Pulm Clin Med Quick Hits - Maddie PDF
Document Details
Uploaded by BoundlessObsidian4130
Maddie
Tags
Summary
This document appears to be a collection of quick reference notes or summaries of pulmonary conditions, likely intended for medical use or study. It includes conditions such as chronic asthma, acute asthma, COPD, as well as other respiratory-related topics and information.
Full Transcript
Condition Dx Tx Other info, key words Chronic Asthma pirometry - S obstructive pattern, Decreased FEV1 and FVC ABA - albuterol S LABA - Formoterol Bronchodilators: SAMA and LAMA topic triad (rhinitis, A eczema, dermatitis) ronchodilator B challenge amters tria...
Condition Dx Tx Other info, key words Chronic Asthma pirometry - S obstructive pattern, Decreased FEV1 and FVC ABA - albuterol S LABA - Formoterol Bronchodilators: SAMA and LAMA topic triad (rhinitis, A eczema, dermatitis) ronchodilator B challenge amters triad (nasal S polyps, asthma, aspirin sensitivity) VC/FEV1 is F normal→ methacholine challenge Acute asthma Peak Flow Rate lbuterol A Ipratropium - Steroid - Sink Montelukast rouble breathing T Cough that's worse at night Dyspnea Wheezing on expiration Triggers Status Asthmaticus oesn’t improve with D meds ronchodilators B Mag (IV) Epinephrine intubate/ MechanicalVentilation cute severe asthma A that does not improve w/usual doses of bronchodilators & steroids COPD XR / Spirometry C Sputum Culture O2 Screen for alpha1 antitrypsin deficiency ong term L Stop smoking SABA and LABA SAMA and LAMA “ Occupational hazards” “tobacco exposure” requent F exacerbations - steroids OPD acute C exacerbation PFTs CXR ost are viral, but if it M has cardinal symptoms that require ventilation - antibiotics (augmentin) q5 O2 Steroid ay have chest wall M abnormalities or flattened diaphragm ducation don’ts: E DON'T adjust your medicines (including oxygen) without first talking with your provider ￫ DON'T go outside or exercise if air is polluted or if the air quality index is poor ￫ DON'T spend lot of COPD bronchitis FTs gold standard P (decreased FEV1 and FVC 3mo in each 2 years” Peripheral edema ore symptoms + M low risk: LAMA or LABA + SABA inimally M symptomatic daily: LAMA +/- LABA igher sx burden: H LAMA+LABA +/- inhaled steroid COPD emphysema FTs: gold standard P 5 days hildren: increased C fluid, honey, antipyretics, oral analgesics RIsx, malaise, U dyspnea, wheezing, hemoptysis Fever is rare Epiglottitis Croup Laryngoscopy Airway management XR→ thumb sign BX ceftriaxone/ A cefotaxime or vanco Tripod position Vaccines (HIB) Cherry red epiglottis examethasone.6 D mg/kg Racemic epi in children w/ sever symptoms arking cough B usually at night, stridor, use of accessory muscles CXR: steeple sign ysphagia, drooling, D distress Parainfluenza Idiopathic Pulmonary fibrosis Lung Biopsy XR - peripheral C honeycombing T scan - patchy C peripheral reticular abnormalities with intralobular linear opacities, thick septum, subpleural honeycombing, ground- glass opacities Sarcoidosis CXR ulm. function tests - P restrictive pattern Inc. ACE level PFT: inc. FEV1/FVC nti fibrotic - A pirfenidone yrosine kinase T inhibitor - nintedanib 6 months of > exertional dyspnea, nonproductive cough Inspiratory crackles “velcro” Lung transplant Clubbing reat when organ T C in African M function is threatened American Women - corticosteroids 50% are non Progressive - symptomatic methotrexate (immunosuppressant) Dry nonproductive cough, rales, dyspnea iopsy- non-casing B granuloma Erythema nodosum Lupus pernio Uveitis Cor Pulmonale EKG: S1Q3T3 ECHO xygen to correct O hypoxia (goal 90%) tiology: Caused E COPD, pulm embolism, ARDS odium and fluid S restriction ow level aerobic L exercise ower extremity L edema, neck vein distension, hepatomegaly, loud S2 Tx underlying IURETICS NOT D HELPFUL Pulmonary HTN ight heart R catheterization (gold standard) XR C ECHO ECG CMR PFT Remain active Exertional dyspnea Identify and tx underlying norexia /abdominal a pain Vasoreactivity: CCB Insidious Diuretics Hoarse voice rostanoids and P PDE5 Hemoptysis Dig olosystolic tricuspid H regurg Heart-lung transplant Pulmonary embolism Well’s criteria Heparin Homan’s sign (DVT) a inhibitors X (coumadin) D-Dimer Stable: anticoagulant ulmonary P angiography is the gold standard nstable: U thrombolysis and thrombectomy/embol ectomy yspnea sudden D onset* Tachypnea Cough Weezing Chest pain pleuritic* Syncope Fever, diaphoresis Hemoptysis* Evidence of DVT Increased pulmonic component of S2 murmur. Right ventricular heave Friction rub cute respiratory A distress syndrome (failure) ECHO Low tidal volume Bronchoscopy Noninvasive or yspnea D Anxiety, paradoxical breathing and use of mechanical OCUS (point of care v P entilation → ICU ultrasound) Tx underlying ccessory muscles a Coarse crepitations or crackles in BOTH lungs Low tidal volume EEP: improve P hypoxemia Cystic fibrosis weat chloride test S (most accurate) XR C PFTs DNA testing BX (macrolides, A cephalosporins, augmentin, fluoroquinolones, ucus clearance M mucolytics FTR dysfunction on C 2+ studies ronchodilators with B airflow obstruction Mutation CFTR gene ffect GI, pancreas, A lungs, reproductive systems (infertility in men), greasy stool, clubbing Common pneumonia urulent sputum - P Long-term pancreatic most common enzyme replacement pseudos Bronchiectasis PFTs Augmentin CXR Postural drainage T scan of the chest C has become the best tool to detect cystic lesions - ring sign, tramtrack appearance Vibrating vest ost commonly M caused by cystic fibrosis + pseudo oist crackles at lung M bases ( main goal is mucus clearance) Purulent sputum vaccinations Hemoptysis Halitosis oreign body F aspiration CXR T is CXR is C negative Infants less than 1 given 5 chest compression alternated with 5 blows between scapula brupt onset of A respiratory distress in a child Adults→ heimlich olalize/cough→ v partial obstruction hoking, striador, C drooling Rigid bronchoscopy ollowing removal→ F nebulizer treatments ower: cough, L wheezing, decreased breath sounds nilateral wheezing U or breath sounds yaline membrane H disease (respiratory distress syndrome) XR→ Ground glass C appearance other→ antenatal M steroids (betamethasone) espiratory distress R in a premature newborn CPAP for baby asal flaring, N tachypnea, cyanosis, expiratory grunting and retractions Interstitial lung disease iopsy (best)-> B CT->XR (done first) CXR: eggshell calcifications upper lobes orticoid steroids, C supportive care, vaccinations “ Coal workers” - occupational hazards Shaggy heart sign ilicosis - rocks and S eggshell ulmonary function P testing will show a restrictive pattern: decreased FEV1, FVC, TLC, and residual volume yssinosis - textile b factory workers eriliosis - aerospace B and electronics sbestos- broken A down buildings Carcinoid tumor Lung cancer ronchoscopy B Biopsy Biopsy - histology urgical removal, S cytotoxic chemo ctreotide and O sandostatin ed, purple flushes R starting in the face and spread to the neck and truck, tricuspid insufficiency urgical removal, S chemotherapy hest, shoulder, and C bone pain CXR ET superior for P NSCLC orner Syndrom: H constricted pupil, ptosis, facial anhidrosis ronchogenic, B adenocarcinoma, SCC, small cell oat cell Pulmonary nodules CXR T - likelihood of C malignancy of modules ow - active L surveillance oin shaped lesions, C usually an incidental finding edium - M bronchoscopy needle S piculated irregular aspiration borders PET scan High - resection Biopsy if > 8mm Influenza iral culture, rapid V test (RIDT) ed rest, hydration, B antipyretics brupt onset of fever, A myalgias, headache igh risk pt can be H given oseltamivir, zanamivir, or baloxavir Pertussis neumonia P (bacterial) CR most sensitive P method accination V prevention lood cultures B CXR CBC Supportive care XR C CBC Blood cultures moxicillin, cefdinir, A doxy osttussive emesis P or/and inspiratory whoop BX indicated A (azithromycin, erythromycin, TMP-SMX) ith comorbidities: W macrolide or doxycycline + amox- clav or cefdinir igh fever, chills, H insidious onset, rusty sputum (mycoplasma) egionella: high L fever, mental status change Inpatient: fluoroquinolone Steroids TB CXR (primary) eactivation ( apical R caviatary lesion, sputum smears or tissue culture atent: TST skin test L >15mm no known RF IPE! With vitamin B R 6 ycobacterium TB, M airborne HIV pt rimarily: P asymptomatic HIV→ fever, night 10MM Immigrant, > ive drug use, >5mm HIV, recent contact Viral pneumonia sweats CR test (COVID, P flu,, rsv) OVID- supportive or P C resence of remdesivir/ steroid epidemic/pandemic Sputum gram stain Flu- tamiflu XR(generalized C interstitial opacities) RSV- ribavirin OVID, Influenza, C RSV, metapneumovirus Fever, SOB, cough naerobic pulmonary A A naerobic culture infections Blood culture US CT rainage of abscess D (CT guided) Oral ABX (clindamycin) ecrotizing N pneumonia, empyema, lung abscess Lung abscess xygen O ABX (piper tazo ampicillin- sulbactam 3 g IV Q 6 Increased risk of periodontal disease BC/ sputum C CXR djust ABX after A sputum culture comes back oul odor sputum F Dullness to percussion, whispered pectoriloquy, and bronchophony amphoric breath sounds (low pitched ) Aspiration! Fungal pneumonia XR. Doesnt mention P C JP/PCP anything about DX (TMP-SMX) same as pneumonia Aspergillus (Ampho B, Voriconizole) ryptococcus C (ampho B, fluconazole) andida C (caspofungin) JP: marked P hypoxia, dyspnea, and cough with a paucity of physical or radiologic findings Covid 19 PCR rapid test pparent distress→ A immediate Lab tests (secondary) assessment of ABC ral antiviral O *(paxlovid) Steriods Can be asymptomatic ild: no or mild M pneumonia evere: dyspnea, S hypoxia or >50% lung involvement oss of smell or L taste, GI manifestations “appear quite ill” “ Silent” (or happy) hypoxemia hilblain like acral C lesion Pleurisy nti-glomerular A basement membrane disease (Goodpasture) KG, E CBC D-dimer CXR CT SAIDS +/- N indomethacin leuritic chest pain P worsens with respiration nti-GBM antibodies a Kidney biopsy w/light microscopy, w/ linear IgG staining x emergently before 3 T rd decade of life confirming dx then again at 6-7th decade Therapeutic plasma exchange daily for 2 Onset may be weeks preceded by URI Pleural friction rub orticosteroids and C cyclophosphamide ranulomatosis w/ G x not suspected D polyangiitis (Wegener until systemic sx granulomatosis) develop Fatal without tx induction : rituximab + prednisone (first Labs: serum test line) , long term use (ANCA) 80-90% seen of cyclophosphamide increase cancer risk Cytoplasmic ANCA (can get PML with → proteinase 3 rituximab and cyclophosphamide) Perinuclear ANCAA → myeloperoxidase Maintenance: rituximab CT ecrotizing N granulomatous lesions on upper and lower resp. Tract Inflammation caused by ANCA RI sx, lung affected U (cough, hemoptysis) Renal involvement “Saddle nose” x confirmation by D tissue biopsy rbital involvement O leads to devastating morbidity and mortality osinophilic E granulomatosis (Churg Strauss syndrome) ANCA testing orticosteroids first C line atients with P unexplained eosinophilia and vasculitis iffuse alveolar D hemorrhage latelet count P PT INR PTT CXR all pts (new patchy or diffuse opacities) Bronchoalveolar lavage x underlying once T identified emoptysis but may H be absent in ⅓ of pts ulse oximetry P Glucose ABG Serum electrolytes CXR CBC D-Dimer ECG Toxicology scan reat underlying T cause ABG xygen O Hyperbaric oxygen if severe yperventilation H syndrome arbon monoxide C poisoning Inflammatory causes: A cute respiratory glucocorticoids w/ distress immunosuppressive therapy Onset of new respiratory symptoms Hypoxemia: oxygen & ground glass or consolidative opacities Breathing retraining nxiolytics (benzos A like lorazepam) if cyanide poisoning→ hydroxocobalamin bstructive sleep O apnea ight time lab N polysomnography (O2 drops and an ECG can show bradyarrhythmias) ild: 5 episodes M Moderate: 15-30 episodes nxiety disorders A Carpopedal spasm Slow or fast deep breaths ires, intentional, F cars in garage ie before reaching D hospital from ventricular arrhythmias ifestyle L modifications (weight loss) Daytime fatigue PAP (continuous C positive airway pressure) bserved (partner O comes in with pt) Snoring HTN Tx underlying Severe: >30 BMI 35 or greater racheostomy (bed T bound pt) Over 50 Male eck circumference N > 40cm Central sleep apnea ight time N polysomnography Primary CSA CPAP A fib octurnal oxygen N therapy CHF Nocturnal angina SA with cheyne C stokes breathing Similar OSA sx on't use CPAP if EF D < 45% in CHF besity O hypoventilation syndrome ABG (PaCO2 >45) Inhalation injury erial CXR S Pulse oximetry (false elevated w/ carbon monoxide) ABG: can give you carboxyhemoglobin level ositive airway P pressure therapy (CPAP,BiPAP) ypoventilation in H obese pt during wakefulness imit exposure, L remove pt moke inhalation S exposed to fire aintain secure M airway oss of L consciousness onsider early & pre C emptive intubation triator or upper way S turbulence → prompt intubation In lab polysomnography (if not already Weight reduction diagnosed with OSA) Tx supportive teroid use NOT S PROVEN BENEFICIAL bx NOT A recommended ydrogen cyanide H poisoning→ hydroxocobalamin arbonaceous C material in the mouth oss of facial hair or L intranasal hair Facial burns Pre op care: MEDS USE SHOULD DISCONTINUE MEDS YOU DO NOT DISCONTINUE lpha 1 blockers (consult opthalm) A Allopurinol Antiepileptic Antipsychotics, benzos, TCA, valproic acid, lithium levothyroxine , PTU, methimazole Oral contraceptives (low to mod risk of VTE) H2 blockers PPI Inhaled bronchodilators Baby aspirin (preference) Alpha 2 agonist Statins CCB BB erbal meds H Colchicine (hold morning) Rheumatologic (determine by rheumatologist) Bisphosphonates Methylphenidate/ ADHD meds Opioids can take AM for pain otherwise hold SSRI Theophylline (evening) Oral contraceptives with high risk VTE (4 weeks before) Clopidogrel (hold 7-10 days prior, consult cardio) NSAIDS (held 5 days before) Factor Xa inhibitors (2-3 days prior) Warfarin ( 5 days prior) Insulin (use half dose, long acting) Oral antidiabetic meds (hold AM) Niacin and fibrates (day before) Diuretics ( morning dose) ACE/ARB (10 hrs prior) A dults and teens over 12 may have solid foods and dairy products until 8 hours before surgery, pt encouraged to drink clear liquids NOT milk or dairy until 2 hours before surgery time a. E x of clear fluids: water, clear fruit juice (apple, white cranberry), plain tea or black coffee, clear electrolyte replenishing drinks, ensure clear RF for surgery: a. Age b. Alcohol misuse c. Smoking (stopping smoking within 8 weeks of surgery might worsen post op outcomes) d. Obesity not a risk factor for most major post op outcomes (increases rates for wound infection) Cardiac assessment: RCRI (revised cardiac risk index) a. 6 element, each positive element increases odds of cardiac complication by a factor of 2 to 3 and more than one positive response indicated the patient is at high risk for complications: hx of ischemic heart disease, CHF, cerebrovascular disease tx with insulin, serum creaking >2.0, high risk surgery b. 0 points→ 0.4% c. 1 point→ 0.9% d. 2 points→ 6.6% e. 3 or more→ 11% ACS NSQUIP/SRC a. Subjective and unreliable RCRI score
