Flashcards in Respiratory Deck (69)
SUBJECTIVE feeling of difficult, labored breathing
What is orthopnea MCly seen in?
low ARTERIAL oxygen, Pa02 under 60 mmHg
Define stridor and causes for it
Upper airway, Inspiratory
Define wheezing and causes
Lower airway, expiratory
4. Cardiogenic pulmonary edema
Define Rales and causes
Lower airway, velcro sound
Define Rhonchi/crackles and causes
Define Respiratory Distress or Failure
Inadequate oxygenation and/or ventilation
What organism is associated with bradycardia and hyponatremia in pneumonia?
What organism is associated with bullies myringitis in pneumonia?
PNA in patient who has not been hospitalized or resident of long-term care facility for 14 days prior to presentation
Define Hospital-acquired (nosocomial) and Ventilator-acquired PNA
PNA occurring > 48 hours after admission or intubation
MC cause of pneumonia
MC presentation in Streptococcus Pneumoniae
1. Sudden onset fever
3. Productive cough
CXR findings in Streptococcus Pneumoniae
1. Lobar infiltrate
2. Para-pneumonic pleural effusion (25%)
What organism causes a secondary bacterial pneumonia following influenza?
Define high altitude illness
1. Hypoxic environment
2. Partial pressure changes with elevation
@ what elevations do we see high altitude illness?
MC @ 8,000-14,000 ft
Increased ventilation rate
Induces respiratory alkalosis
Increased red cell mass
Begins 2 hrs. after ascent
1. Peripheral venoconstriction- increases central blood volume
2. ADH and aldosterone suppressed- Diuresis
1. Decreased SV, Increased HR
2. Pulmonary vessels constrict
3. Increased cerebral blood flow
Acute mountain sickness sx's
2. HA-Worse with valsava or bending over
3. Breathlessness with activity
What is the hallmark findings in Acute mountain sickness
Pathophysiology of Acute mountain sickness
D/t hypobaric hypoxia
Cerebral blood flow increases-->brain enlarges-->vasogenic edema
Acute mountain sickness treatment
1. Discontinue ascent
4. ASA, Tylenol, Motrin
Acute mountain sickness prevention
1. Gradual onset
2. Avoid overexertion
3. Avoid alcohol
4. High carb meal
High Altitude Cerebral Edema sx's
2. Neurologic sx's: CN 3 & 6 Palsy- Eye is down and out
What is the most lethal high altitude illness
High Altitude Pulmonary Edema
High Altitude Pulmonary Edema etiology
High Altitude Pulmonary Edema sx's
1. Dry cough-->productive cough
2. Increasing dyspnea
3. Coma, death
What is the treatment of choice in High Altitude Pulmonary Edema
1. Immediate descent
What is the MC reason for admission in medicare pt's?
What BNP value is suggestive of CHF?
EKG findings in CHF
What imaging has both the highest sensitivity and specificity in CHF?
CXR findings in CHF
2. Enlarged pulmonary artery
3. Pleural effusions
4. Kerley B lines
US findings in CHF
What does an echo evaluate in CHF?
1. LV and valvular function
Pharmacologic treatment in CHF
1. NTG-Reduce preload and BP
2. Diuretic (Lasix)
3. Morphine sulfate- Reduces preload
4. Dobutamine-adjunct to NTG, use in hypotensive pt's
What medications do you want to avoid in CHF?
1. Venous stasis
2. Vessel wall inflammation/injury
PE risk factors: MOIST CAMEL
M- Mobility (lack of)
L-Long bone fx
Triad of sx's in PE
1. Pleuritic CP
CXR findings in PE
1. Hampton's Hump
2. Westermark's sign
3. Fleischner sign
What is considered by most to the dx test of choice in PE
What echo findings indicated a poor prognosis in PE
RV enlargement + RV dysfunction= large clot
MC EKG finding in PE
Followed by T wave inversion
"Classic" EKG findings in PE
Anticoagulation treatment in PE
4. Rivaroxaban (Xeralto)- factor Xa inhibitor
Indications for thrombotic treatment in PE
Asthma pathophysiology triad
1. Airway inflammation
2. Obstruction to airflow
3. Bronchial hyperresponsiveness
Asthma clinical triad
Chronic irreversible disorder
Define Chronic Bronchitis
1. Presence of chronic productive cough for 3 months in 2 successive years
2. Clinical diagnosis
1. Destruction of bronchioles and alveoli
2. Pathologic diagnosis
What does FEV1 measure?
Severity of pt's airway restriction
What are the treatment goals in COPD?
1. Reverse airflow obstruction
2. Provide adequate oxygenation
3. Relieve inflammation
What is the cornerstone of therapy in Asthma/COPD?
1. Beta Agonist: Albuterol
2. Corticosteroids (high-dose): Prednisone, Methylprednisolone, Dexamethasone
Role of Epinephrine in COPD?
Acts as a bronchodilator
NOT beta selective
What location of the airway does Ipratropium Bromide (anti-cholinergic) primarily work at?
Large central area
What is Magnesium Sulfate reserved for?
What is Heiolx reserved for?
Severe reactions in pediatrics
1. Cooperative patient
2. Dyspnea (moderate to severe)
3. Tachypnea (>24 breaths per minute)
4. Increased work of breathing
1. Need for emergent intubation
2. Cardiac or respiratory arrest
3. Inability to protect airway or clear secretions
4. Decreased LOC
5. Facial trauma or deformity
6. Recent esophageal surgery
What age groups does FB aspiration MCly occur in?
< 1 year and >75 years of age
Adult risk factors in FB aspirations?
1. Altered level of consciousness
2. Impaired swallowing mechanism
3. Stroke related dysphagia
4. Alzheimer’s dementia
5. Parkinson’s disease