Pulmonary and Cardio Treatments Flashcards Preview

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Flashcards in Pulmonary and Cardio Treatments Deck (77)
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1

PE treatment

Provoked DVT of calf or upper extremity: 3 months of anticoagulation
Provoked DVT of proximal leg: 6 months of anticoagulation
Unprovoked, malgnancy or antiphospholipid: indefinite
IVC filter: prevents recurrent PE, during active bleeding or other contraindication

Primary: clot dissolution with thrombolysis or surgical removal reserved for those with high risk of adverse outcomes: RHF or hypotension

Secondary: Anticoagulation-unfractionated heparin (must be monitered every 4-6 hrs) right away
subcutaneous LMWH (enoxaprin or tinzaparin) or direct factor Xa inhibitor (fondaparinux)
Warfarin-overlapped with UFH or LMWH for 5 days-INR goal of 2.5 for 2 consecutive days
Duration of treatment relates to risk of recurrence

2

PE imaging choice

chest CT with intravenous contrast

CT contraindicated (renal insufficiency or contrast allergy)-use V/Q scan

Both negative but still have a suspicion=lower extremity ultrasound

3

Hemodynamically unstable patient in A. Fib

Meaning shock or hypotension symptoms
Urgent direct cardioversion
Electrical better than pharmocological

Pharm if electrical failed: procainamide, flecainide, sotalol or amiordarone


4

Hemodynamically stable patient in A. fib

Ventricular rate control-IV Beta blockers, CCBs or digoxin

5

Persistently symptomatic A. fib

electrical cardioversion with 3 to 4 weeks of anticoagulation prior to and after cardioversion

Goal INR or 2-3

6

Wolf Parkinson Wright Diagnosis and treatment

Diagnosis: narrow complex tachycardia, short PR interval, delta wave

Treatment: procainamide, quinidine or amiordarone
Radiofrequency catheter ablation

7

drugs to avoid in wolf parkinson wright syndrome

Beta blockers
Verapamil
Other AV nodal blockers

May paradoxically increase the ventricular rate

8

Best initial test for all forms of chest pain

ECG

9

Treatment of Angina

Mild (normal EF,, mild angina, single vessel disease)
Nitrates and B blockers

Moderate (normal EF, moderate angina, two vessel disease)
Try nitrates and B blockers
consider coronary angiography to assess suitability for revascularization-PCI or CABG

Severe (decreased EF, severe angina, and three vessel/LAD)
Coronary angiography and consider CABG-decrease symptoms

10

Treatment of unstable angina

Acute
Aspirin +Clopidogrel-9-12 mos
BB blockers
Enoxaparin (LMWH)-2 days
Nitrates
Oxygen
Abciximab, tirofiban

After acute
Continue aspirin, B blockers, and nitrates
Reduce smoking, weight, diabetes, HTN, hyperlipidemia

11

Treatment of cardiac tamponade

relief of pericardial pressure either echocardiographically guided pericardiocentesis or surgical pericardial window

While waiting treat with IV fluids (cardiac tamponade is preload dependent)

12

Treatment of constrictive pericariditis

Resection of pericardium

13

Treatment of acute MI

Aspirin/heparin
Beta blockers
Nitrates
morphine
supplemental O2

ST segment elevation-thrombolytics within 1-3 hours
PCI perferred within 90 mins

14

when to use angioplasty in acute MI

less than 1 hour
Contraindication to lytic therapy-major recent surgery active internal bleeding, or suspected acortic dissection, severe hypertension, or a prior history of hemorrhagic stroke
Cardiogenic shock
Refractory ventricular arrythmia
large infract size

15

Treatment of COPD

Most importantly smoking cessation

B2 agonists for symptomatic relief
Anticholinergic (ipratropium bromide)-longer acting
Both together work better than separate

Inhaled corticosteroids (budesonide, fluticasone)-significant symptoms or repeated exacerbations

Systemic Corticosteroids and antibiotics (azithromycin/levofloxacin) for acute exacerbations, change in sputum, or increased SOB (IV methylpredinsolone)
Possible noninvasive positive pressure ventilation may be necessary

Theophylline if unresponsive to everything else

O2-imporves survival and QOL of those with COPD and chronic hypoxemia (pO2 55%)

Flu vaccine annually
Strep pnemo vaccine every 5-6 yrs if >65 or have severe disease

intubation Acute respiratory acidosis and CO2 retention

16

Treatment of asthma

Inhaled B2 agonists for acute attacks
Long acting (salmeterol)-nighttime and exercise induced

Inhaled corticosteroids for moderate to severe asthma

Montelukast-prophylaxis of mild exercise induced and moderate persistent asthma

Cromolyn sodium/nedocromil sodium-prophylaxis

17

Treatment of acute exacerbation of asthma requiring hospital admission

Inhaled B2 agonist with ipratropium-first line

Corticosteroids-IV or orally

IV Mg- if not responsive to other therapies

Antiobiotics

Endotracheal intubation if in respiratory failure-hypercapnia

18

Treatment of Bronchiectasis

antiobiotics for acute exacerbations

Hydration
Chest physiotherapy-postural drainage, chest percussion

Inhaled bronchodilators

19

Treatment of CF

pancreatic enzyme replacement
Fat soluble vitamin supplements
Chest physical therapy
Vaccinations-influenza and pneumococcal
Antibiotics
Inhaled recombinant human deoxyribonuclease

20

Treatment of pleural effusions

Transudative (CHF, cirrhosis, nephrotic syndrome)
Diuretics and sodium restriction
Therapeutic thorancentesis if causing dyspnea

Exudative: treat underlying disease
Thorancentesis

Pleural effusion with pneumonia
Antibiotics
Complicated or empyema: chest tube drainage, intrapleural injection of thromboytic agents, surgical lysis of adhesions

21

Treatment of empyema

aggressive drainage of the pleura sometimes repetitive
If severe and persistent rib resection and open drainage

22

Treatment of pneumothorax

Primary spontaneous
small and asymptomatic: observation or one way valve chest tube

Large or patient is symptomatic: supplemental O2
Chest tube

Secondary complicated pneumothoraxx
chest tube drainage

23

Treatment of tension pneumothorax

medical emergency-do not obtain CXR

Chest decompression with large bore needle (2nd or 3rd intercostal space in MCL)
Followed by chest tube placement

24

Sarcoidosis treatment

Systemic corticosteroids

Methotrexate for those refractory to corticosteroids

25

Wegener's granulomatosis treatment

immunosuppressive agents and glucocorticoids

26

churg-strauss syndrome treatment

glucocorticoids

27

Treatment of berylliosis

glucocorticoid therapy

28

Treatment of Goodpastures syndrome

Plasmapharesis, cyclophosphamide, and corticosteroids

29

Treatment of idiopathic pulmonary fibrosis

Most do not respond to anything
Supplemental O2
Corticosteroids with or without cyclophosphamide
lung transplantation

30

Hypercarbic respiratory failure treatment

High flow venturi mask preferred because one can control oxygenation more precisely

NPPV given to patients in impending respiratory failure in an attempt to avoid intubation and mechanical ventilation -patient should be neurologically intact, awake and cooperative