Term
| when someone comes into the ER with shortness of breath and chest pain, what must you consider? |
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Definition
PAPPA
Pericardial effusion with tamponade
Acute coronary syndrome
PTX
PE
Aortic Dissection |
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Term
| WHats the typical pt of a primary PTX? |
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Definition
| male smokers who are tall and lanky. seems to result from rupture of a bleb |
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Term
| What type of pt does secondary PTX usually occur in? |
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Definition
| pts with COPD or other underlying dz's such as asthma, CF, CA, and interstitial lung dz |
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Term
| what does a tension PTX result from? |
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Definition
| positive pressure in the pleural space leading to decreased venous return, hypotension, and hypoxia |
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Term
| What is the rate of oxygen recommended for a pt with PTX? |
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Definition
| to be used in stable patients, 2-4 L/min via nasal cannula (help absorption of intrapleural air) |
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Term
| what bacteria is the responsible for 90% of pna cases? |
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Definition
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Term
| What is the ironic thing about people in high risk groups (such as older adults and people with chronic illnesses) that acquire pna? |
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Definition
| they may have fewer or milder symptoms than less vulnerable people do (i.e. instead of having a high fever, they may have a lower than normal temperature) |
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Term
| What should cross your mind when you see an increase in eosinophils, basophils, lymphocytes, or neutrophils? |
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Definition
E= worms, allergy, asthma
B= mores significant abnormality going on
L= can be high with PNA
N= shift to the left with increase in N, think infection |
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Term
| What is the drug class of choice for CAP? |
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Definition
Macrolide!
Azithromycin (500 mg PO on day one then 250 mg a day x 4 days- lots of resistance)
Clarithromycin (500 mg BID x 10 days)
Telithromycin (800 mg BID x 10 days) |
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Term
| what is a lower respiratory tract infection that causes reversible bronchial inflammation? |
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Definition
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Term
| is the cause of acute bronchitis usually viral or bacterial? |
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Definition
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Term
| purulent sputum is most often caused by _______ infection in bronchitis, so therefore cultures are usually what? |
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Definition
viral
negative or exhibit normal flora |
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Term
| the dx of _________ should be considered in patients with repetitive episodes of acute bronchitis |
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Definition
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Term
| what are two tx options for acute bronchitis? |
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Definition
-bronchodilators (albuterol- short acting beta agonist) have been found to relieve some symptoms of acute bronchitis
-narcotic and non-narcotic cough suppressants should be considered |
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Term
| what is reversible airway obstruction associated with hyper-responsivness of the tracheo-bronchial tree? |
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Definition
| Asthma (inflammation, smooth muscle spasm and increased mucous production leading to partial obstruction) |
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Term
| What are the two dominant forms of COPD? |
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Definition
-pulmonary emphysema: characterized by abnormal, permanent enlargement and destruction of the air spaces distal to the terminal bronchioles
-chronic bronchitis: condition of excess mucous secretion on the bronchial tree, with a chronic productive cough occurring on most days for at least three months in a year for at least two consecutive years |
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Term
| what are some signs of impending respiratory failure in asthma or COPD? |
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Definition
| alterations in mental status, lethargy, quiet chest, acidosis, worsening hypoxia, and hypercapnia |
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Term
| What are two interventions for a COPD or asthma patient in the ED? |
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Definition
-beta agonist: aerosolized albuterol (1.25-5 mg)
-Anticholinergic: nebulized ipratropium (500 mg= 2.5 mL) can be given alone or mixed with albuterol |
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Term
| What is the prime concern in anaphylaxis? |
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Definition
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Term
| What are the parameters to giving epi to a patient with anaphylaxis? |
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Definition
do not give to someone who is old and has COPD
IM injection 0.3-0.5 mL (1:1000) |
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Term
| what are the 4 other tx interventions for anaphylaxis besides epi? |
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Definition
diphenhydramine 25-50 mg (serous IV)
rantidine 50 mg IV
albuterol 5% 0.5 ml/3 mL saline (bronchospasm)
steroids- delayed or persistent reactions |
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Term
| What criteria is used to establish a patients likelihood of DVT/PE? |
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Definition
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Term
| What is the tx intervention for PE? |
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Definition
-LMW Heparin (Dalteparin, Enoxaprin, Tinzaprin)
-unfractionated heparin if LMWH is not available
-Oral anticoagulation warfarin (5 mg/day initially. INR=2-3) |
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