Exam 1 Flashcards
(216 cards)
1
Q
Pt comes in with neck trauma, how do you open their airway?
A
Jaw thrust
2
Q
What type of airway do you use in an obtunded Pt?
A
Oropharyngeal
3
Q
How do you determine size of orotracheal tube in a kid?
A
(Age + 16)/4
4
Q
What is rapid sequence intubation?
A
Uses paralysis + sedation to intubate pt
DON’T use if difficult/distorted airway
5
Q
You need to RSI, & Pt is an asthatic, which sedation should you use?
A
Ketamine - relaxes bronchial smooth muscle
6
Q
Sedation meds
A
- Fentanyl
- Midazolam
- Etomidate
- Propofol
- Ketamine - good for asthma
7
Q
Paralysis meds
A
- Succinylcholine
2. Vecuronium
8
Q
Causes of failure to oxygenate/ventilate?
A
- Mechanical failure
- Tension pneumo
- ARDS
- CHF
9
Q
If you can palpate a radial pulse, what must SBP at least be?
A
> 80
10
Q
If you can palpate a femoral pulse, what must SBP at least be?
A
> 70
11
Q
If you can palpate a carotid pulse, what must SBP at least be?
A
> 60
12
Q
How much cardiac output does chest compressions provide?
A
25-30%
13
Q
What is the only intervention consistently proven to improve outcome in cardiac arrest?
A
Defibrillation
14
Q
When do you use electrical pacing?
A
- Refractory tachycardia
- Torsades
- Unstable bradycardia
15
Q
MCC sudden cardiac death?
A
CAD - MI
16
Q
When does sudden cardiac death usually occur?
A
Morning
MC in winter, home, males 50-75
Beta-blockers protective
17
Q
Which arrhythmias usually cause sudden cardiac death?
A
Pulseless VT or VF
18
Q
What factors inc. your chance of survival if you go into VF?
A
- Witnessed collapse
- Prompt CPR
- Early defibrillation
- Younger
- Arrest occurring away from home
- Initial rhythm was VF/VT
19
Q
What is bradyasystole?
A
Vent rate <60 &/or periods of asystole
Rarely survives
20
Q
The SA node experienced ischemia/infarction…what rhythm would you typically see?
A
Bradycardia or asystole
21
Q
The AV node experienced ischemia/infarction…what rhythm would you typically see?
A
AV block
22
Q
Risk factors for sudden cardiac death in adults >35y/o
A
- Age
- Male
- CAD
- Cardiomegaly w/ LVH
- Impaired LV function, EF<30%, CHF
- Long QT
- Vent. arrhythmias
23
Q
Is coarse or fine VF better?
A
Coarse
24
Q
What is shock?
A
Circulatory insufficiency that creates imbalance btwn tissue Ox supply & demand
Causes anaerobic metabolism which creates lactic acid
25
Causes of lactic acidosis
1. Inc. oxygen demand - Status epilepticus
| 2. Impaired tissue Ox use - septic shock, postresuscitation phase of cardiac arrest
26
Dx SIRS
Systemic Infammatory Response Syndrome - from shock
Need 2 or more
1. Temp >100.4 or 90bpm
3. RR >20
4. WBC >12 or <4 or 10% immature forms or bands
27
Classification of shock
1. Hypovolemic
2. Cardiogenic
3. Obstructive
4. Distributive
28
Tx shock
```
Airway
Breathing
Circulation
Delivery of Ox
End points of resuscitation
```
29
When do you use vasopressors & name them
When volume resuscitation not adequate or contraindicated (cardiogenic shock)
1. Dopamine
2. NE
3. Phenylephrine
4. Vasopressin
5. Epi
6. Dobutamine
30
Risk factors for maternal death
1. Maternal age
2. Inc. live birth order
3. Lack of prenatal care
4. Unwed mother
31
What are the leading causes of maternal death?
1. PE
2. Hemorrhage
3. Pregnancy-induced HTN
4. Infection
32
When shouldn't you use a femoral vein for IV access in a pregnant woman?
>20 wks
| Uterus compresses IVC
33
What position should a pregnant lady be in if you're intubating?
Supine but elevate R hip to prevent vascular compression
34
When is the fetus viable?
22-26 wks
35
If a pregnant lady goes into cardiac arrest, what should you do?
Tilt Pt
C-section if baby >20wks after 5 min
Open chest CPR after 15 min
36
Pregnant lady gets PE, what tests should you do?
CT b/c D-dimer inc. w/ pregnancy
Tx w/ Heparin
37
What is the MCC of global brain ischemia in adults?
VF/VT
38
What is the MCC of global brain ischemia in kids?
Asphyxia
39
When should you induce therapeutic hypothermia?
Pts who remain in coma after resuscitation from arrest
1. Reduces neuronal cell death
2. Beneficial to heart, lungs, kidneys & intestines
ROSC 34 C
40
Contraindications of therapeutic hypothermia
1. Trauma
2. Sepsis
3. Advanced dementia
4. Active bleeding
5. CA w/ brain mets
6. DNR
41
What temp do you cool Pt to in therapeutic hypothermia?
33 C
| Cool for 24h then rewarm over 24h
42
Name some opiates
1. Morphine
2. Hydromorphone
3. Fentanyl
4. Meperidine
5. Oxycodone
6. Hydrocodone
7. Codeine
8. Tramadol
43
Name some opiate agonists-antagonists
1. Buprenorphine
2. Butorphanol
3. Nalbuphine
4. Pentazocine
44
Contraindications to propofol
Egg or soy protein allergy
45
Which sedative has a risk of myoclonic jerking?
Etomidate - amnestic not analgesic
46
Visceral pain fibers
Sensation from heart, blood vessels, pericardium, lungs & esophagus
Pain poorly localized, dull, heavy or achy
47
Somatic pain fibers
Sensation from pleura, peritoneum, muscle, skeleton & skin
Pain well localized & sharp
48
Referred pain
Visceral pain signals perceived in somatic structures - arms, neck & jaw
49
Factors that inc. likelihood of acute MI
1. Radiation to R arm/shoulder***
2. Radiation to both arms/shoulders
3. Worse w/ exertion
4. Radiation to L arm
5. Diaphoresis
6. N&V
7. Worse than previous angina/similar to previous MI
8. Pressure
50
Factors that dec. likelihood of acute MI
1. Pleuritic
2. Positional
3. Sharp
4. Reproducible w/ palpation
5. Inframammary location
6. Not exertional
51
What is costochondritis & S/S?
Inflammation of costal cartilage
| Sharp, dull &/or worse w/ breathing
52
What is xiphodynia?
Sharp pain at xyphoid
53
Troponin is elevated, but no MI, what could it be?
1. Tachyarrhythmias
2. LVH
3. Myocarditis
4. Pericarditis
5. Cardiac contusion
6. HF
7. PE
8. Sepsis
54
What influences coronary artery blood flow?
Duration of diastolic relaxation of the heart, coronary vascular resistance
55
Tx STEMI
PCI w/in 90mins or Fibrinolysis w/in 30 min
| Antiplatelets, antithrombins, beta-agonists, nitrates
56
Absolute contraindications to fibrinolytics
1. Prior intracranial hemorrhage
2. Known structural cerebral vascular lesion (ex. AV malformation)
3. Known intracranial CA
4. Ischemic stroke w/in 3 mo
5. Active internal bleeding
6. Suspected aortic dissection/pericarditis
57
When would you use a glycoprotein IIb/IIIa inhibitor with an MI?
with PCI
1. Abciximab
2. Eptifibatide
3. Tirofiban
58
When should you use caution with nitrates?
Inferior MI - nitrates dec. preload & may cause HOTN due to RV involvement
Do not use w/in 24h of Viagra or 48h of tadalafil use
59
You should start oral beta-blockers in MI Pts unless...
1. Signs of HF
2. Low cardiac output
3. Inc. risk for cardiogenic shock
4. Prolonged PR, 2/3rd degree heart block, active asthma, reactive airway disease
60
STEMI from crack...what is the Tx?
Get EKG, Troponin
1. Aspirin
2. Nitrates
3. Benzos
4. PCI
DO NOT use beta-blockers - will inc. BP
61
Define cardiogenic shock
Dec. cardiac output leading to inadequate tissue perfusion despite adequate or excessive circulating volume (pump problem)
62
Risk factors for cardiogenic shock
1. Old
2. Female
3. Acute/prior ischemic event
4. PMH
5. CHF
6. Diabetes
63
MCC of cardiogenic shock?
Large MI
64
S/S Cardiogenic shock
Hypoperfusion
1. AMS
2. Dec. urine output
3. Ashen/cyanotic, cool skin, mottled extremities, weak pulses
4. Weak pulses due to sympathetic nervous system
5. HOTN
6. Sinus tachycardia
7. Tachypnea
8. JVD
9. Rales
10. Loud/new systolic murmur
11. Cardiac PMI moved
65
Tx cardiogenic shock
1. PCI usually
2. Correct hypoxia, hypovolemia, rhythm disturbances, electrolyte abnormalities, acid base abnormalities
3. Foley-cath to monitor output
66
Tx cardiogenic shock + MI
Tx same way as w/o shock except
1. No NTG if SBP <90
2. No beta-blockers for Pts in shock or at risk for shock
67
MCC HF & Pulmonary edema
1. Myocardial ischemia
2. Cardiomyopathy
3. HTN
4. Cardiac dysrhythmias
5. Noncompliance
68
What is normal ejection fraction?
60%
69
Describe systolic dysfunction
1. EF <40%
2. Impaired contractility - difficulty ejecting blood
3. Leads to inc. intracardiac volumes & pressures, pulm. congestion & edema
70
Describe diastolic dysfunction
1. EF normal/higher
2. Impaired vent relaxation - difficulty receiving blood
3. Atrial pressures inc.
inc. w/ age, women
Often due to chronic HTN & LVH, sometimes CAD
71
CXR - L-sided CHF
1. Cardiomegaly
2. Interstitial edema
3. Effusions
4. Kerley B lines
5. Cephalization
6. Bat wing pattern
72
BNP in chronic HF?
always inc. - but change of 40% from baseline = acute exacerbation
73
MC precipitants of acute HF syndrome
1. Noncompliance - excess salt, meds
2. Raid AFib
3. Acute MI
4. Renal failure
74
Tx HTN HF
1. O2, SL NTG
2. BP >150/100 - add IV NTG/nitroprusside
3. IV diuretic - furosemide
4. If severe dyspnea - begin BiPAP
Admit PRN
75
When should you avoid nitrates w/ HF?
1. RV infarction
2. Aortic stenosis
3. Volume depletion
4. Hypertrophic cardiomyopathy
76
Tx HOTN HF
SBP<90
1. Inotrope - dobutamine/dopamine until SBP 90-100
Admit - may need vasodilator
77
Drugs to avoid in HF
1. CCB
2. NSAIDs
3. Antiarrythmics - quinidine, procainamide
78
Tx bradyarrhythmias
Only Tx if hypoperfusion or risk of AV block
1. TransQ pacing at 100
May need sedation w/ narcotics/benzos
79
Tx regular stable narrow tachyarrhythmias
1. Vagal maneuvers
2. Adenosine
Tx underlying cause
80
Tx irregular stable narrow tachyarrhythmias
1. Control rate - diltiazem or beta-blockers
Tx underlying cause
81
Tx regular stable wide tachyarrhythmias
If VT - amiodarone
Consider synch. cardioversion
SVT - adenosine
82
Tx irregular stable wide tachyarrythmias
If WPW w/ AF - amiodarone/procainamide
If Torsades - Mg
If VT - synch. cardioversion
83
If defibrillator Pt is in cardiac arrest, how many shocks have they already had?
4
84
When a Pt presents to the ED, at what time are their BP measurements most representative?
60-80 mins
85
MCC hypertensive urgencies?
Noncompliance w/ meds
86
Tx hypertensive urgency
Reduce BP w/in 24-48h
Commonly use Clonidine
87
What is malignant HTN?
Elevated BP w/ papilledema
88
S/S hypertensive emergency
1. HA
2. N/V
3. Visual complaints
4. AMS - encephalopathy - cardiac Sx, confusion, lethargy, coma
5. Eyes - hemorrhages, exudates, papilledema
6. Acute CHF
89
S/S hypertensive urgency
Nonspecific
| Usually HA
90
Tx hypertensive emergency
Lower MAP ASAP by 20-25%
Use Labetalol/Metoprolol/Esmolol
Nicardipine/NTG/sodium nitroprusside
Benzos
91
If a Pt has asthma & presents w/ hypertensive emergency, what should you use to lower BP?
Esmolol - short acting
92
Tx aortic dissection w/ HTN emergency?
goal SBP <140-110
Morphine
Labetalol
93
Tx pulm edema w/ HTN emergency
NTG then diuretics
94
Tx acute MI w/ HTN emergency
NTG
| beta-blockers
95
Tx cocaine intox. w/ HTN emergency
Benzos
DO NOT use beta-blockers
96
Tx eclampsia w/ HTN emergency
Labetalol
| Nicardipine
97
Tx HTN encephalopathy w/ HTN emergency
Nicardipine/Labetalol
98
Tx SAH w/ HTN emergency
Labetalol/Nicardipine
| Oral nimodipine
99
Tx intracranial hemorrhage w/ HTN emergency
Labetalol
| Nicardipine
100
Tx acute ischemic stroke w/ HTN emergency
Labetalol
101
Tx acute postop HTN
Tx pain & anxiety first
| Nicardipine/Labetalol
102
When in doubt w/ HTN emergency on test, use what??
Labetaol & Nicardipine
103
Do you treat ED identified HTN?
If significantly elevated but no S/S - start meds & arrange follow up
HCTZ or Lisinopril
104
MCC syncope
Unknown - have inc. risk of death
105
What is the most dangerous type of syncope?
Cardiac
1. Structural
Old people? Aortic stenosis
2. Dysrhythmias - usually no prodrome
106
Why are seizures usually confused with syncope?
Brief tonic clonic mvmts may occur w/ syncope
107
What is a good predictor of syncope in old people?
CV risk
108
Which types of syncope need admitted?
Cardiac & neuro
109
S/S pericarditis & pericardial effusion
1. Sharp, stabbing, severe retrosternal CP
2. Sudden/gradual onset
3. Worse w/ inspiration or mvmt
4. Referred to back/trapezius
5. Worst when supine, better when leaning forward
6. Fever, malaise, dyspnea, dysphagia
7. Pericardial friction rub
110
EKG changes w/ pericarditis & CXR
1. Diffuse ST elevation
2. PR depression (II, aVF, V4-V6)
3. Later see T wave inversion & ST normalization
4. ST to T amplitude >0.25
CXR usually normal
111
EKG changes w/ pericardial effusion & CXR
Low QRS - pulsus alternans
CXR - enlarged heart w/ water bottle appearance
112
How do you diagnose pericardial effusion & Tx?
Echo
Tx - pericardiocentesis
Treat underlying cause
113
MCC tamponade in ED?
Trauma
Metastatic effusion MC non-traumatic cause
114
S/S tamponade
1. Dyspnea at rest
2. Fatigue
3. Beck's triad - neck vein distention, HOTN, muffled heart sounds
4. Tachycardia
5. Pulsus paradoxus
115
Dx tamponade
Echo -Dx
RA compression, RV diastolic collapse, hyperdynamic heart
EKG - low voltage, electrical alternans
CXR - may be normal
116
What is Beck's triad & when is it seen?
1. Neck vein distention
2. HOTN
3. Muffled heart sounds
seen w/ tamponade
117
Tx tamponade
1. IV fluids
2. Dobutamine
3. Pericardiocentesis
Traumatic - surgery
118
What is constrictive pericarditis & when is it seen?
Pericardium becomes thickened & scarred preventing diastolic filling
1. Trauma w/ intrapericardial hemorrhage
2. Pericardiotomy
3. Chronic renal failure
4. Fungal/TB pericarditis
5. Idiopathic
119
S/S constrictive pericarditis
1. DOE, orthopnea
2. Fatigue, weakness
3. JVD
4. Inspiratory neck vein distension - Kussmaul sign
5. Paradoxical pulse
6. Pericardial knock
7. Hepatomegaly
8. Ascites
120
What is a pericardial knock & when is it seen?
Constrictive pericarditis
Early diastolic sound just after S2
121
Dx constrictive pericarditis
EKG - low voltage QRS, inverted T waves
CXR - pericardial calcification on lateral
**Doppler echo, CT or MRI preferred
122
Tx constrictive pericarditis
1. Fluid restriction & diuretics
| 2. Pericardiectomy
123
S/S myocarditis
1. Fever
2. Fatigue
3. Myalgias
4. HA
5. CP
6. Palpitations
7. Dyspnea
124
Dx myocarditis
Labs - inc. WBC, ESR & troponin
May need nuclear imaging/Bx
125
Tx myocarditis
Supportive
126
Types of cardiomyopathies
1. Dilated - Most common
2. Hypertrophic
3. Restrictive
127
What is the main indication for heart transplantation?
Dilated cardiomyopathy
death w/in 2 years w/o transplant
128
S/S dilated cardiomyopathy
1. DOE
2. Orthopnea
3. PND
4. Bibasilar rales
5. Dependent edema
6. CP
129
Dx dilated cardiomyopathy
CXR - CMG, pulm congestion
EKG - LVH, LAE, Afib, AV conduction abnormalities, vent. arrhythmias
Echo - Chamber enlargement, dec. vent. function
130
Tx dilated cardiomyopathy
1. Nitrates, diuretics
2. Anticoagulation
3. Antiarrhythmics PRN
131
Which cardiomyopathy shows systolic & diastolic dysfunction?
& diminished vent. contractile force - low CO & HF
Dilated
132
Which cardiomyopathy shows diastolic dysfunction?
Hypertrophic
Muscular hypertrophy of nondilated LV - muscle becomes stiff
Restricted vent. filling
133
Dx hypertrophic cardiomyopathy
EKG - LVH, LAE, deep septal Q waves
Echo*** - disproportionate septal hypertrophy
134
Tx hypertrophic cardiomyopathy
Emergent? Beta-blockers for CP
Arrhythmias? Amiodarone
DO NOT give digoxin, nitrates, diuretics or beta-agonists
135
Which cardiomyopathy shows elevated venous pressures?
Restrictive
May be from amyloidosis, sarcoidosis, hemochromatosis, scleroderma
136
Which valve is most often infected w/ endocarditis?
Mitral
Then aortic, tricuspid then pulmonic
137
MCC endocarditis acute & subacute
a - S. aureus
High fever, systemic toxicity
s - Strep. Viridans
Gradual onset
138
When are Osler nodes & Janesway lesions seen?
Endocarditis
O - painful nodules on pads of digits
J - nontender hemorrhagic plaques on palms/soles
Bacteria seeds & heart spits out little clots
139
Dx endocarditis
1. Cultures - 3 diff sites
2. Inc. ESR, CRP
3. UA - hematuria, proteinura, pyuria
4. EKG - conduction abnormalities
5. Echo
6. TEE better - can rule in but not out Dx
7. Duke criteria
140
Tx endocarditis
1. ABCs
2. Abx
Sick - Nafcillin + Gentamicin
Subacute - PCN + Gentamicin
Prosthetic valve - Vanco + Gentamicin + Rifampin
141
Should you anticoagulate an endocarditis Pt?
NO mammary glands
142
During aortic dissection, what happens if the blood dissects through the adventitia?
you die
143
MCC thoracic aortic dissection?
HTN
Prego MCC women <40
144
Type A vs. B aortic dissections
A - ascending, surgery
B - below, medical mgmt
145
S/S aortic dissection
1. Abrupt severe onset CP that radiates to back/abdomen
2. Ripping/tearing
3. Diaphoresis, N/V
4. FH
5. Migratory findings
6. SBP diff. >15mm btwn each arm
7. Unilat pulse deficit/absent
8. Diastolic murmur
9. Neuro deficits
10. Neuro deficits/dysphagia, Horner syndrome
146
Dx aortic dissection
CXR - mediastinal widening, obliteration of aortic knob, tracheal displacement to the R, Pleural effusion to L
CT
147
Tx aortic dissection
Tx HTN
Beta-blockers - Labetalol, Esmolol
Nitroprusside
148
MCC acute limb ischemia?
Thrombotic occlusion
149
Where do most emboli from arterial occlusion come from?
Heart
150
MC locations for arterial occlusion
Lower extremities at the bifurcation of the common femoral artery
Then popliteal
Arm - brachial artery
151
S/S arterial occlusion
1. Pain
2. Pallor
3. Paralysis
4. Pulselessness
5. Paresthesias
6. Poikilothermia
152
Dx acute arterial occlusion
ABI 30mm = obstruction
US - most accurate above knee
CT angio
153
Tx arterial occlusion
Supportive
1. Aspirin
2. Heparin
3. Analgesia
4. Fluids
Revascularization
1. Thrombolytics
2. Embolectomy
3. PTCA
4. Bypass graft
5. Amputation
154
What does dysfunction of venous valves cause?
Stasis & endothelial injury
155
Are distal DVTs bad?
Not really
156
Define phlegmasia alba dolens
Iliofemoral thrombosis causing edema of extremity
Pale, cool, possible limb loss
157
Define phlegmasia cerulea dolens
Iliofemoral thrombosis that inclues all collateral veins of extermity
Arterial ischemia & cyanosis, possible limb loss
158
Dx DVT
1. Pain, tenderness, swelling
2. Upper extremity - hand swelling
3. Swelling, edema, tenderness in calves & thighs
4. Arm - distended superficial veins that don't collapse when arm is raised
5. Measure - diff. >2 cm
6. Homan's sign
7. US - better above knee
159
Tx DVT
1. Heparin/Lovenox then switch to PO
Contraindicated? IVC filter/umbrella
2. Thrombolytic therapy
Superficial thrombophlebitis - NSAID, warm compresses
Calf vein? Watch
160
What murmurs do you usually hear with prosthetic aortic valves?
Systolic
Diastolic not good
161
What murmurs should you worry about with prosthetic mitral valves?
Loud holosystolic murmur
162
MC organism for prosthetic valve endocarditis?
S. epidermidis
163
Who commits more suicides, men or women?
Men commit 4x more but women attempt 4x more
164
Screening for suicide
```
Sex
Age
Depression
Previous attempt
Ethanol use
Rational thinking loss
Social supports lacking
Organized plan
No spouse
Sickness
```
>5 = high risk
165
What medical conditions can cause mental status changes?
1. Diabetes
2. Thyroid disorders
3. Intoxications
4. Withdrawal
5. AIDS
6. Head injury
166
Screening for depression
```
Sleep disturbance
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal thoughts
Mood
```
5or+ = major depression
167
When are there more psych emergencies for kids?
school year
168
MCC CHF
Afib
169
What is the best Tx for COPD to extend life?
Oxygen
170
What is your drive for breathing?
CO2
Ox in COPD Pts
171
Tx hiccups
Thorazine
172
Exudate - protein & LDH levels
p >0.5
| L >0.6
173
What drug commonly causes pleural effusions?
Exudative - amiodarone
174
Dx pleural effusion
1. +/- dyspnea
2. Dullness to percussion & dec. breath sounds
3. CXR
4. Thoracentesis
175
Tx pleural effusion
1. Diuretics
| 2. Thoracentesis if <1-1.5L
176
MCC hemoptysis?
Bronchitis
177
Dx hemoptysis
1. CXR
2. Bronchoscopy if >600mL
3. CT
178
When is asthma worse during the day?
Late evenings & early mornings
179
MCC COPD
Smokingggggggggg
next is asthma
180
3 diseases of COPD
1. Asthma
2. Emphysema
3. Bronchitis
181
How is staging of COPD determined?
FEV1
182
S/S COPD
1. Exertional dyspnea***
2. Chronic productive cough***
3. Minor hemoptysis
4. Tachypnea, accessory muscle use
5. Pursed lip breathing
6. Wheezing
7. Prolonged expiratory time
8. Crackles/rhonchi
9. Barrel chest/reduced diagphragmatic motion
10. Displacement of PMI - R HF & R axis dev.
11. Dec. breath sounds
183
S/S pulm. HTN/Cor Pulmonale
1. Distended neck veins
2. Passive hepatic congestion
3. Peripheral edema
184
S/S hypercarbia
1. Confusion
2. Tremor
3. Plethora
4. Stupor
5. Hypopnea/apnea
185
S/S PE
1. Dyspnea
2. Pleuritic CP worsened w/ cough/breathing
3. Referred pain
4. Neuro Sx
5. Tachypnea
6. Hypoxia
7. LCTA usually
8. R vent. S3 or split S2
186
EKG PE
1. S1Q3T3 - McGinn White sign
| 2. Sinus tachycardia MC** w/ R axis dev.
187
Dx PE
1. Ox<93%
2. Dec. end tidal CO2
3. CXR - westermark, CMG, Hampton, Fleischner
4. Sinus tach, S1Q3T3
5. CT angio
6. V/Q scan
7. Pulm. angiography***gold std
188
When is Hampton's hump sign seen?
PE
Peripheral dome shaped dense opacification on CXR
189
When is Fleischner's sign seen?
PE
local widening of artery at site of occlusion on CXR
190
When is Westermark sign seen?
PE
Wedge shaped oligemia on CXR
191
Gold Std for Dx PE?
Pulm angio
But you'll prob get CT angio
192
Tx PE
1. UFH/LMWH
2. Coumadin
3. +/- fibrinolytics
193
3 categories of PE
1. Massive - BP t give fibrinolytics
194
MCC PNA
Pneumococcus
195
S/S PNA
1. Cough
2. Fatigue
3. Fever
4. Dyspnea
5. Sputum
6. Pleuritic CP
196
Classic S/S Pneumococcus PNA
1. Sudden onset w/ fever
2. Rigor
3. Dyspnea
4. Hemoptysis
5. CP
6. Tachycardia
7. Tachypnea
8. Abnormal lung sounds
197
Currant jelly sputum?
Klebsiella
Pulm. abscess common
CXR - necrotizing lobar PNA
198
PNA w/ ear problems?
Bullous myringits from Mycoplasm
Tx - Azithromycin
(Macrolide)
common in young adults
confirm w/ cold agglutinin
199
S/S consolidation
1. Bronchial breath sounds
2. Egophony
3. Inc. tactile & vocal fremitus
4. Pleuritic friction rubs
5. Cyanosis & jaundice
6. Abdominal distention
200
Who gets H. flu PNA?
Immunocompromised & unvaccinated
CXR - patchy infiltrates
201
Who should you consider pseudomonas PNA in?
1. CF
2. Hospitalized
3. Central venous catheters
4. Burn wounds
5. Bronchiectasis
6. HIV
202
Who usually gets Staph PNA?
After viral illness
IVDU, hospitalized Pts, debilitated
203
PNA & contact w/ pigeons?
Chlamydia psittaci
204
Old person w/ PNA, GI Sx & bradycardia?
Legionella
205
Tx PNA in healthy PT
Azithromycin
206
Tx PNA w/ comorbidites
Levaquin
207
If Pt aspirates - should you give abx?
No - wait 24-48h
208
MCC empyema
S. aureus
209
Dx empyema
1. Thoracentesis
2. Fluid w/ +GS/culture
3. Glucose 1000
210
MCC lung abscess
Aspiration
211
S/S lung abscess
Several weeks of
1. Cough
2. Fever
3. Pleuritic CP
4. Wt loss
5. Night sweats
212
Dx lung abscess
CXR - dense consolidation w/ air-fluid level inside thick walled cavitary lesion
213
Tx lung abscess
Clindamycin + Flagyl
Might need bronchoscopic drainage/surgery
214
Primary TB S/S
```
Asymptomatic
Active
1. Fever
2. Malaise
3. Wt loss
4. CP
```
Reactivation has same Sx w/ extrapulm - Lymph MC
215
Gold Std for Dx TB?
Culture
216
What is the first acid-base abnormality with shock?
Resp. alkalosis
Then Met. acidosis
