EM-Pulm Flashcards Preview

Surgery/ER Fall 2013 > EM-Pulm > Flashcards

Flashcards in EM-Pulm Deck (88):
1

dyspnea upright

platypnea

2

dyspnea a/w one of several recumbent positions

trepopnea

3

hyperventilation

hyperpnea

4

dyspnea in recumbent position

orthopnea

5

dyspnea that awakens the patient from sleep

paroxysmal nocturnal dyspnea

6

S3 gallop, pulmonary venous congestion on xray, and JVD suggestive of

CHF

7

what signs DO NOT DISCRIMINATE between heart vs. lung problem?

wheezing, exertional dyspnea, orthopnea, PND (paroxysmal nocturnal dyspnea), leg edema

8

BNP less than 80 pgm/ mL can r/o

cardiac cause

9

basic labs for dyspnea

pulse ox, ABG, CXR, spirometry, EKG, CBC, BNP

10

specialized labs for dyspnea

cardiac stress testing, echo, pulmonary function testing, CT angiography of chest, and cardiopulmonary exercise testing

11

dyspnea tx

treat cause of dyspnea. administer oxygen, maintain airway- keep paO2 above 60 mmHg, and pulse ox above 90%

12

acute respiratory failure categories

oxygenation (hypoxemia) and removal of carbon dioxide (hypercapnia)

13

hypoxemia vs. hypoxia

hypoxemia- decreased oxygen partial pressure in blood. hypoxia- insufficient delivery of oxygen to organs/tissues

14

causes of hypoxia

low cardiac output, low hemoglobin, and low oxygen saturation

15

causes of hypoxemia

hypoventilation, R to L shunt, V/Q mismatch, diffusion impairment, low inspired oxygen

16

hypoxemia

partial pressure of oxygen in blood less than 60 mmHg. need an ABG to get this value

17

hypercapnia defined as

paCO2 greater than 45 mmHg

18

hypercapnia caused by__, NOT ___

caused by alveolar hypoventilation, not by excessive CO2 production

19

symptoms of acute hypercapnia

increased ICP- headache, confusion, lethargy, seizures, coma (paCO2 over 100 mmHg)

20

causes of hypercapnia

depressed central respiratory drive (drug overdose, brainstem lesions, tetanus), thoracic age disordres (morbid obesity, kyphoscoliosis), neuromuscular impairment (MG, GB), intrinsic lung disease (COPD), and upper airway obstruction

21

wheezing a/w

asthma or COPD

22

acute vs. subacute vs. chronic cough

acute- lasts less than 3 weeks. a/w self limited URI or bronchitis. Subacute cough- more than 3 weeks but less than 8, usually postinfectious. Chronic cough- lasts more than 8 weeks, a/w smoking, upper airway cough syndrome, asthma, GERD, ACE/ARB

23

central vs. peripheral cyanosis

central- cyanosis caused by inadequate pulmonary oxgenation. peripheral- cyanosis peripherally caused by vasoconstriction

24

management of acute respiratory failure

intubation and mechanical ventilation

25

what conditions cause exudative vs transudative pleural effusion?

exudative- infection or neoplasm (pleural disease). transudative- imbalance between oncotic and hydrostatic pressures, like in CHF

26

Patient presents with dyspnea and PAIN with INspiration. Upon PE, there is DULLNESS to percussion and decreased breath sounds. suspect..

pleural effusion

27

diagnosis of pleural effusion

diagnostic thoracentesis indicated for all cases except if CHF suspected. If CHF, treat for 3-4 days and if effusion does not resolve THEN drain

28

how much fluid on decubitus CXR or US is significant in pleural effusion

1 cm

29

tx pleural effusion

therapeutic thoracentesis- drain no more than 1-1.5 L

30

consider bleeding in cough according to vessels

bronchial or pulmonary vessels

31

Emergent bleeding in sputum/cough results from..

bleeding from the bronchial vessels 90% of the time

32

mild, moderate, severe hemoptysis

mild- less than 20 ml in 24 hours. moderate is 20-600mL in 24 hours. Severe- more than 600mL in 24 hours

33

chronic, productive, blood streaked cough in patient

chronic bronchitis, bronchiectasis, CF, TB, neoplasm

34

hemoptysis, night sweats, fever, weight loss

TB

35

clustering cases of hemoptysis with fever, cough, chest pain, and fulminate course

plague

36

abrupt onset of bloody, purulent sputum

pneumonia or bronchitis

37

life threatning hemoptysis treatment

intubation with large ET tube, 2 large bore IV's, pulse ox, type and crossmatch, CXR, CBC, PT, PTT

38

acute bronchitis caused by

usually viral- influenza A and B, parainfluenza, RSV

39

common cold caused by

rhinovirus, coronavirus, adenovirus

40

SARS (severe acute resp syndrom) caused by

coronavirus

41

diagnostic testing in acute bronchitis and URI

not indicated in absence of rales and egophony on chest exam. Exception= elderly with cough- get chest xray

42

5 criteria suggestive of pneumonia. if present, get CXR. if all 5 absent, no need for CXR

1. HR over 100. 2. RR over 24. 3. temp over 38. 4. age over 64. 5. chest exam findings of egophony or fremitus

43

influenza tx

give antivirals within 48 hours of symptom onset

44

bronchitis tx

no need for abx, antitussives, inhaled bronchodilators

45

PNA tx

empiric antibiotics, bronchodilators. steroids in severe cases

46

pus in the plerual space

empyema

47

localized supparative necrotizing process in the lung parenchyma

lung abscess

48

Patient is on empiric abx for PNA. Symptoms are not resolving though- patient is ill, has weight loss, night sweats, anemia, pain with inspiration. PE shows decreased breath sounds, dullness to percussion, decreased fremitus, friction rub, rales. suspect

empyema

49

diagnosis of empyema

aspiration of grossly purulent fluid on thoracentesis AND at least one of the following: positive gram stain or culture, pleural fluid glucose less than 40 mg/dL, ph less than 7.1, and LDH more than 1000 IU/L

50

3 stages of empyema

exudative (easiest to treat), fibrinopurulent (loculations), and organizational (pleural peel)

51

empyema tx

pain control, tx of underlying condition (abx if PNA), if early- chest tube drainage. if late- VATS

52

lung abscess commonly caused by....

aspiration pneumonia, happens 7-14 days after aspiration

53

lung abscess caused by anaerobic vs. aerobic bacteria

anaerobic- immunocompetent. aerobic- immunocompromised

54

lung abscess presentation

cough for several weeks, putrid sputum, hemoptysis, fever, weight loss, night sweats, pleuritic chest pain

55

CXR shows air-fluid level and cavitating lesion in the lower lobes. CT shows smaller abscesses in consolidations. diagnosis:

lung abscess

56

tx of lung abscess

clindamycin and metronidazole. drainage usaully occurs spontaneously. surgical- percutaneous drainage or thoracotomy and resection.

57

what type of bacteria is mycobacterium TB

slow growing aerobic rod, acid fast bacilli

58

CXR shows cavitating lesions in UPPER lobe, caseation necrosis, gohn complexes. Sputum for AFB positive. dx?

TB

59

diagnostic tests for TB

sputum for AFB (60%), culture for M. Tuberculosis takes 4-8 weeks, CXR showing gohn complexes and cavitating lesions. and TB skin test

60

TB tx

four drug (INH, RIF, PZA, EMB) for 8 weeks, followed by 2 drug for 18-31 weeks

61

risk factors for spontaneous pneumothorax

marfan body habitus, smoking, male, asthma, COPD, Tb, AIDS, CF

62

spontaneous pneumothorax result from

bullae rupture

63

Patient presents with dyspnea, hypoxemia, pleuritic chest pain, decreased breath sounds, decreased fremitus, hyperresonance. EKG shows ST changes and T wave inversion,

pneumothorax

64

tx for pneumothorax

oxygen. catheter aspiration for small (heimlich valve). Tube thoracostomy for large (Pleurivac)

65

clinical hallmarks of tension pneumothorax

tracheal deviation, hypotension, and hyperresonance of affected side

66

how is tension pneumothorax managed?

do NOT wait for chest xray. clinical diagnosis. insert 18G needle into pleural space at mid clavicular line in 2 or 3 intercostal space to decompress, then put in chest tube

67

ribs broken in 2 places on the same rib

flail chest

68

problematic issue in flail chest

pulmonary contusion more than rib fractures

69

tx in flail chest

pain control, oxygenation. chest tube if pneumothorax or hemothorax

70

tx of sucking chest would

cover would with occlusive dressing on 3 sides, creating a valve

71

is wheezing pathognomonic in asthma

NO

72

asthma classification

mild- pulse ox over 92%, peak flow over 80%. moderate- pulse ox over 90%, peak flow 50-80%. severe- pulse ox less than 90%, peak flow less than 50%

73

asthma diagnosis

history of asthma, pulse ox, peak flow, cxr to r/o pneumonia, ABG- respiratory acidosis. cardiac workup if dx not certain

74

inflammation of the bronchioles causing bronchoconstriction, increased mucous secretion

asthma

75

tx of mild asthma

nebulizers, follow up outpatient

76

tx of moderate asthma

nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT

77

tx of severe asthma

nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT. IV steroids, IV magnesium. Intubation and mechanical ventilation if ARF

78

chronic productive cough for 3 months in the year for 2 consecutive years when all other causes of chronic cough have been excluded

chronic bronchitis

79

COPD main causes

smoking, alpha 1-antitrypsin deficiency, other respiratory irritants (coal, silica)

80

patient presents with wheezing, dypsnea, chest tightness, anxiety. Hypoxia, barrel chested, and clubbing. Has smoking history for last 20 years. suspect

COPD (exacerbation)

81

diagnosis of COPD exacerbation

pulse ox, cardiac monitoring, CXR, ABG, cardiac workup if indicated

82

mild COPD exacerbation tx

smoking cessation counsel, nebulizers, abx if bacterial infection, OP F/U

83

moderate COPD exacerbation

smoking cessation counsel, albuterol, ipratropium, prednisone, zithromax

84

severe COPD exacerbation

smoking cessation counsel, albuterol, IV steroids. intubation and mechanical ventilation if indicated

85

common causes of PE

smoking, BCP, pregnancy, clotting disorder, previous DVT/PE, recent surgery

86

patient presents with tachycardia, tachypnea, hypoxia. may have fever. automatically think---

PE

87

PE labs

CBC, d-dimer, troponin, EKG

88

Diagnosis of PE

CT angiogram, VQ scan, wells criteria