MDT (acute B, thorax, pneumon, hema)

Question 1

Hallmarks of Acute Bronchitis?

Answer 1

• Cough with midline burning chest pain
• Fever
• Dyspnea
• Rhonchi that clears with coughing
• Smokers

Question 2

When is X-Ray indicated for Acute B?

Answer 2

• Dyspnea
• Hypoxia
• Significant comorbidities

Question 3

When is it considered chronic bronchitis?

Answer 3

Productive cough 3 months for 2 consecutive years

Question 4

How can you differentiate between pneumonia and acute bronchitis?

Answer 4

X-rays to identify infiltrates

Question 5

Tx for Acute B?

Answer 5

Symptomatic

• Antipyretics
• Cough suppressants/ DM
• Expectorants
• NSAIDS

Question 6

Is acute B considered most likely Viral or bacterial

Answer 6

Viral until proven otherwise

Question 7

Disposition for Acute B?

Answer 7

SIQ 24h

Question 8

Hallmarks of Hemoptysis

Answer 8

Smoker
Cough
Fever
Nasopharyngeal or GI bleed

Question 9

What truly defines Hemoptysis

Answer 9

> 500ml of expectorant blood 24hr period
OR
100ml/hr

Question 10

Labs/Rads for Hemoptysis

Answer 10

CHEST RADIOGRAPH to identify site of bleed

Hb and hct (amount of bleed)
WBC (infection?)

Question 11

Differentials for Hemoptysis?

Answer 11

TB
Chronic Bronchitis
Pneumonia
Pulmonary AVM

Question 12

Treatment for massive hemoptysis?

Answer 12

O2
Site of bleed?
Large bore ET (8 or bigger)
Position on effected side

Question 13

Why a large bore ET for hemoptosys?

Answer 13

For interventional and diagnostic bronchoscopy

Question 14

Why a large bore ET for hemoptosys?

Answer 14

For interventional and diagnostic bronchoscopy

Question 15

Disposition for Hemoptysis

Answer 15

MEDEVAC

• Pulmonology
• ENT for URI issues

Question 16

Hallmarks of Pnuemonia

Answer 16

Fever
Cough
Sweats, Rigors
Dyspnea
Chest Discomfort

Crackles/Rales, Bronchial Sounds

Infiltration on X-Ray

Question 17

What does the development of lower respiratory tract infections come from?

Answer 17

• aspirations of secretions containing bacteria

* infected aerosols

Question 18

What respiratory mechanical protection do we have?

Answer 18

Cough reflex
Mucociliary clearance system
Immune response

Question 19

When does community aquired pneumonia occur?

Answer 19

Defect in the respiratory defenses

Question 20

Are bacteria or viruses more likely the cause of pnuemonia?

Answer 20

Bacteria

Question 21

Most common bacterial acquired pneumonia?

Answer 21

Streptococcus

Question 22

Hallmarks specific to Community acquired pneumonia?

Answer 22

Acute/Subacute fever
Cough
Dypsnea

Question 23

Hallmarks for anaerobic pleuropulmonary infection?

Answer 23

Smelly purulent sputum

poor dentition

Question 24

Hallmarks of aspiration pneumonia

Answer 24

Literally same as anaerobic pulmonary infection

• Gen 7
• Cough
• Poor dentition
• Smelly sputum

Question 25

What mhx is a predisposition for aspirated pneumonia?

Answer 25

< LOC
Drug/Alcohol abuse
Seizures
Anesthesia
CNS disease
Advanced airways
Dental

Question 26

What is imporant about the onset of acquired pneumonia?

Answer 26

It’s insidious (slow)
* Poor conditions by the time they are finally seen

• necrotizing pneumonia
• lung abscess
• empyema (pockets of puss)`

Question 27

How long does it take for the clearing of pulmonary infilitrates?

Answer 27

6 weeks

Faster for ;

• young
• non-smokers
• one lobe

Question 28

Treatment for pneumonia

Answer 28

Antipyretics
Cough suppression
NSAIDS

Empiric Antibiotics

• Azithromycin
• Amoxicillin
• Doxycycline
• ‘floxacins

Question 29

Disposition of pnuemonia?

Answer 29

Keep unless unresponsive to treatment

Question 30

Conditions for MEDEVAC regarding pneumonia?

Answer 30

• Unresponsive to treatment
• Hypoxemia
• Pleural effusion
• Decreased mental status

Question 31

Hallmarks of Hemothorax

Answer 31

Penetrating Chest Trauma

Dullness to percussion
Decreased breath sounds effected side
Respiratory Distress
Hypotension

Flat neck veins
Narrow pulse pressure

Question 32

Definitive Rads for hemothorax?

Answer 32

Chest x-ray
* As little as 200ml of blood can be seen

Ultrasound

Question 33

Treatment for Hemothorax

Answer 33

Tube throacostomy 36fr - 40fr

Occlusive dressing for and penetrating sites

Stop external bleeding

O2
IV

MEDEVAC

Question 34

Disposition for Hemothorax?

Answer 34

MEDEVAC due to possible hypovolemia

Question 35

Classifications of Pneumothorax?

Answer 35

Spontaneous (Primary and Secondary)
Traumatic
Tension

Question 36

Hallmarks of pnuemothorax?

Answer 36

Diminished breath sounds effected side
Hyper resonance effected side

Decreased chest movement effected side

Chest pain
Dyspnea
Guarding

Question 37

Diagnostic findings from rads for pnuemothorax?

Answer 37

Chest X-Ray
* Shows visceral pleural line (fine, sharply defined opaque line)

Ultrasound
* Absent lung sliding

Question 38

Typical causes of primary spontaneous pnuemothorax?

Answer 38

Tall
Skinny
Male
20-40
Smoker

Question 39

“Stable” vital signs for pneumothorax?

Answer 39

BP: normal
RR: <24
HR: 60-120
O2: >90

Question 40

How soon should you get a chest x-ray for pnuemothorax?

Answer 40

3-6 hours

Question 41

Treatment for unstable pnuemothorax?

Answer 41

Re-expansion of the lung

Needle D 16g 3.25in needle 2nd midclavicular intercostal space

Small bore chest tube for primary spontaneous pnuemo

Large bore chest tube for everything but primary spontaneous pneumo

Question 42

Hallmarks for Tension Pneumothorax?

Answer 42

Tracheal deviation away from distress

Respiratory distress

• Pursed Lips
• Flared nostrils
• cyanosis
• slow cap refill

JVD

all other pneumo s/s

poor chest wall expansion on affected side

Question 43

Treatment for tension pneumo?

Answer 43

Large bore IV cath to 2nd intercostal

Chest tube

Question 44

Disposition for Pneumothorax?

Answer 44

MEDEVAC