Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
240 Cards in this Set
- Front
- Back
|
Is any object originating outside the body?
|
foreign body (corpus alienum)
|
|
|
What would be some symptoms for foreign body?
|
suddenly agitated but is unable to speak.
Victim often gives universal signal of choking distress- |
|
|
What on exam findings would you expect Foreign bodies?
|
marked distress (Large or central airway)
Acute cough or wheezing in lower airway |
|
|
Long standing foreing bodies may lead to what other condition?
|
Bronchiectasis or lung abscess
|
|
|
What are some differential dx of Foreign body obstruction?
|
Sarcoidosis
TB Bulla Fibrosis |
|
|
What is the disposition for patient with airway obstruction?
|
if removed outside the hospital, it should be examined by direct or indirect laryngoscopy.
|
|
|
What is Tension pneumothorax?
|
air enters the pleural cavity, trapped during expiration; intrathoracic pressure builds to levesl higher that ATM pressure causing compression on the lungs, displacing mediastium and its strucutre toward the opposit side, causing Cardiopulmonary impairment
|
|
|
Without proper treatment for tension pneumo, what is the main concern?
|
impaired venous return can cause systemic hypotension (late sign) and respiratory and cardiac arrest within minutes
|
|
|
What are some symptoms of Tension pneumo?
|
dyspnea
pleuritic chest pain, and Anxiety. |
|
|
What are some physical findings for Tension Pneumo?
|
Inspection: JVD, Trachea deviation, accessory muscle use aidding in breathing
Palp: maybe crepitus Percussion: absent Tactile fremitus, Hyperresonance Auscu: Decreased Breath sounds, may be Hamann |
|
|
What are some Differential Dx of Tension Pneumo?
|
PE
Pleurisy Dissecting aneurysm Hemothroax Asthma |
|
|
What is the operational labs/test performed for Tension?
|
Upright insp. x-ray.
|
|
|
Disposition of this pt?
|
MEDEVAC
|
|
|
What is the procedure of choice in the treatment for Tension Pneumo?
|
Needle thoracentesis tube thoracostomy.. inserted 14-16 gauge with catheter. Sound of high pressure escaping confirms dx.
|
|
|
Medication tx for Tension?
|
Supporitive O2, diuretics, C-P support as needed
|
|
|
What could be some complications of Tension pneumo?
|
Reoccurence, Cardiac arrest secondary to compression, death.
|
|
|
On exam, pt presents with Borborygmi that is heard in the chest and has dullnes to percussion over the left side of the chest. What could be this patient condition?
|
Diaphragmatic injury
|
|
|
Traumatic rupture of the diaphragm must be differentiated from what other conditions?
|
Atelectasis, space consuming tumors of lower pleural space,
Pleural effusion intestinal obst. due to other cause. |
|
|
What independent operational lab/test would you perform on pt with a Diaphramtic injury?
|
DIAPHRAGMATIC EXCURSION EXAM
|
|
|
You have a patient whose wall moves paradoxically with respiration, owing to multiple fractures of the ribs. What is the condition of the patient?
|
Flail chest
|
|
|
Most common type of pulmonary embolus is that which has usually formed where?
|
in a leg or pelvic
|
|
|
What are some signs of a larger emboli in a pt?
|
acute dyspnea
pleuritic chest pain and less commonly, cough or hemotysis. |
|
|
Massive PE presents How?
|
hypotension
tachycardia syncope cardiac arrest |
|
|
what are the most common signs of PE?
|
tachycardia and tachypnea
|
|
|
What are some less common signs of PE?
|
pt having hypotension, loud 2nd heart sound (S2) due to a loud pulmonic component (p2), and/or crackles and wheezing.
|
|
|
In the presence of RT ventricular failure what are some signs?
|
distended internal jugular veins and a RT ventricular heave may be evident with RT vent. Gallop S3 and S4 with or without tricupsid regurg may be audible.
FEVER can occur |
|
|
Chronic thromboembolic pulomonary hypertension causes signs and symptoms of RT heart failure include?
|
exertional dyspnea
easy fatigue peripheral edema the develops over months to years |
|
|
Dx is hard, but it starts by included what other conditions into your differentials?
|
cardiac ischemia
heart failure COPD exacerbation pneumothroax PNA Sepsis Acute chest syndrome (sickle cell) |
|
|
what is the procedure for PE?
|
supportive as need for pt.
M/T ABC's and support hemodynamic, You might have to intubate, IV access, and pressure support, Monitor I &O, relieveing pain and generalized supportive measures MEDEVAC |
|
|
Class of medications will you give your pt with PE?
|
O2 5-10L/min NRB or simple mask
2-6 L nasal canula |
|
|
For a Acute PE or proximal (DVT), what is the best treatment?
|
heparin (anticoagulation)
|
|
|
What is preferred alternative over surgical emolectomy?
|
Lysis of pulmonary thromboemboli (only available definitive medical treatment)
|
|
|
What is the initial treatment of PE?
|
O2 for hypoxemia
IV .9% saline and vasopressors for hyoptenstion MEDEVAC |
|
|
The present of free air or gas in the pleural cavity?
|
Pneumothorax
|
|
|
What is it called when penetrating chest would allows outside air to penetrate the pleural space, causing the lung to collapse?
|
open pneumo
|
|
|
What is a primary pneumothorax?
|
occurs in absence of an underlying cause.
|
|
|
Primary spontaneous pneumothorax occurs in what type of person?
|
pts without underlying pul. dz.
Tall, thin young men in their teens and 20's. Thought to be Spon. Rupture of subpleural apical blebs or bullae that result from smoking or inherited. Generally occurs at rest |
|
|
who develops Secondary spon. pneumothorax?
|
pt with underlying pul dz.
Occurs as complication of COPD, Asthma, CF, TB and other pul. dx. |
|
|
What is the most serious out of primary and secondary pneumo's?
|
secondary b/c of the underlying cause
|
|
|
Some symptoms of Pneumothroax?
|
Usually asymptomatic, but
Dyspnea, pleuritic chest pain and Anxiety. |
|
|
Pain from PNeumo can simulate what other condtions?
|
Cardiac ischemia, MSK injury (when referred to shoulder) or intraabd process.
|
|
|
What are some classical exam findings for pneumo?
|
Absent tactile fremitus
Hyperresonance to percussion Dec. BS. IF large, side with Pneumo may be enlarged with the trachea visibly shifted to the opposit side. |
|
|
Blood in the pleural cavity?
|
Hemothorax
|
|
|
What is it called when there is a mixture of blood and pleural flood?
|
Hemorrhagic pleural effusion
|
|
|
If a pt has 350 to 1500cc of blood in the pleural space, what class of hemothorax whould the pt have?
|
mode
|
|
|
Pt has penetrating or severe blunt trauma, causing a Hemothorax, what are some signs of this pt condition?
|
Dec. BS
Dullness to percussion and Chest x-ray should be promptly obtained. |
|
|
In 85% of cases of hemo or pneumothoraces, what is the only treatment required?
|
Tube thoracostomy
|
|
|
what are some symptoms of a small effusion?
|
usually asymtomatic, with large effusion
may cause dyspnea, particulary in the presence of underlying cardiopul dz. |
|
|
What is a concern for diaphramatic injuries to patient's?
|
Rarely obivous, and they must not be overlooked , and rarely heal spontaneously and because herniation of abdominal visera into the chest can occur with catastrophic complications now or years later
|
|
|
What are some signs , symptoms and exam findings for diaphramtic injury?
|
Acute: pt recently experienced blunt trauma or penetrating wound to chest, abd, or back. Clinical manifestations associated with injuries.
Chronic: diaphramtic tear unrecognized at injury, symptoms appear from herniation of viscera Exam: Borborygmi occasionally may be heard in the chest. Penertraing injuries. Dullness to percussion over hemothroax |
|
|
What are some differential diagnosis for diaphragmatic injuries?
|
must be differentiated from atelectasis, space-consuming tumors of the lower pleural space, pleural effusion, and intestinal obstruction
|
|
|
What is labs/test that can be performed for Diaphgramtic injuries?
|
Diaphragmatic excursion exam
|
|
|
What is the treatment plan for Diaphragmatic injury?
|
Disp:MEDEVAC
Procedures: Tx injury. Perform tube thoracostomy for hemothroax or pneumothroax. NG tube Meds: supporitve Ptedu: done by surgical team F/U: post surgical with eval for fitness of duty |
|
|
What could be some potential complications of Diaphragmitc injury?
|
Hemorrhage and obstruction may occur.
Herniation is massive, progessive cardiorespiratory insufficieny may threaten life. Most serious is Stragulating obstruction of hernitaed viscera |
|
|
Pt is complaining of chest pain and tenderness that worsens as he takes a breath. He fell onto his handle bars while riding his dirt bike. On exam, you notice audible crunching and point tenderness over the left 4th rib. What is his dx?
|
possible rib fracture
|
|
|
What would be other differentials for rib fracture?
|
flail chest, costochondritis, pleurisy
|
|
|
How would you determine if a pt has a true rib fracture?
|
xrays to confirm
|
|
|
What is the treatment plan for pt with rib fractures?
|
Disp: LD, tailor job
meds: analgesics (codiene or morphine if needed) F/u: in few days, Reexamine Pt edue: encourage to deep breath and cough. |
|
|
So, if pt fractures more than 3 ribs, the pt would be associated with an increase of condition?
|
lung contusion
|
|
|
If pt fractures his sterum, what should we be thinking about?
|
myocardial contusion
|
|
|
If pt hits his stirring wheel with his chest, what should you be thinking about for condition?
|
Pulmonary contusion
|
|
|
What is the most typical cause of pulmonary contusion?
|
compression-decompression injury tothe chest.
ie. High speed automobile crashes |
|
|
No specific clinical findings for pul. contustion, but what could be some symptoms of pul. contusion?
|
chest pain
dysnpnea and pulmonary infiltrates on xray |
|
|
What are some sign/exam findings of pul. contusion?
|
Chest pain, dyspnea, pulmonary infiltrates on xray are common.
Areas of opacification within 6h, consider Pul contusion |
|
|
What are some differentials for pul. contusion?
|
a. Cardiogenic pul. edema
b. Specific to traumatic condtion that caused the injury. |
|
|
What are some complications of Pul. contusion?
|
Respiratory failure and or death
Cardiac arrest Shock |
|
|
ARDS is characterized by what ?
|
intersitial and/or alveolar edema and hemorrhage as well as perivascular pul. edmea associated with hyaline membrane formation, proliferation of collagen fibers, and swollen epithelium with increased pinocytosis
|
|
|
What are some mediators of ARDS?
|
Cytokines
Complment activation Coagulation activation Platelet activating factors Oxygen radicals Lipoxygenase pathways Neutrophil proteases Nitric oxide Endotoxin...systemic inflammaotyr response with activation of the previous mediators. |
|
|
What two things comprises of COPD?
|
chronic obstructive bronchitis and emphysema, many pts has both
|
|
|
What is another name for Chronic bronchitis?
|
chronic mucous hypersecrtion syndrome
|
|
|
What is considered Chronic bronchitis?
|
productive cough for at least 3month in 2 consective years. and spirometric evidence of airflow obstruction develops.
|
|
|
What defines Emphysema/
|
desturction of lung parenchyma leading to loss of elastic recoil and loss of alveolar septa and radial airway traction with increase the tendency for airway collapse
|
|
|
After all the damage has been done with emphysema, what are the results from the damage?
|
lung hyperinflation, airflow limitation, and air trapping follow.
Airspaces enlarge and may eventually develop bullae |
|
|
What are some S/S of COPD or emphysema?
|
wheezing, lung hyperinflated that decrease heart and lung sounds. Barrel chest. Pt with advance emphsema lose wt and experience muscle wasting b/c of immobility, hypoxia.
|
|
|
What are some signs with the advance state of COPD?
|
pursed lip breathing, accessory muscle use, paradoxical indrawing of the lower intercostal interspaces, cyanosis.What
|
|
|
What is the characteristics of early stage of COPD?
|
Mild "smokers cough
Graudally progressive exertional dyspnea is the most common presenting complaint Wheezing Recurrent respiratory infections Prolonged expiratory phase Occasionally, weakness, wt loss, loack of libido may be seen. |
|
|
Late stages of COPD?
|
barrel chest
finger clubbing cyansosi and hypoxemia Hyperreonsance INcreaed use of accessory muscles Pursed lip breathing Calloused elbow for repeated use of Tripod position. |
|
|
What is the criteria for referral to an emergency room for tx if two or more of the following :
|
Dyspnea at rest
RR >25min HR 110min Use of accessory muscles |
|
|
What are some Procedures and meds that we can use to help alleviated some symptoms?
|
Pulmonary tolieting help relieve sputum
Meds: O2, Bronchiodilator and/or oral corticosteriods as prescribed |
|
|
What are some complications of COPD?
|
a. Pul HTN, cor pulmonale, chronic resp. failure are common
b. Spont pneumo uncommon c. Hemoptysis may result from Chronic bronchitis or may signal bronchogenic carcionma d. PNA, pul embloi, and concomitant left vent failure may worsen . |
|
|
What are some differential diagnosis of flail chest?
|
a. Rib fracture
b. Multiple chest trauma |
|
|
With a flail chest what is the intial assessment for you patient?
|
patency of airway and the adequacy of ventilation must be established or confirmed.
|
|
|
When would you intubate a pt with flail chest?
|
hardley never, unless associated injuries, most commonly to the CNS
|
|
|
What is the mainstay of pain control in pts with flail chest?
|
Thoracic epidural anesthesia sol contains .002% to .005% morphine sulfate and .075% to .2% bupivacaine .
.15-.75 mg morphine/hr. |
|
|
What does Epidural anesthesia bring to a patient with flail chest?
|
immediate comfort, dramatically improves vital capacity and tidal volume, most important enables the patient to produce a forceful cough.
|
|
|
When will a thrombosis be commonly contributed to PE?
|
followed an operation or confinment to bed
|
|
|
Where are some places does PE arise from?
|
venous circulation or right side of the heart (thromboembolism) , tumors that have invaded the venous circulation (tumor emboli), or from other sources
|
|
|
Most common type of pulmonary embolus is that which has usually formed where in the body?
|
leg or pelvic vein
|
|
|
How does a large emobli compare to Massive emboli?
|
Large causes:acute dyspnea and pleurtic chest pain (less commonly cough and hemoptysis.
Massive PE presents with Hypotension, tachycardia, syncoe and cardiac arrest |
|
|
What are the most common signs of PE?
|
Tachycardia and tachypnea.
|
|
|
Chronic thromboembolic pulmonary hyertension causes what S/S?
|
Right heart failure, including exertional dysnpnea, easy fatigue, and peripheral edeam the develops over months to years
|
|
|
what does the diagnosis start for PE?
|
including PE in Differential dx of large number of conditions, Cardiac ischemia, heart failure, COPD exacerbation, pneumothorax, PNA, Sepsis, Acute ches syndrome
|
|
|
What are some proceudres that you can perfrom for pts with PE?
|
supportive . M/T ABCs and support hemodynamic needs.
Intubation, IV access, Pressure suport, monitoring I&O, releiveing pain and generalized supportive measures |
|
|
What are some medications you can use for PE?
|
O2 5-10L/min by nasal prongs or mask.
|
|
|
Anitcoagulation for established pulmonary embolism is really preventive rather than definitive therapy. What choice of medication is perferred for Acute pulmonary embolism?
|
HEPARIN
|
|
|
What do you treat pain for with pt who had PE?
|
Morphine and meperidine PRN. M/T adequate blood pressure and monitor for hypoxemia
|
|
|
An estimated 10% of pts with PE die within what time frame?
|
1h
|
|
|
What are some definitive treatments and diagnosis of PE?
|
a. CT and V/Qscanning
b. Initial tx for PE is O2 for hyposemia and IV .9%saline and vasopressors for hyptenstions. Mointor life-threatening cardiovascular complications in the first 24-48 h. |
|
|
Air leaks are more commone in which type of pnemothorax?
|
secondary , most resolve spontaneously in <1wk
|
|
|
Failure of the lung to re-expand is usually due to what?
|
persistent air leak, Endobronchial obstruction or trapped lung or malpostitioned chest tube
|
|
|
Hemothroax should be suspected with what ?
|
penetrating or severe blunt thoracic injury.
|
|
|
What are the most common symptoms for Hemothorax?
|
Pleuritic chest pain and dyspnea
|
|
|
What are some exam findings for Hemothroax?
|
BS reduced and chest is dull to percussion on the involved side
Decreased Tactile fremitus Percussion dullnes Decreased to absent breath sounds over the effusion |
|
|
In a massive hemothroax what exam findings will stand out?
|
The neck veins are usually collpased.
|
|
|
If the patient has a thready or absent pulse and distended neck veins the main differential diagnosis will be what?
|
btw cardiac tamponade and tension pneumothorax
|
|
|
What type of procedures should you perform on patient with hemothorax?
|
chest tube, the larger tube should be chosen for trauma situations
|
|
|
What are some complications of hemothorax?
|
shock, fibroid mass formation
|
|
|
Sternal fractures is commonly associated with what problems?
|
myocardial contusion
|
|
|
How many rib fractures are assocated with increased incidence of lung contusion?
|
more than 3 ribs
|
|
|
When should you hospitalized a patient for rib fractures?
|
a. Fractues of 1st and 2nd rib
b. suspected visceral injury c. Sternal fractures d. Antecedent physiologically significant chronic pulmonary dz e. If parenteral analgesics are required |
|
|
What type of medications do you not give for Pulomnary contusion?
|
Corticosteriods and diuretics
|
|
|
What are some differential diagnosis of ARDS?
|
Cardiogenic pulmonary edema
|
|
|
What is the treatment plan for pt with ARDS?
|
Treat underlying cause
Prevent complications (GI bleeding, nosocomial infections, thromboembolus) Support ventilation using lung proteciont stargies (low tidal, PEEP |
|
|
When should high-dose of glucocorticosteriods be used for patients with ARDS?
|
severe, refractory diseases
|
|
|
What are some complications of ARDS?
|
MODS
Death Permanent lung disease Oxygen toxicity Barotrauma superinfeciton |
|
|
What are some definitive treatment and diagnosis for ARDS?
|
a. acute lung injury Pa02/FiO2 <300
ARDS PaO2/FiO2 <200 |
|
|
What is the condition of a pt with inflammed upper airways, commonly following an URI?
|
Acute Bronchitis
|
|
|
What seems to be the cause of Acute bronchitis?
|
Viral infection, someties Bacterial.
Various Mineral and vegetable dusts, fumes from strong acids, solvents, chlorine, environmental irritants |
|
|
What are some common symptoms that is present with Acute Bronchitis?
|
most common (Cough with or without fever and Sputum.
|
|
|
What are some symptoms of Acute Bronchitis?
|
PReceding URI, such as common cold (coryza, malaise, chills, slight fever, back and muscle pain
COugh, dry and unproductive, then productive; later mucopurulent Fever (suggest PNA Wheezing, after cough |
|
|
what signs and exam findings for Acute bronchitis?
|
Rales, rhonchi, wheezing
No consolidation Pharynx injected Fever, Tachypnea |
|
|
what are some Differential diagnosis of Acute bronchitis?
|
Asthma
Allergies Bronchiectasis retained Foreign body |
|
|
What are some treatments for Acute bronchitis?
|
a. Rest
b. Steam inhalations c. Antitussives d. stop smoking e. Antibiotisc if complicated comorbidity (copd) |
|
|
What are some procedures and disposition of patient with A.Bronchities?
|
Self-limited
No procedures needed |
|
|
What should you tell your patient with A. Bronchitis?
|
a. Pulmonary toileting
b. Force cough (HUFF cough) c. Deep breathing d. I.S. use |
|
|
What are some complications for A. bronchitis?
|
Bronchopna
ARF Bronchiectasis Chronic cough Hemoptysis Superinfection |
|
|
what is the definition of PNA?
|
Inflammation of the lung parenchyma with consolidation of the affected part, Alveolar air spaces being filled with exudate, inflammatory cells, and fibrin.
|
|
|
What are some causes of PNA?
|
Most cases are due to infection of bacteria or viarl, few to inhalation of chemicals or trauma to the chest wall, small minority to rickettsiae, fungi and yeasts
|
|
|
What constitutes 30-60% of all CAP for which etiology can be determined?
|
Pneumococci
|
|
|
The second most common bacterial cause of CAP is what?
|
H. influenzae 10% of cases
|
|
|
what are some risk factors for Nosocomial infection s?
|
aspiration
gram negative PNA (in serious underlying Dz |
|
|
What type of PNA are more commone in older children and young adults?
|
Nonbacterial Pneumonias
|
|
|
What is a tail-tail sign of patients with viral, mycoplasmal, or chlamydial pneumonias?
|
severe hacking cough, but substantial sputum production is unusual
|
|
|
Patients with bacterial will usually present with what type of signs?
|
copious sputum production as well as an abrupt onset of illness, high temp. chills, and development of significant pleural effusions than are patients with nonbacterial pneumonias
|
|
|
What pna's are the most commonly implicated causes of gram-negative pneumonias?
|
Pseudomonas, Dlebsiella, and E. coli
|
|
|
What are some Major signs/exam findings for pt with Bacterial pneumoina?
|
pt looks sicker
Consolidation or as least localized rales and rhonchi. Fever chills Cough with Purulent sputum Myalgias, Malasie |
|
|
Pt with Lobar pneumonia, what are some findings?
|
Inc. TF
Percussion dullness Whispered Pectorilquy |
|
|
What are some findings with effusion or empymea?
|
Diminshed BS
Pleural friction rub Dullness to percussion Pleurtic pain |
|
|
What are some differential diagnosis for PNA?
|
other infections pneumonitis
viruses Nocardia ( Fungi (aspergillus, Histoplasma Protozoans (toxoplama TB Sarcoidosis, Pul. Contusion ARD |
|
|
What are some independent studies that we can perform to r/o PNA?
|
CBC, UA, chest xray, sputumm culture
|
|
|
What are some common treatments for PNA?
|
1. Hydration
2. Expectorants 3. Antitussives 4. Cough technique, I.S. 5. O2 with hypoxemia 6. anitbiotics if infection |
|
|
What are some indications for Hospitalzation for PNA?
|
Neutropenia, involvment of > one lobe, poor host resistance (alcoholism, DM, malnutrition)
|
|
|
What are the cornerstone of therapy when it comes to PNA?
|
a. Bedrest
b. supplemental oxygen c. antibiotics |
|
|
What is the disposition of a patient with bilateral pneumonia?
|
should be hospitalized
|
|
|
What are some procedures for PNA?
|
CPT
Pulomnary toileting |
|
|
What should you tell your patient with PNA?
|
a. hydrate, cough, rest and eat well
b. enourage coughing and deep breathing |
|
|
How often should a pt f/u with PNA?
|
as often as needed, at min. when antibiotic course is completed and a f/u CXR
|
|
|
What are some major complications of PNA?
|
Resp failure with MV
Endocarditis Meningitis Pul. Superinfection emphyema |
|
|
What condtion is caused by nonbacterial pathogen, calssically caused by Mycoplama pneumoniae?
|
Atypical Pneumonia
|
|
|
What is Primary atypical pneumonia?
|
older term of acute systemic dz with involvement of the lung caused by Mycoplasma.
|
|
|
What are some findings with Primary Atypical pneumonia?
|
fever, cough, realtively few signs, scattered densities on xray
|
|
|
What is the most common cause of Atypical pna?
|
Mycoplasma pneumoniae but other pathogens can cause it.
|
|
|
What are some classic signs and symptoms of Atypical pna?
|
Gradual onset with URI
Fever, chills, cough sore throat, HA rales. bullous myringitis, skin rash NONPRODUCTIVE COUGH absent Consolidation absent Wheezes and rales |
|
|
what are some differential diagnosis of r atypical pneumonia?
|
Viral, bacterial, fungal, Chlamydia, Pneumocystis jerovici
TB |
|
|
What class of medications will you give a pt with PNA?
|
Macrolides
ketolides Tetracyclines Most Fluoroquinolones |
|
|
What is the prognosis for pt with atypical pna/
|
Mycoplasma infection usually resolve in 2wks
Some sysptoms may persist for wk |
|
|
What is the definition of Aspiration Pneumonia?
|
bronchopneumonia resulting from the inhalation of foreign material, usually food particles or vomit, into the bronchi
|
|
|
What is aspiration pnumonitis?
|
inflammatory chemical injury of the tracheobronchial tree and pulmonary parenchyma produced from inhalation of regurgitated sterile gastric contents
|
|
|
A patient with aspiration pneumonitis may have only minor symptoms like?
|
nonproductive cough and tachypnea
|
|
|
Aspiration of larger or more acidic gastric contents may produce what type of symptoms?
|
Tracheobronchitis with bronchspasms, bloody or frothy sputum and respiratory distress
|
|
|
The physical examination of Aspiration pna may reveal signs of PNA, what are those signs?
|
Tachycardia, tachypnea, fever, rales, or decreased BS in an ill appearing pt.
|
|
|
Patients with mixed aspiartion pna may present with what type of signs?
|
acute febrile illness, or illness may follow a more indolent course, extending over many days or even weeks,. Fever, cough, and sputum production are the dominant symptoms; sputum may be copious, FOUL SMELLING or both
|
|
|
What are some commmon and uncommon findings of aspiration pna?
|
common: Altered mental statues, Periodontal dz, poor oral hygiene, Rhonchi, Decreased resonance on percussion, bronchovesicular BS
UNCOMMON: Wheezes, crackles, severe dyspnea or acute resp. failure |
|
|
What is some treatment plans for Aspiration PNA?
|
1. prompt suction with large aspiration and if bronchospams (bronchodilators)
2. Small aspiration of nontoxic material observed for 1h if stable can be released 3. Empiric broad-specturm antibiotic therapy is indicated in pt with Aspiration PNA |
|
|
This condition is usually due to anaerobes, and aspirated infected material from the upper airways with symptoms of indolent cough, fever, pleuritic chest pain, wt loss and night sweats that is present for app. 14 days?
|
Lung abcess
|
|
|
What are some other symptoms that can go along with Lung abcess?
|
Foul smelling putrid purulent sputum, with poor dental hygiene. ONset may be acute or insidious
|
|
|
What are some Sign and exam findings of lung abcess?
|
V/S: Tachypnea, Tachycardia
crackles, wheezing dullnes to percussion consolidation by ausculatation and Cavernous BS |
|
|
Certain factors tend to worsen the prognosis of Lung abcess/
|
large abcess >6cm
anatomic obstruction Right lower lobe location Certain baceriologic species. S. aureus, Klebsiella Pseudomas |
|
|
What are some differential diagnosis for Lung abcess/
|
Bronchogenic carcinoma
TB Vasculitis Wegener granulomatosis Infected pulmonary bulla |
|
|
What are some complications of lung abcess?
|
empyema
massive hemopysis contamination of univolved lung and failure of the abcess cavity to resolve |
|
|
What is the definition of Costochondritis?
|
inflammation of one or more costal cartilages, characterized by local tenderness, and pain of the anterior chest wall that may radiate, but without th elocal swelling typical of Tietze syndrome
|
|
|
What are some symptoms /signs and exam findings for costochondritis?
|
Insidious onset
Pain usually sharp, somtimes pleuritic 2nd-5th costal cartilage most often involved Pain worsen with movment and breathing Pain sometimes radiates into arm Reddness and warmth at sites of tenderness |
|
|
What are some causes of Pleuritis?
|
a. underlying lung process
b. Direct entry (ruptures esophagus, amebic empyema) c. Transport of infectious or noxious agent or neoplastic cells via blood stream or lymphatic d. Parietal pleura injury e. Asbestos f. Pleural effusion related to drug ingestion. |
|
|
What are some symptoms of Pleuritis?
|
a. Sudden onset
b. pain is dominat c. Vague discomfort to intense stabbing d. Aggravated with breathing/ cough e. USUALLY SUBSIDES WHEN PLEURAL EFFUSION IS DEVELOPED f. Rapid and shallow resp. |
|
|
What is some Diff DX of pleuritis?
|
a. MI
b. SPont. Pneumo c. Pericarditis D chest wall lesions e. PLEURAL FRICTION RUB OF PERCARDITIS IS NOT INFLUENCED BY BREATHING |
|
|
What class of meds can you give for pt with pleuritis?
|
Analgesics and anti inflammatories are helpful
Codeine (30-60mg PO TID) used to control cough if retention of secretions is not complication. |
|
|
What are some causes of Hyperventilation?
|
a. asthma or early emphysema
b. excercise, fever, hyperthyroidism c. lesion on CNS, d. hormones/drugs(epi, progesterone, Salicylates) e. diff. with MV f. Psychogenic factors (anxiety) |
|
|
What are some S/S and findings for Hyerventilation?
|
a. hypernea
b. Paresthesias c. Carpopedal spasm d. Tetany e. Anxitey |
|
|
What are some S/S and finding of Chronic hyperventilation?
|
1. Non specific symptoms
2. Fatigue 3. Dyspnea 4. Anxiety 5. Palpitiations 6. dizzines |
|
|
What are some treatments for Hyperventilation/
|
1. Reassurance
2. R/O organic causes 3. Rebreathe CO2 decrease Resp Alkalmeia 4. ANxiolytic drugs |
|
|
What could be some potential complications of Hyperventilation/
|
1. Hypocapnia
2. Resp alkalosis 3. Cerebral Vascocaonstriction and hypoxia may result |
|
|
What is the definition of Sarcoidosis?
|
systemic granulomatous dz of unknown cause. Involving the lungs with resulting Intersitiial fibrosis, also involving the lymph nodes, skin, liver, spleen, eyes phalangeal bones, and parotid glands.
|
|
|
What are some exam findings for sarcoidosis?
|
1. skin rashes 2. erythema nodosum
3. Parotid gland enlargment, hepatosplenomegaly and lymphadenopathy 4. lab (leukopenia, eosinophilia, elevateed ESR, Hypercalcemia and hypercalciuria |
|
|
What two conditions comprises of COPD?
|
Chronic obstructive diseases and emphysema
|
|
|
What is another name for chronic bronchitis?
|
Chronic mucous hypersecretion syndrome
|
|
|
How is Chronic bronchitis defined?
|
have a productive cough for at least 3months in 2 successive years.
|
|
|
How is Emphysema defined?
|
destruction of lung parenchyma leading to loss of elastic recoil and loss of alveolar septa and radial airway traction, which increases the tendency for airway collapse.
Lung hyperinflation, airflow limitation and air trapping follow |
|
|
What are s/s and findings with pt who have COPD?
|
1. Wheezing, lung hyerinflation
2. barrel chest 3. lost wt with muscle wasting 4. hypoxia, increased metabolic rate 5. Advanced (pursed lip, accessory muscle use, cyanosis, paradoxical indrawing. |
|
|
Pt with cor polmonle will have signs of what?
|
neck vein distention
splitting of 2nd heart sound with accentuated pulmonic component |
|
|
What is the most important cause of COPD and what are some of its findings?
|
smoking:
Inhibits ciliary function Increases mucus production Causes inflammation of lung tissue Impairs lung defenses Decreases lung elasticity by destroying alveoli Passive smoking increases risk in the non-smoker |
|
|
what are some early stages of COPD?
|
"smokers cough"
Gradually progressive exertional dyspnea most common Wheezing Recurent respiratry infections Prolonged exp. phase Occasionally, weakness, wt loss, lack of libido |
|
|
Lates stages of COPD?
|
1. barrel chest
2. finger clubbing 3. cyanosis and hypoemia 4. hyperresonance 5. Inc. use of accessory muscles 6. Pursed lip breathing 7. Calloused elbows from repeated assumption of "tripiod position" chest may be quiet in advanced stages |
|
|
What is the criteria for referral to ER for tx includeds two or more of the following?
|
Dyspnea at rest
RR >25/min HR >110/min Use of accessory muscles |
|
|
What is the criteria for hospital admission of pt with COPD?
|
pt has acute exacerbation plus
Inability to walk btw rooms Inability to eat or sleep Prescence of high risk comorbid condition Altered mentation Worsening hypoxemia New or worsening Hypercarbia Pt has new or worsening cor pulmonale |
|
|
What are some class of medications a COPD pt will need?
|
supp o2, usually NC on low flow
Trial BD and/or oral corticosteriods or inhaled steriods |
|
|
Some treatment plans and pt education you want to give a pt with COPD?
|
a. Stop smoking
b. CPT, Supervised PT c. HOME O2 with hypoxemia d. Mang. just like acute or severe asthma |
|
|
What are some complications of COPD?
|
Pul HTN
COR pulmonale, CHronic resp failure Spont. PNEUMO occus in small fraction of pts with emphysema Hemoptysis (chronic bronchitis or signal for bronchogenic carcionma PNA, PE, and concomitant LVF may worsen |
|
|
What is the definition of Smoke inhalation?
|
inhalation of noxious fumes or irritating particulate matter causing severe pulmonary damage
May result in thermal injury of airways, chemical injury or airways and systemic chemical posisoning |
|
|
What are some signs of smoke inhalation
|
a. thermal injury, trapped in fire
b. Complications become evident in 18-24 hrs c. Inpaired ability to clear oral secretions d. Airway obstruction, producing inspiratory stridor e. Resp failure with hypercapnia and hypoxemia in severe cases |
|
|
What are some signs and exam findings for smoke inhalation pts?
|
chemical injury(acrolein)
Prolonged or high concentrations for short times fatal lesser may cause Pul edema or Spasms |
|
|
What are some signs of Hydrochloric acid exposure?
|
combustion from high rise buildings well with furnishings and plastics
a. exposre is associated with dyspnea, chest pain and irritation of mucus membranes |
|
|
Toluene diisocyanate exposure from combustion of polyurethane can cause what type of symptoms?
|
may cause severe bronchospams
|
|
|
What are some signs of impending airway obstruction?
|
a. labored or rapid breathing
b. stridor c. severe wheezing d. progressive decrease in air exchange |
|
|
What are some signs of CO poisoning in a Patient?
|
HA
Tachycardia Irritablity Cutaneous flusing Mental confusion Vomiting Incontience Cyanosis or pallor |
|
|
What are some lab/test findings for Smoke inhalation?
|
a. chest xray normal, but show pul edema hours later.
b.ABG and carboxyhemoglobin determination will determine oxygen/hemoglobin concentrations c. ECG may indicate cardiac arrhytmias associated with CO poisoning d. Urine speciment show myglobinuria (oxygen binding protein excreted in urine indicating oxygen scarce) |
|
|
what as an IDC, do you have to monitor pt with smoke inhalatino?
|
Monitor and eval airway
Pulse oximetry (could be false reading) Peak flow readings |
|
|
What can be some major complications for Smoke inhalation?
|
1. death
2. ARDS 3. Respirator failure |
|
|
At altitudes of 9,000 ft pt starts having AMS after about the 3 day at this height. Pt condition was abrupt with Ha and malaise. What type of sickness does this pt have?
|
High altitude cerebral edema. HACE
|
|
|
What is the commonest and most prominent sign of Hypoxemia with AMS?
|
HA
|
|
|
what are some other major signs of AMS with hypoxemia?
|
a. Lassitude, difficulty concentrating, sleep distrubances, dizziness, insomina
b. Symptoms worse on 2nd-3rd day after ascent but usually clears within 5-7 days c. More severe Pul. edema and encephalopathy |
|
|
AMS with mild to mod symptoms with HA and one of the following other symptoms?
|
a. ANorexia
b. N/V c. Dizziness and LH d. INsomina |
|
|
In Severe cases of AMS, what are some symptoms?
|
Increased HA
irritability, Marked fatigue dyspnea withexertion N/V |
|
|
What are some differential diagnosis of Hypoxemia?
|
AMS/HACE
Migraine HA dehydration CO exposure CNS infection PNA PE Asthma Poison Really any major lung condition |
|
|
What are some medications for AMS?
|
Acetazolamide 125-500mg PO bid until symptoms resolve
Dexamehtasone effective treating moderate AMS. 4mg PO/IM/IV q6h Analgesics and antiemetics as needed |
|
|
An acute or chronic disorder charc. by widespread and largely reversible reduction in the caliber of bronchi and bronchioles, due in varying degrees to smooth muscle spasm, mucosal edema and excessive mucus in the lumens of airways.
|
Asthma
|
|
|
What are some causes or etiologies of Asthma?
|
a. subacute inflammatory diseaes of airways
b. Heredity, allergies and envirn. irritants are implicated c. Susceptibility genes and envir. factors d. T-helper 2 cells and their cytokines (IL4,5,9,13 and ADAM33 gene) stimulate airway smooth muscle and fibroblast proliferation or regualte cytokine production. |
|
|
What are the allergic or extrinsic factors of asthma?
|
Antigen-antibody recation that cause the release of histamine, serum eosinophilia, and produces and anphylaxis like reaction
Episodic or paroxysmal symptoms |
|
|
Idiopathic or intrinsic fators of asthma?
|
Non allergic form of asthma
-cause by inhalation of pollutants (dust particles, smoke, aerosols, paint fumes) cold dry air Chronic and persisten symptoms |
|
|
What is known as the Triad of asthma?
|
combination of asthma, aspirin senstivity and nasal polyposis
Occurs in <10% of asthma pts. |
|
|
What type of asthma that only has Nocturnal cough for symptoms?
|
occupational asthma
|
|
|
what drugs have the potential to cause asthma?
|
Beta blockers
ASA NSAIDS Histamine Acetylcysteine |
|
|
How many stages of asthma are contriubuted to this condiction?
|
4
|
|
|
What stage would a pt be in if he/she had marked resp. distress, cyanosis, sue of accessory muscles, marked wheezes and absent BS with pulsus paradox of 20-30mmHg?
|
Stage III
|
|
|
Stage II of asthma will have what type of signs?
|
a. Resp. distress at rest
b. hyperpnea c. use of accessory d. marked wheezes e. air exchange normal or decesed |
|
|
Mortality risk increase in asthma pts follows what type of criteria?
|
a. >3 ER visist per year
b. Nocturnal symptoms c. Hx of ICU d. MV e. >2 hospilatizations per yr Systemic steriod dependence f. HX of syncope with asthma e. Hx of noncompliance |
|
|
What is the definition of Pulmonary Edema?
|
medical emergency demanding prompt an defective treatment characterized by effusion of serous fluid into the alveloi and intersitial spaces
|
|
|
What are some causes of Pulmonary edema?
|
Cardiogenic (secondary to CHF), MI, severe ischemia, valvular regurg or ventricular septal defect
NON cardiogenic (ARDS) injury to pulmonary capillaries resulting in leakage. Sepsis, drugs, inhalation of smoke or toxic substances, near drowning, burns, aspiration ect. |
|
|
What are some classic signs of Pul. edema?
|
Severe dyspnea with production of PINK, FROTHY sputum, Diaphoresis, and cyanosis
RALES (crackles) in all lung fields |
|
|
What are some respiratory complications for Pulmonary edema?
|
SOB
Dyspnea on exertion Orthopnea, Cough with PINK< FROTHY, sputum Wheezing, rhonci, gurgles Moist, crepitant rales noted initially at base then to apices Tachypnea CHEYNE-stokes respirations |
|
|
What are some Cardiac signs of Pul. Edema?
|
Tachycardia
Eleveated JVP Increased P2 S3 S4 Nocturnal angina Pulsus alternans or |
|
|
What is the disposition of pt with Pul. Edema?
|
MEDEVAC
|
|
|
What would be the treatment plan for pt with Pulmonary edema?
|
Supp O2 10-15L/min mask
ET and MV Morphine highily effective 4-8mg IV and may be repeated 2-4 hrs Furosemide 20-80 mg IV will often improve respiratory function |
|
|
What are some complications of Pulmonary edema?
|
Death
REveresible or irreversible organ ischemia Pul. Fibrosis, particuarly with non-cardiogenic pul EDEMA PUL Edema may occur as a complication of tocolytic therapy with Mg sulfate, terbutaline, or ritodrine |
|
|
What accounts for >90% of all lung tumors?
|
Bronchogenic carcinoma
|
|
|
What is the most important cause of LUNG cancer in both men and women in the USA?
|
Cigarette smoking
|
|
|
what are some other causes of lung cancer?
|
ionizing radiation, asbestos, heavy metals (nickel, Chromium) and industrial carcinogens (chloromethly ether)
|
|
|
What is the most common type of lung caner arising in the larger bronchi and commonly spreading by direct extension and lymph node metastasis. Accounts for about 30-35% of primary lung tumors?
|
Squamous cell carcinoma
|
|
|
This type of cancer usually spreads thorugh the bloodstream and resemles adenocarcinoma and appears in the periphery of the lung?
|
Undifferentiated large cell carcinoma
|
|
|
What are some symptoms noted with pt who have Lung cancer?
|
Nonspecific complaints, cough with or without hemoptysis, dyspnea and chest pain.
Change of pattern of cough, blood streaked sputum , anorexia with wt loss, and hoarseness point to Bronchogenic carcinoma Late symptoms include weigth loss and weakness |
|
|
What are some complications of Lung cancer?
|
Superior Vena cava syndrome/obstruction
Phrenic nerve palsy (1% of cases) Recurrent laryngeal nerve palsy: resulting in hoarness |
