Pulmonary and CP Flashcards

Question

Tx for pneumothorax

Answer 1

1. Treatment depends on size Pigtail catheter w/ Heimlich valve Chest tube 2. Small, primary pneumos (<15% total lung) in select cases, a stable patient can go home if:

Answer 2

with a pigtail Not a secondary pneumo b. Stable vitals after 3-4hrs c. Repeat CXR with no enlargement d. Pt is reliably able to return in 12-24hrs for repeat CXR e. If catheter re-expansion i. Stable x6hrs f. Surgical consult agrees

Answer 3

CLINCALLY pt will die if not treated

Answer 4

Pt with trauma to the chest 1. Severe dyspnea, sudden change in VS/LOC 2. *Decreased breath sounds affected side 3. *Hypotension 4. *Distended neck veins 5. *Tracheal shift (late)

Answer 5

iv. Needle thoracentesis: 2nd ICS at MCL with 16 gauge at second intercostal space mid-clavicular line v. Follow with chest tube immediately

Answer 6

Don’t know yet DDx? PE, sepsis, malnutrition/dehydration, is she in hypovolemic shock? PE and pulmonary effusion are at the top b/c of hx of chemo ``` BP is low P 100 RR 28 T 99.3 93% on room air ``` IV, OT MONITOR

Answer 7

i. IV, O2, monitor, pain control, labs ii. CXR; Lateral decubitus film – does it layer out? iii. Bedside ultrasound - see fluid, guides tap – also check for pericardial effusion iv. Chest CT - gold standard

Answer 8

pericardial effusion -triple scan

Answer 9

1. Excellent for small effusions, other dx’s 2. CT guided thoracentesis if loculated – doesn’t layer out 3. Effusions can be infectious, malignant, reactive, chronic, post-surgical, traumatic

Answer 10

1. Sick? Is this shock? Fever? 2. Triple scan US: fluid status, pericardial effusion 3. US guided Thoracentesis Diagnostic and therapeutic Slow removal of fluid - ultrasound guided` No more than 1000 - 1500ml To avoid re-expansion pulmonary edema CXR after to check for pneumothorax 4. Pleural fluid analysis

Answer 11

diagnostic and therapeutic

Answer 12

Young, old, immunocomp, recent surg/hosp, lung Dz

Answer 13

1. Hypotension/tachy/tachy, hypoxic, lung findings 2. No viral syndrome sx’s, worsening (We are worried about PNA) sxs for more than 2 weeks

Answer 14

Abnormal VS, chest pain, young/old, risks, look sick

Answer 15

1. ROS: SOB, DOE, hemoptysis, leg edema/pain, syncope 2. PMHx (cardiac, lung dz, DM, steroids), SH (etoh, homeless) 3. VS, diaphoresis, new wheezes, rales, edema, rash

Answer 16

1. Bacteria/pneumonia is very narrow minded and tends to stay in one spot 2. Flu gives you symptoms all over – malaise, sore throat, fever, vomiting, maybe diarrhea (viruses affect a lot of different systems)

Answer 17

helps predict mortality in a person with pneumonia ``` CONFUSION BUN RR BP OVER 65 ```

Answer 18

v. Abx: Azithro mostly Levo?, Doxy

Answer 19

1. Pneumonia = MCC 2. Coumadin 3. Tuberculosis 4. Cancer 5. Pulmonary embolus 6. Hematemesis? 7. Nasal, dental, oral source? 8. Trauma

Answer 20

iii. Hemodynamically stable? Hemodynamically unstable patients don't have enough pressure in the circulatory system to keep blood flowing Pale and cool skin Diaphoresis (sweating) Fatigue Very fast or very slow pulse (fast can be either a reaction to or a cause of instability; slow is almost always a cause) Low blood pressure (very late sign) Shortness of breath (not enough blood getting to the lungs) Chest pain (could be related to inadequate blood flow in the heart) Confusion (probably comes after the blood pressure drops) Loss of consciousness (syncope, which is bad)

Answer 21

 ABC’s, vitals; IV(s), O2, monitor  Hx: Onset? Chest pain? SOB? Weight loss? Fever? Trauma? Coumadin? CAM?  PE: Usual suspects + look for non-pulmonary source  CXR, EKG, Labs, lactic acid, PT/INR. Type and screen/cross?  Chest CT if significant, stable  If very significant, ongoing: a big airway concern (blood is coming from the airway). Make a plan everybody needs to be in the room. need a bronch  Pulmonary consult: bronchoscopy

Answer 22

``` CXR Labs: lactic acid LDH-helps predict severity cultures HIV labs: CD4 count, viral load ```

Answer 23

1. CD4 >200 = immunocompetent

Answer 24

Cough, fever, weight loss, fatigue, night sweats, pleuritic chest pain, dyspnea and hemoptysis.

Answer 25

Classic sx’s, endemic area of origin - travel Risks: immunocomp, incarcerated, known exposure, homeless, EtOH

Answer 26

can't be diagnosed variable need CXR and labs

Answer 27

a. Infiltrates/consolidation b. Reactivation favors upper lobes c. Pleural effusion d. Cavitary lesions e. Calcifications f. Miliary pattern

Answer 28

if in respiratory distress--> ADMIT if high risk (+ PPD, hx of exposure, alcoholic, incarcerated, form endemic area) if your CXR has ANY infiltrate of effusion --> ADMIT

Answer 29

home PCP or TB coordinator f/u and intiate tx ED does not initiate tx

Answer 30

```  CHF  AMI/ACS  PE  Pericardial effusion  Infection  Pleural effusion  Renal failure  Cancer ```

Answer 31

Begin with: IV, O2, monitor, EKG, CXR, Triple scan US Labs, lactic acid, troponin, UA, Tox screen Careful Hx & PE when stable she's probably acidotic and we already know where we are going to start with her BNP is $$$$$

Answer 32

1. LMNOP-N ``` Lasixs Morphine NTG O2 Position NIPPV ``` 2. -Diuretics: Lasix 3. -Vasodilators – NITRO IV reduce preload, afterload: 4. Morphine +/-, Nitrates 5. -Oxygen, Position 6. -NIPPV is awesome 7. -US better than BNP in ED unless Dx uncertain 8. -Admit all new CHF – search for cause 9. -Admit moderate, severe, recurrent, unstable 10. B lines on lung U/S

Answer 33

structural functional inability to fill and pump can be acute or chronic acute: flash pulmonary edema, L-sided MI, HTN emergency, valve rupture chronic: HTN, valve dz, CAD--> cardiomegaly, mitral regurg

Answer 34

R or L or both systolic or diastolic high or low output failure

Answer 35

``` DOE cough fatigue orthopnea PND rales S3 gallop ```

Answer 36

JVD peripheral edema hepatomegaly anascara

Answer 37

can't squeeze enough

Answer 38

can't relax to fill

Answer 39

common chronic CHF low EF

Answer 40

compensating for demand thyroid storm anemia etc

Answer 41

``` right sided inferior MI viagra tamponade aortic stenosis or hypovolemia ```

Answer 42

pulse a little high RR pretty high CXR-->good Pulse OX--> good get a Hgb 6.2 hct 20%

Answer 43

when compensation fails i. When compensation fails = Sx’s: DOE, dizzy, weak, malaise, palpitations, chest pain, syncope

Answer 44

blood need occult blood test MCC- menstration need CA workup So...why is this patient anemic?? Melena? Menstrual? Cancer? Renal Failure? Iron? Macro- or Microcytic?

Answer 45

thoracic aortic dissection

Answer 46

Marfan’s, Ehlers-Danlos, connective tissue dz, pregnancy, syphilis, family hx of sudden death at young age – all are risk factors

Answer 47

sudden “tearing/ripping” w/ SOB, HTN. Jaw, neck, chest - pain evolves, changes. Migrating pain above and below the diaphragm; GI complaints – n/v/d Dizziness, near-syncope, neuro sx’s common (extremities can get weak)

Answer 48

PE WELLS score is 6

Answer 49

previous DVT/PT

Answer 50

```  Signs/Sx’s DVT - 3pts  PE #1 Dx – 3pts  Heart rate >100 - 1.5pts  Immobilization 3 days or surgery <1mo - 1.5pts  Hx proven PE/DVT-1.5pts  Hemoptysis – 1pt  Active malignancy – 1pt ```

Answer 51

 Low prob = <2 pts (1.3%)  Moderate = 2-6 pts (16.2%)  High prob = >6 pts (37.5%)  Two tier model  “PE Unlikely” = 0-4 pts (12%)  “PE Likely” = >4 pts (37%)

Answer 52

must answer YES to all of them * Age <50 * Pulse <100 * SaO2 >94% * No unilateral leg swelling * No hemoptysis * No recent trauma or surgery * No hx prior DVT or PE * No hormone use

Answer 53

low to moderate risk that can't be PERC out

Answer 54

(2 A’s, 3 P’s, a B) ii. AMI/ACS/USA iii. Thoracic aortic dissection iv. Pericarditis/pericardial effusion v. Pulmonary embolus vi. Pneumothorax vii. Boerhaave’s (espohageal rupture/pneumomediastinum)

Answer 55

chronic bronchitis and people that have had surgery

Pulmonary and CP Flashcards

(81 cards)