12 articles Pulmonary

Hypoxia

Type I respiratory failure – hypoxia: CHF: Fluid overload – needs diuresis. Hypoxia improves when fluid in lungs in removed. May require CPAP for oxygenation. COPD exacerbation: May be accompanied with hypercapnia too. Order ABG to assess CO2 level. May need BiPAP. Infectious etiologies: PNA – hypoxia improves with infection improving. Pleural effusion Atelectasis: Encouraged…

Asthma

Asthma, maintenance: Albuterol-Ipratropium (DueNeb): breathing treatments Montelukast (Singular) Proventil (Albuterol) Symbicort (budesonide/formoterol – steroid/long acting beta agonist) Start only on outpatient basis when patient is stable, not when acutely symptomatic. Tudorza Pressair (Aclidinium, treats COPD – long-acting anticholinergic bronchodilator) Asthma Exacerbation, acute Ex: Acute exacerbation of chronic bronchitis is setting of probably underlying Severe Persistent Asthma:…

Restrictive Lung Disease

Restrictive lung disease: Diagnose from PFTs Labs to order: Hypersensitivity pneumonitis blood, extractable nuclear antigen antibodies (ANA), FANA blood serum, Scleroderma antibody blood serum, Jo-1 antibody blood serum, anti-DNA (ss) IgG blood serum, anti-DNA double strand blood (SLE), anti-histone antibodies blood serum (drug-induced SLE), Sjogren’s antibodies blood serum, Glomerular basement membrane antibodies (Goodpasture’s syndrome), HIV…

Thoracentesis

Pleural fluid: Thoracentesis Labs: Serum glucose and serum LDH and total protein Pleural fluid labs: Tube #1 (Chemistry): glucose, total protein, LDH Tube #2 (Microbiology): culture and susceptibility (includes Gram stain), Fungal stain, AFB Tube #3 (Hematology): Cell count and differential Other: Cytology, pH Light’s Criteria. Used to distinguish transudative from exudative pleural effusions [thoracentesis…

Tuberculosis (TB)

Tuberculosis: Symptoms: night sweats, weight loss, chronic cough, hemoptysis Risk factors: foreign travel, prisoner, healthcare worker, known exposure to a person with TB Chest x-ray – look for apical lesions PPD: http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm Acid fast bacilli (AFB) Put patient into isolation.  

Respiratory failure

Acute respiratory failure: Tachypnea (>30), use of accessory muscles, hypoxia, already of BiPAP but struggling STAT orders: ABG, BNP, EKG, chest x-ray, Troponin. Consider D-dimer if want to r/o PE. ABG: Interpretation help – http://www.medcalc.com/acidbase.html Call ICU and talk with attending about possible ICU transfer – Critical Care to manage intubation if necessary. Look at…

Acute Respiratory Distress Syndrome (ARDS)

Acute Respiratory Distress Syndrome (ARDS): ARDS is a severe manifestation of acute lung injury: acute and persistent lung inflammation with increased vascular permeability. Common in ICU patients (10-15%), especially intubated patients (20%) Causes: ***Sepsis: most common cause of ARDS*** Aspiration of gastric contents Infectious pneumonia Severe trauma or surface burns Massive blood transfusion Drug overdose:…

Pulmonary Embolism (PE)

Pulmonary Embolism: Symptoms/Clues: pleuritic chest pain, long travel, immobile, SOB, tachypnea, tachycardia, hemoptosis, palpitations Chest CT scan with IV contrast (or V/Q scan if cannot tolerate IV contrast) CT angiography (CTA) of the chest (CT per PE protocol) – confirms PE, cannot rule out PE. Doppler US of bilateral LE (even if negative CT of…