Pulmonary ER Flashcards by cortney davis

You think I have CO poisoning, what do I look like, and what do you do to check

Cherry red lips

Carboxyhemoglobin

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What is the basic workup for all dypneas

CBC, CMP, CXR

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I have an expiratory/ mixed stridor, what could I have??

Croup
FB
Bacterial tracheitis

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I have shaggy borders on x- ray of my neck

bacterial tracheitis

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I have JVD with clear lungs, what could I have?

Cardiac tamponade

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I have JVD WITH crackles, what could I have?

ARDS

ADHF

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What diagnosis could crackles lead you too

ADHF, ARDS or pneumonia

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YOu hear wheezes, what could I have?

Asthma
FB
ADHF
COPD

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I have absent or diminished breath sounds what could I have

COPD
Asthma
Pneumothorax
Hemothorax

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I am using accessory muscles to breathe…what is my differential

Respiratory failure
severe COPD
Severe Asthma
RSV- children

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Why could I be hyperventilating

Acidosis
Sepsis
Salicylate poisoning
Anxiety

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I have an inspiratory stridor why?

FB
Epiglotitis
Angioedema

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Why do I have pulsus paradoxus?

RHF
PE
Cardiogenic shock
Pericardial tamponade
Asthma exacerbation

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Name some “danger signs” of asthma

use of accessory uscles, fragmented speech, inability to lie supine, profound diaphoresis, agitation, cyanosis, depressed mental statis

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What do you use to assess an asthma exacerbation?

Peak flow

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What are a signs of imminent respiratory arrest?

severe hypoxemia, hypercapnia

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do asthma pts need a CXR?

No- not unless they are febrile to 101 or a focal lung exam

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What do you give me if I am having an asthma attack

Inhaled beta agonist, oxygen, IV NS

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If the initial treatment does not work what should you consider next

Systemic glucocorticoids

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For someone having a life threatening attack of asthma what do you do?

Mag sulfate
Epi
Terbutailine
Intubate +Admit

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What doses can you give of albuterol

1) 2.5 to 5 mg Q20 mins for 3 doses - neb
2) 4-8 puffs Q20 mins
3) 10-15 mg over 1 hr – severe

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If I am having a severe asthma attack when I come in what beta agonist will you start…albuterol or ipratropium bromide…and how much

Ipratropium bromide
500 mcg neb Q20 mins for 3 doses
8 puffs Q20 for 3 hours

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IF you give steroids how do you give them

Tapering dose - 60mg3 days, 40mg 3 days, 20mg*5 days

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Why do you taper

For the lungs….not the adrenals

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I am a 20 kg child, what is my prednisone dose for each administration

10mg BID to come out to a total of 20mg a day | Dose=1mg/kg

I need mag sulfate, how much will you give me

2g IV over 20 mins

I need epi for my asthma, what dose will you give me

0.3-0.5 mg IM

If you give me terbutaline can I get epi too

No- one or the other

How much terbutaline do you give

0.25 mg SC ever 20 mins for up to 3 doses

When do you admit me for my asthma

after not responding for 4-6 hours with treatment

What are the classic symptoms of CAP

Cough, Fever, pleuritic CP, dyspnea, sputum

I have mucupurulent sputum- what type of PNA do i have?

bacterial/typical

I have scant or watery sputum- what type of PNA do I have?

Atypical

If an elderly person comes in with mental status changes what should yo consider

PNA, UTI

What percentage of people with PNA have rigors

15%- but rigors pretty much mean PNA

COPDers get what pathogen with PNA?

H. Flu

HIV pts get what pathogen with PNA?

Atypical or Pneumocystitis jirovecii

I was on a cruise ship and now I have PNA...what pathogen?

legionella

I had the flu and now I have PNA...what pathogen?

Staph aureus

I am an alcoholic with PNA...what pathogen?

Klebsiella or aspiration

I inhale bird droppings and now i have PNA...what pathogen?

Histoplamosis

I have been spending some time in the southwest now I have NA...what pathogen?

Coccidiodes, hantavirus

What may my CBC show if I have PNA

Nothing or....> 15, 000 with left shift

I f I have leukopenia and PNA what is my prognosis

poor

What is the work up for PNA

CBC, CMP, UA, BC, CXR, pulse ox

What is the gold standard for PNA

CXR- infiltrate

I have a bad PNA and my troponin is positive do I have an MI??

Prob not- just heart strain or ischemia

I have a lobar consolidation...

Typical bacteria

I have interstitial infiltrates...

viruses, or pneumocystis jirovecii

Treat my CAP

Cephalosporin with macrolide | Quinalone

Should you send me home with PNA if my O2 sat is 87% on RA?

Nope keep at 88 or below

What is the most common predisposing factor for an abscess

aspiration

What does pus or an abscess look like on CXR?

straight line

I have rust colored sputum, with fever chills and CP while coughing. What will my CXR show?

Unilobar consolidation- strep pneumo

I have diarrhea, fever of 102.2, a focal infiltrate on CXR, and am confused...what interesting lab values will I have

Legionella - Hyponatremia and elevated LFTs

I have failed beta lactams for PNA what bug could I have?

Legionella or klebsiella

So how do you treat y legionella

Macrolides, quinalines, tetracyclines

I recently had a URI, now I have ear pain and pharyngitis, fever, and a low gad fever what do I have

Mycoplasm

I have bullous myringitis, what does my CXR look like

patchy infiltrates

I am an alcoholic and I passed out drunk now I have a low grade fever, diffuse crackels, and cyanosis, what does my CXR show

Aspiration- Will be neg initially then will be infiltrates involving dependent pulmonary segments

Treat my aspiration PNA

Clinda 600mg IV Q8hrs followed by 300mg QID

I am a tall thin smoker what am I at risk for?

Pneumothorax

My trachea is deviated and I have labored breathing...help me!!

needle decompress- 2nd ICS midclavicular line

Is a needle decompression good enough...

NO- put a chest tube in after

I am on my period and my CXR shows a colapsed lung, what is that called?

Cat menial - can be from endometriosis of the thoracic cavity

I have decreased chest excursion, diminished breathsounds and hyperresonant percussion, why

large pneumo

Describe deep sulcus sign

marked deepening of the left costophrenic angle- seen with tension pneumothorax or with a vented patient laying down

what is the modality of choice to see a pneumothorax

CXR- white visceral pleural line

My pneumothorax is 7% of my lung do i need a chest tube?

No- less than 10% needs observation and repeat CXR

what does a large Pneumothorax need

chest tube

What are major risk factors for COPD

Famliy Hx, smoking, environmental hx, and asthma

What are the symptoms of COPD exacerbation?

dyspnea, cough, wheezing

Barrel chest

emphysema

I have a prolonged expiratory phase

COPD

Work up for COPD exacerbation

CBC, CMP, CXR (Trop, EKG- if CHF is thought)

Tx my COPD exacerbation

duoneb (atrovent and albuterol) | PO predinsone if no relief with duoneb

If I have PNA with my COPD what antibiotics will you give me?

5 days of Avalox or z pack

when do you admit a COPD exacerbation

hypoxia, underlying PNA, failure to outpaieint therapy, maxed out on therapy in ER

What is the definition of Massive hemoptysis

bleeding that has the potential to be life threatening

1 thing to think with hemoptysis

PE!!

Other causes of hemoptysis

CA, infection (TB, PNA), PE, airway trauma, anticoagulant problem

Work up for hemoptysis

CBC, CMP, PT/INR, CXR

If you can't find a cause for hemoptysis what do you need to do

Flexible bronhoscopy

I have a tram track appearace on CXR... treat me!

Bronchiectasis- Start on Avalox or levoquin while wait for sputum cultures

What test do I need to have if I have bronchiectasis

Sputum culture- often polymicrobial and very helpful to Tx

I have dyspnea, decreased lung sounds, dull percussion - what work up do i need

Pleural effusion --CXR, Fluid analysis

Do you need to admit me-- I have a asymptomatic new pleural effusion

yep

I have pleuritic CP and a friction bub may be heard, what is the most common cause and what will you treat me with

Pleurisity (Viral) | NSAIDs

PAthologic hallmark of diffuse aveolar damage

ARDS

Clinical hallmarks of ARDS

hypoxemia, bilateral radiographic opacities

Work up for ARDS

CBC, CMP, PT/INR, BCx2, UA cx, Port CXR, ABD

Tx of ARDS in ER

``` 2 large bore IVs Cardiac monitoring Intubate Full sepsis work up Admit ```

How do you get the diagnosis of ARDS

respiratory failure not due to cardiac failure

I have had a cough for 2 weeks with a preceding URI, what caused it

Bronchitis (viral)

Bacterial causes bronchitis

mycoplasm Chlamydophila Bordetella

Should you get a CXR for cronchitis

No- not unless fever

Tx my bronchitis

Will resolve on its own

A child will not stop coughing what should you think

FB aspiration

Who gets FB aspiration

children, decreased level of consciousness, alcohol

Dx of FB aspiration

Expiratory CXR for children (Unilateral hyperinflation), FB, pleural effusion, area of consolidation

Tx of FB aspiration

Bronchoscope

Pulmonary ER Flashcards

(101 cards)