Respiratory emergencies Flashcards
(42 cards)
What is pneumonia
infection of alveoli d/t bacteria, viruses, fungi, or yeast
What pathogens cause PNA based on presentation
Strep Pneumo: Rust sputum
Klebsiella: red currant jelly sputum (alcoholics/NH)
Pseudomonas, Heamophilus: green sputum
Anaerobes: foul smelling, bad tasting sputum
Legionella: Bradycardia, Hyponatremia
M. Pneumo: Bullous myringitis, OM
(Staph. Aureus more common after a virus, like influenza)
How does PNA present symptomatically
Triad: Fever + Dyspnea + cough
sudden onset fever
Rigors
Productive cough
What are pathogen specific CXR findings in PNA
Strep pneumo: Lobar infiltrate +/- parapneumonic pleural effusion
Staph Aureus: extensive infiltrates
What is CURB 65
Confusion Uremia (BUN >20) Respiratory Rate >30 BP <90/60 65+ y/o
How do you treat PNA
IV fluids O2 anti-pyretics Bronchodilator Abx Cough suppressant Steroids HCAP: Cefipime/Ceftazadime/Zosyn, Cipro/Levo/Vanco
What is Acute Mountain Sickness
High altitude sickness 2/2 hypobaric hypoxia
Cerebral blood icreases, brain enlarges, vasogenic edema develops
What are Sx of acute mountain sickness
Light headed HA (bi-frontal, worse w/ valsalva) Breathless w/ activity Anorexia Nausea weakness irritable
What are PE findings of Acute Mountain Sickness
Postural hypotension
Localized rales
Retinal hemorrhage
Fluid retention (anuresis)
How do you treat acute mountian sickness
Stop ascending Acetazolamide 125mg PO BID ASA/APAP/Motrin Dexamethasone Prevent w/ radual ascent, aovid alcohol or resp depresant, eat high carbs, Acetazolamide 24 hr prior, dexamethasone
What are Sx of High Altitude Cerebral edema
Ataxia
stupor
coma
CN 3, 6 palsy
How do you treat high altitude cerebral edema
Oxygen
Descent
Dexamethasone
Loop (Furosemide, Bumetanide)
What are symptoms of high altitude pulmonary edema
Dry cough progressive to productive Decreased exercise rales s/p exercise increasing dyspnea coma death
How do you treat high altitude pulmonary edema
Recognition
Immediate descent
O2 (takes 3 days)
Nifedipine
What is CHF
LV dysfunction (2/2 aortic stenosis, HTN, AFib, or CAD) causing hypoxemia, HTN, tachy, dyspnea, weight gain, and rales
What are L and R symptoms of CHF
L= Lungs (dyspnea, fatigue, cough, PND, orthopnea) R= Swollen (peripheral edema, JVD, RUQ pain)
What are PE findings in CHF
CXR: dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulmonary artery, pleural effusion, Kerley B lines)
Pro BNP >200
Get a CXR, EKG, lung US, and echo- CBC, CMP, cardiac enzymes, pro-BNP
How do you treat CHF
O2 Vent Nitro Morphine Furosemide Dobutamine
What do you AVOID in CHF
CCB (pulm edema or shock)
NSAID (inhibit diuretic)
Anti-arrhythmics (pro-arrhythmics)
What is a PE
Proximal portion of venous thrombosis breaks off and travels to lung (MC pelvic or LE veins)
Big cause of non-surgical maternal death in peripartum period
What are Sx of PE
Virchows triad (Hypercoagulable + venous stasis + vessel wall inflammation)
Dyspnea, pleuritic CP, syncope, LE pain/edema, confusion, anxiety, hypoxemia
PE Triad: Pleuritic CP + SOB + hemoptysis
What are some PE findings in PE
Calves >2cm difference
Wells score 2-6 = moderate, 6+ high risk
Geneva score 3+ high risk
What are diagnostic findings due to PE
CT*: pref Dx
CXR: Hampton’s hump, westermark’s sign, fleischner sign
VQ scan: mismatch
Echo: RV enlargement
Cardiac enzymes: pro-BNP or trop
ECG: sinus tach common (S1Q3T3 classic R heart strain)
Venous compression, ABG, D-dimer
How do you treat PE
Heparin (monitor aPTT) Coumadin Lovenox Rivaroxaban IVC filter if coags C.I. Thrombolytics (streptokinasse, urokinase, tPA) Embolectomy if massive and tPA C.I. Catheter thrombolysis (tPA then heparin)
