly older adults, usually after influenza
4
PNE- Organism- Mycoplasma Pneumonia
Walking Pneumonia- usually in younger adults
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Signs and symptoms of Pneumonia
Sudden, rust color sputum, myalgia, prouctive cough, crackles, egophony, dense shadows on CXR, putrid sputum, Fever >100
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How often is a causative organism found in PNE?
Rarely
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What two things are needed to diagnose pneumonia?
1. CXR
2. Clinical findings
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Evaluation of sputum sample for PNE?
>25% of epithelial cells suggests contamination; correct specimen should show polymorphonuclear leukocytes
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Differential Diagnosis for PNE?
Bacterial Bronchitis, lung cancer, exposure to moldy hay
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When does PNE need O2?
PaO2 < 55 or O2 <90%
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What does CURB 65 measure?
C-confusion
Bun >19
RR >30
BP 65
>65 y.o.
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CURB 65 recommendations?
1- home treatment
3- severe, hospital treatment
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Treatment for uncomplicated PNE? with no recent use or comorbidities
Macrolid or doxycycline
1. Azyithromycin 500 mg QD x 3 days
2. Doxycycline 100 mg BID x 7 days
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Treatment for PNE with recent ABX in last three months? or Comorbidities
1. Levofloxacin 750 mg x 7 days;
2. Azithromycin 500 + amoxicillin 750 mg 93-4 g/day)
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PNE Treatment with MRSA?
Linezolid
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When do you do a follow CXR on patients with PNE?
If they smoke. If it has not cleared, reevaluate ABX and possible cancer
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Classic chronic bronchitis
Blue bloaters
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Classic emphysema?
Pink puffers
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Physical Assessment for COPD?
barrel chest, prominent palpable heart, wheezes, clubbing of nails
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Differential dx of COPD?
Bronchitis vs emphysema and if it's reversible
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What is the FEV1/FVC in COPD?
22
GOLD stages of COPD with FEV1 ?
All have FEV/FVC 80%- Mild
2- 50-79%- Moderate
3- 30-49%- Severe
4- <30%- Very Severe
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Diagnostics in COPD?
ABG, PFTs, not usually CXR; A1 antitrypsin in patients less than 45 y.o.
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When do you start patients on oxygen for COPD?
PaO2 <55 or Saturation < 88%
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Lines of Therapy in COPD? There are 4
1. short SABA
2. Anticholinergic Bronchodilators
3. Long acting BA
4. Steroids
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How often do you check theophylline levels? and Correct levels?
Every 6-12 months.
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What is a short acting B2 Agonist?
Albuterol
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What is a long acting B2 Agonist? x2
Formeterol, salmeterol
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What is an anticholinergic bronchodilator?x2
Ipratropium, tiotropium
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