Pneumonia Case Study Solution

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Register to read the introduction… Oxygen is the only pharmalogical therapy shown to decrease mortality
COPD is leading indicator for lung transplant
Asthma-unknown etiology
Most common chronic disease in children
No beta blockers in asthma patients
Chronic inflammation of the mucosa of the lower airways characterized by acute exacerbations
Major components- airway inflammation, intermittent airflow obstruction, and bronchial hyper responsiveness
Characteristics- constriction of airway smooth muscle, thickening of the airway epithelium, and presence of liquids or mucus in the airway
Severe asthma- pco2 tend to be low due to increased ventilation
Hallmark sign- wheezing
Blood eosinophilia greater than 4% or300-400 supports diagnosis of asthma
Treatment-beta2 agonist (most commonly used), anticholinergics, and theophylline. EX albuterol
Sleep apnea- CSA and OSA
CSA- respiratory pause caused by lack of respiratory effort. Associated with cardiac failure or neurologic disease such as
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Fractures seen in ribs 1 and 2 potentially life threatening
Pneumothorax-caused by loss of negative pressure in the pleural space resulting in collapse of lung and inability to inflate during respirations
Chest tube- placed to maintain negative pressure
Tension pneumo requires immediate intervention- thoracostomy at the midclavicular second intercostal space
Massive hemothorax is considered more than 1500ml of blood
Pulmonary Edema
Often found with complications of heart failure
Cardiogenic pulmonary edema and noncardiogenic pulmonary edema
CPE- most common- LV dysfunction
NPE- drowning, aspiration, allergic reaction, ARDS
Neurogenic Pulmonary Edema- subarachnoid and intracerebral hemorrhage
S3 typically found in CPE
Normal PAWP 10-18. In CPE pressure will typically read 25-30
PEEP-decrease preload and afterload resulting in increased cardiac function
Preload reduction- diuretics, nitrates, morphine
Afterload-ACE inhibitors, Nitroprusside (relaxing smooth muscle)
Inotropic support- dobutamine, milrinone (decrease in preload and afterload)
IABP-improve coronary blood flow during balloon inflation and reduces afterload during balloon deflation

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