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36 Cards in this Set

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dyspnea during pregnancy is common however
pregnant women with acute or unexlained sob deserve eval for a PE
pregnant women imaging
CXR while shielding abdomen, V/Q scan as opposed to CT also a half dose perfusion scan without ventilation can be done
functional test that can provide tremendous info about the patients resp status
ambulation
a patient fails a breif trial of NIPPV...
the physician should be prepared for intubation
in severe asthma or status what else is given
mag epi or heliox can also be tried
high doses of CS are used initially for
moderate to severe asthma exacerbations
in the setting of acute pulmonary edema...
100% O2 must be provided often under positive pressure the patient is maintained in the upright position with legs dangling if possible to assist fluid redistribution from the lungs
IV loop dieuretics are used in acute pulmonary edema because
not only diurese but cause increased venous capacitance with the usual starting dose of furosemide being 20-80mg IV...sublingual NG also causes redistribution and can be administered
patients requiring nitrodrip because of high BP require what
art line
may be of limited benefit in patients presenting with acute pulmonary edema
refers to Beta blockers as there is often mild to moderate bronchospasm
no definitive role in acute management of CHF
dig
if absolutely needed in the setting of CHF what beta blocker should be used
often reserved for Diastolic dysfxn choose esmolol (short acting)
usually the only therapy for patients on dialysis and chronic renal failure
emergent dialysis
standard anticoagulation therpy for PE
heparin and warfarin
If anaphyulaxis or allergic rxn suspected give
(aerosolized, SC or IV) epi, IV benadryl, IV CS and IV H2 blockers
dyspnea occurs in 75% of pregnant women by when
30th week 2/2 higher diaphragm, blood redistribution and progesterone causing increased CO2 sensitivity...the physiologic dyspnea of pregnany rarely increases in severity in the final weeks
life threatening causes of dyspnea in the pregnant patient are
preeclampsia and PE
which dyspnea patients need to be admitted
patients requiring supplemental O2 to maintain Oxygenation and those with distress...also recommended in in someone with unstable angina having dyspnea even if they respond to therapy in the ED
normal A-a gradient
2-10 but this increases with age and may be as high as 30 in elderly
A-a gradient calculated by
(713)FiO2- PaCO2/0.8
causes of an A-a gradient
1. V/Q Mismatch (ex: PNA, CHF, ARDS, atelectasis, etc)

2. Shunt (ex: PFO, ASD, PE, pulmonary AVMs)

3. Alveolar Hypoventilation (ex: interstitial lung dz, environmental lung dz, PCP PNA)
best CXR for dyspnic
PA and Lateral however a portable AP is often necessary at bedside
CXR worrisome for PE
a normal one in the setting of Hypoxemia
incongruity
lack of harmony; absurdity; incompatible; inconsistent
incidence of a silent MI is approximately
20%
calssic PE finding on ECG
S1Q3T3
dirge
to lament with music; a slow, solemn, and mournful piece of music
ECG of PE
S1Q3T3
the VQ scan is reserved for what patients
renal insufficiency

contrast allergies

and pregnant patients
chemoreseptors for respiration
aortic and carotid bodies
one of the earliest findings in people with diaphragmatic weakness from neuromuscular D/Os
orthopnea
dyspnea associated with unilateral recumbant position may opccur in patients with unilateral dz, ball-valve airway obstruction diaphragmatic paralysis or COPD
trpopnea
diaphragmatic paralysis from injury to what levels
C3-5
a patient that can speak in few words has
moderate RD
suggstive of hypercarbnia
somnolence
jugular venous distention on inspiration is referred to as
cussmall's sign