Pneumothorax, effusion + acute resp failure

Question 1

How do you treat pleuritis?

Answer 1

NSAIDs, codeine, other opioids

Question 2

What’s the first step for pneumothorax tx?

Answer 2

stabilize patient
- RR <24
- HR>60 but <120
- normal BP
- O2>90%
- ability to speak in whole sentences

Question 3

What is treatment for a small primary pneumothorax?

Answer 3

6 hour observation
Repeat CXR to confirm no progression
Follow up in 24 hours

Question 4

What’s treatment for a large primary pneumothorax?

Answer 4

Needle aspiration followed by chest tube (second intercostal space at midclavicular line of the affected side) if fails
Attach to heimlich valve to prevent tension

Question 5

What’s treatment for a secondary pneumothorax?

Answer 5

Chest tube placement (large, severe, or from mechanical ventilation) + hospitalization
Thoracostomy (recurrence, bilateral, failure)

Question 6

How do you treat a tension pneumothorax?

Answer 6

Medical emergency → emergent chest decompression with a large-bore needle followed by immediate chest tube placement

Question 7

How do you treat a transudative pleural effusion?

Answer 7

treat underlying cause, diuretics + sodium restriction

Question 8

How do you treat an exudative pleural effusion?

Answer 8

drainage w/ consideration for placement of indwelling pleural catheter
(pleurodesis for refractory >2 or 3)

Question 9

How do you treat an empyema?

Answer 9

antibiotics + drainage

Question 10

How do you treat a hemothorax?

Answer 10

drainage

Question 11

What’s first line for acute respiratory failure?

Answer 11

ABCs: airway, breathing, circulation

Oxygenation -
low flow, simple face mask, high flow, non-invasive positive airway pressure, intubation
Goal: >92% for non-COPD
88-92% w/ COPD

Question 12

What are these indications for:
Respiratory muscle fatigue (current or impending)
Hypoxia not corrected by nasal cannula, HFNC, or mask
Pulmonary edema
FIRST LINE FOR COPD in hypercapnic failure

Answer 12

NIPPV

Question 13

When is NIPPV contraindicated?

Answer 13

CI IF: significant secretions, facial trauma, burns, high risk of aspiration, AMS, long-term need

Question 14

What are these indications for:
Hypercapnic encephalopathy (CO2 narcosis)
Hypoxemia despite oxygen therapy
Impaired airway protection
Respiratory acidosis
Refractory hypoxemia despite HFNC or biPAP
Respiratory muscle exhaustion
Apnea

Answer 14

intubation

Question 15

What are these indications for:
apnea
Acute hypercapnia
Severe hypoxemia
Progressive patient fatigue

Answer 15

mechanical ventilation

Question 16

When do you use ECMO in acute respiratory failure?

Answer 16

for cardiac failure or both cardiac/resp failures