Notes in acute SOB

To Subscribe, use this Key

Status	Last Update	Fields
Published	09/08/2024	three causes of {{c4::stridor}} are {{c2::foreign body aspiration}}, {{c3::angioedema}} or {{c3::anaphylaxis}}, and post-{{c1::extubation}} {{c1::edem…
Published	09/08/2024	infectious causes to consider for {{c4::stridor}} are {{c2::peritonsillar}} abscess, {{c3::epiglott}}itis, {{c1::retropharyngeal}} abscess
Published	09/08/2024	stridor is caused by a {{c2::reduced}} airway {{c1::radius}} which {{c2::increases}} {{c1::resistance }}
Published	09/08/2024	stridor that has an acute onset is an {{c2::emergency}} and an airway {{c1::compromise}} may be pending
Published	09/08/2024	{{c4::Stridor}} will have a {{c1::high}} pitched, predominantly {{c2::inspiratory}} sound produced by {{c3::extrathoracic}} airway obstruction
Published	09/08/2024	to treat a foreign body etiology of stridor, {{c1::imaging}} needs to ordered and possibly need an {{c2::endoscopy}} for treatment
Published	09/08/2024	for an infectious etiology of stridor, you must treat the {{c3::underlying infection}}. Considor {{c2::steroid}} therapy or {{c1::racemic epinephrine}…
Published	09/08/2024	for an angioedema/anaphylaxis etiology of stridor, {{c3::discontinue}} offending agent and treat with {{c2::antihistamines}} and {{c1::corticosteroids…
Published	09/08/2024	risk factors for {{c1::ARDS}} are advanced {{c2::age}}, preexisting organ {{c3::dysfunction}} from chronic disease (i.e. {{c4::CKD}}, {{c4::liver…
Published	09/08/2024	ARDS caused by a {{c1::direct}} lung injury is associated with higher mortality rate, aspiration of gastric content, PNA, toxic inhalation, near drown…
Published	09/08/2024	ARDS caused by an {{c1::indirect}} lung injury is associated with sepsis, severe trauma, multiple transfusions, pancreatitis
Published	09/08/2024	ARDS is caused by acute lung {{c1::inflammation}} with diffuse {{c2::alveolar-capillary}} injury
Published	09/08/2024	in ARDS, the {{c1::interstitium}} becomes inflamed, there is a lack of {{c2::surfactant}} from {{c3::type II}} cells, {{c4::fluid}} accumulates, and t…
Published	09/08/2024	during the {{c1::inflammatory}} phase of ARDS , there is uncontrolled inflammation. There is an increase in {{c2::capillary}} permeability which leads…
Published	09/08/2024	the {{c1::proliferative}} phase of ARDS, is when {{c2::intra}}-alveolar {{c3::exudate}} becomes {{c4::granuated}} tissue, lung {{c5::compliance}} beco…
Published	09/08/2024	the {{c4::fibrotic}} phase of ARDS is when {{c3::remodeling}} and {{c2::fibrosis}} occurs and there is a decrease in {{c1::functional residual capacit…
Published	09/08/2024	not all patients progress to the {{c1::fibrotic}} phase in ARDS.
Published	09/08/2024	{{c1::polymicrobial}} infections should be considered in ARDS
Published	09/08/2024	symptoms of {{c2::dyspnea}}; {{c3::rapid}}, {{c3::shallow}} breathing, and inability to take a {{c4::deep}} breath are consistent with {{c1::ARDS}}
Published	09/08/2024	{{c3::fine}}, {{c2::inspiratory}} crackles on auscultation and {{c4::bi}}lateral infiltrates on CXR and refractory {{c5::hypoxia}} are PE findings of …
Published	09/08/2024	initial {{c1::respiratory}} {{c2::alkalosis}} due to {{c4::tachypnea}} that progresses to {{c1::metabolic}} {{c2::acidosis}} due to {{c5::anaerobic}} …
Published	09/08/2024	severity of ARDS is determined by the {{c1::berlin}} definition.
Published	09/08/2024	All levels of severity of ARDS has an onset time of within {{c1::1 week}} of critical insult.
Published	09/08/2024	Clinical variables of the berlin definition are {{c2::onset}}, {{c3::hypoxemia}}, chest {{c4::radiography}}, and a {{c1::non-cardiac}} etiology.
Published	09/08/2024	Hypoxemia is assessed with PaO2/FiO2 with {{c1::PEEP}} or CPAP > {{c2::5}} cm H20 for the berlin definition.
Published	09/08/2024	{{c1::mild}} ARDS has an oxygenation that is {{c2::200}} mmHg < PaO2/FIO2 ≤ {{c3::300}} mmHg with PEEP or CPAP ≥5 cmH2Oc
Published	09/08/2024	{{c2::moderate}} ARDS has oxygenation that is {{c1::100}} mmHg < PaO2/FIO2 ≤ {{c1::200}} mmHg with PEEP ≥5 cmH2O
Published	09/08/2024	{{c2::severe}} ARDS has oxygenation that is PaO2/FIO2 ≤{{c1::100}} mmHg with PEEP ≥5 cmH2O
Published	09/08/2024	chest radiograph of ARDS has {{c1::bi}}lateral opacities not explained by {{c2::effusions}}, {{c3::atelectasis}}, or {{c4::nodules}}&nb…
Published	09/08/2024	all severity levels of ARDS must have respiratory failure not fully explained by {{c1::cardiogenic}} pulmonary edema. Exclude {{c2::hyd…
Published	09/08/2024	to treat ARDS, must manage {{c1::contributing etiology}}.
Published	09/08/2024	Critical care support for ARDS includes {{c1::nutrition}}, reducing risk of {{c2::infection}}, and early detection and treatment of {{c2::infections}}…
Published	09/08/2024	{{c1::low tidal volume}} ventilations and {{c2::open lung}} ventilations show to improve outcomes in ARDS
Published	09/08/2024	fluid normally lies between the {{c1::visceral}} and {{c2::parietal}} tissues to help them {{c3::adhere}} to each other…
Published	09/08/2024	pleural fluid normally comes from the {{c1::capillaries}} in {{c2::parietal}} pleura and from the {{c2::peritoneal}} cavity through small holes i…
Published	09/08/2024	parietal fluid is normally absorbed into the {{c1::lymphatic system }}
Published	09/08/2024	the main three components of thrombus formation are: {{c2::hypercoagulability}}, {{c3::endothelial damage}}, and {{c1::venous stasis}}. This is known …
Published	09/08/2024	Normal fluid balance requires intact junctions of {{c1::capillary endothelium}}, {{c2::hydrostatic}} pressure, and {{c3::oncotic}}…
Published	09/08/2024	arterial side normally has {{c1::high}} hydrostatic pressure
Published	09/08/2024	the venous side normally has {{c1::high}} oncotic pressure
Published	09/08/2024	{{c1::transudative}} pleural effusions are caused by an increase in diffusion that occurs due to an {{c2::increase}} in {{c3::intravascular}} {{c4::hy…
Published	09/08/2024	{{c1::exudative}} pleural effusions are caused by {{c2::leaky capillaries}} which occur due to {{c3::infection}}, {{c4::inflammation}}, and {{c5::mali…
Published	09/08/2024	an imbalance in {{c1::fluid}} production and absorbtion leads to {{c2::effusions }}
Published	09/08/2024	{{c2::watery}} fluid related to fluid excess that is a {{c3::clear}}/{{c4::straw}} color, and a pH of 7.{{c5::3}} is typically seen with {{c1::transud…
Published	09/08/2024	fluid rich in {{c1::proteins}}, {{c2::glucose}}, {{c3::LDH}}, and {{c4::WBC}}s, {{c5::clear}}-{{c6::turbid}} color…
Published	09/08/2024	if the pH is less than 7.2 in an exudative effusion, suspect {{c1::empyema}}
Published	09/08/2024	pts with pleural effusions will likely have {{c2::SOB}} and {{c1::plueritic}} chest pain
Published	09/08/2024	a chest x-ray of a {{c3::pleural effusion}} will have a {{c2::meniscus}} sign and absence of {{c1::lung markings}}
Published	09/08/2024	pleural effusion chest x-ray will NOT have {{c1::air bronchograms}} like PNA
Published	09/08/2024	a {{c1::thoracentesis}} is therapeutic and diagnostic for pleural effusions
Published	09/08/2024	a {{c1::thoracentesis}} will differentiate between exudative and transudative pleaural effusion by analyzing the {{c2::aspirate}} for gram stain + cul…
Published	09/08/2024	definitive treatment of pleural effusions depends on the tx of {{c1::underlying disease state}}
Published	09/08/2024	539cc2a8ca4e474cb9756e9d9fcbdf35-ao-1
Published	09/08/2024	539cc2a8ca4e474cb9756e9d9fcbdf35-ao-2
Published	09/08/2024	{{c1::Light’s}} Criteria-if ONE of the following is true, the effusion is {{c2::exudative}} Effusion protein/serum protein > 0.5 Effusion LDH/serum…
Published	09/08/2024	example of {{c1::pleural effusion}}
Published	09/08/2024	example of {{c1::pleural effusion}}
Published	09/08/2024	Chest tube placement may be indicated for {{c1::exudative}} effusions
Published	09/08/2024	a {{c1::talc pleurodesis}} is a chemical or surgical obliteration of the pleural space, which may be indicated in recurrent malignant effusi…
Published	09/08/2024	primary spontaneous pneumothorax are caused by ruptured subpleural apical {{c1::blebs}}
Published	09/08/2024	secondary spontaneous pneumothorax are caused by rupture of {{c1::bullae}} in emphysema
Published	09/08/2024	slim, tall males are have a high risk of having {{c1::blebs}}
Published	09/08/2024	{{c1::emphysema}} patients are more likely to have bullae
Published	09/08/2024	traumatic pneumothorax occur due to {{c1::blunt}} force or {{c1::penetrating}} injury
Published	09/08/2024	an {{c1::iatrogenic}} pneumothorax is a type of traumatic pneumothorax that is caused by positive airway pressure, thoracentesis, central line placeme…
Published	09/08/2024	example of a {{c1::bleb}}
Published	09/08/2024	example of a {{c1::bullae}}
Published	09/08/2024	{{c1::Bulla}} has no discernable wall and is within lung tissue. Usually greater than 2 cm in size
Published	09/08/2024	{{c1::Bleb}} is 1-2 cm in size. Thin walled airsac on outside of lung tissue
Published	09/08/2024	Pneumothorax are caused by an initial disruption of {{c1::visceral pleura}} that leads to air in the {{c2::pleural space}}. This creates a disrup…
Published	09/08/2024	symptoms of {{c1::pneumothorax}} depends on the severity but typically will have a sudden onset, pleuritic chest pain, dyspnea
Published	09/08/2024	signs of a pneumothorax are{{c1:: absent }}or {{c1::decreased}} breath sounds, {{c2::hyper}}resonance, hypoxia, {{c3::subcuta…
Published	09/08/2024	a {{c1::tracheal shift}} and {{c1::hypotension}} are red flags for a tension pneumothorax
Published	09/08/2024	a tension pneumothorax requires {{c1::emergent needle decompression}} at bedside for treatment
Published	09/08/2024	example of {{c1::subcutaneous emphysema}}
Published	09/08/2024	example of {{c1::subcutaneous emphysema}}
Published	09/08/2024	a pt with {{c1::subcutaneous emphysema}} could have a puffed up face due to the air going up which can be felt around the orbits of the eyes and cheek…
Published	09/08/2024	{{c1::subcutaneous emphysema}} feels and sounds like rice krispies and is not typically painful to touch. Need to think about a possible infection&nbs…
Published	09/08/2024	example of a {{c1::pneumothorax}}
Published	09/08/2024	example of a {{c1::pneumothorax}}
Published	09/08/2024	example of a {{c1::tension pneumothorax}}
Published	09/08/2024	a pneumothorax may be {{c1::observed}} if small and clinically stable, otherwise, needs a lung {{c2::reexpansion}} + {{c2::hospitalizat…
Published	09/08/2024	Surgical {{c1::pleurodesis}} may be necessary for a pneumothorax if persistent air leak lasts longer than 4 days or recurrent collapse
Published	09/08/2024	a {{c1::chest tube}} is used for treatment of a pneumothorax which helps get the air out. Must watch for air leak resolution.
Published	09/08/2024	a pulmonary embolism typically starts as a {{c1::DVT}} in lower extremities and moves up through the heart and enters the pulmonary vasculature and en…
Published	09/08/2024	a pulmonary embolism creates a {{c1::hypoxia / VQ}} mismatch which is a perfusion problem
Published	09/08/2024	the increased pressure in the pulmonary vasculature creates a {{c2::RV}} strain in a pulmonary embolism which shows up as a {{c1::flattened}} septum o…
Published	09/08/2024	{{c2::pulmonary embolism}} symptoms are widely variable but typically consist of Dyspnea +/- tachypnea, Pleuritic chest pain, and {{c1:…
Published	09/08/2024	signs of a {{c1::pulmonary embolism}} are: Tachycardia (ask about palpitations!){{c2::Tachy}}pnea{{c4::Normal}} pulmonary exam +/- {{c3::c…
Published	09/08/2024	an {{c2::S1Q3T3}} pattern will show on an ekg of a {{c1::pulmonary embolism}}
Published	09/08/2024	a {{c1::v/q scan}} indicates mismatches of ventilation and perfusion, indicated for those with {{c2::renal}} dysfunction or {{c2::contrast}} allergies…
Published	09/08/2024	Compression Ultrasound of lower extremities (CUS) may be used as for diagnostics for patients with a {{c1::PE}}
Published	09/08/2024	A {{c1::pulmonary embolism}} C-XRAY will typically be normal, may show enlarged descending {{c2::pulmonary}} artery, {{c3::Hampton’s hump}}, and {{c4:…
Published	09/08/2024	example of {{c1::westermark sign}}
Published	09/08/2024	Westermark sign: focal area of {{c1::hyperlucency}} due to lack of vasculature/blood flow. Thought to be caused by obstruction of pulmonary artery or …
Published	09/08/2024	example of {{c1::hamptom's hump}}
Published	09/08/2024	initial treatment of a PE should be to correc{{c1::t hypoxemia}}, consider {{c2::TPA}}, {{c3::Anticoagulation}}, {{c4::IVC}} filter if anticoagulation…
Published	09/08/2024	must have caution with {{c1::IV fluids}} in patients with PE due to possible fluid overload
Published	09/08/2024	d79e1baf3bb84e00b2d214f7430dceb5-ao-1
Published	09/08/2024	d79e1baf3bb84e00b2d214f7430dceb5-ao-2
Published	09/08/2024	d79e1baf3bb84e00b2d214f7430dceb5-ao-3
Published	09/08/2024	d79e1baf3bb84e00b2d214f7430dceb5-ao-4
Published	09/08/2024	{{c1::Wells}} Criteria is used for PE:3. Clinical DVT symptoms3. Other dx is less likely than PE1.5 HR > 1001.5 Immobilization ≥ 3 days or surgery …
Published	09/08/2024	406610c4a6704c399b9bc655460018e2-oa-1
Published	09/08/2024	406610c4a6704c399b9bc655460018e2-oa-2
Published	09/08/2024	406610c4a6704c399b9bc655460018e2-oa-3
Published	09/08/2024	406610c4a6704c399b9bc655460018e2-oa-4
Published	09/08/2024	406610c4a6704c399b9bc655460018e2-oa-5
Published	09/08/2024	{{c1::PERC}} criteria is used with low pretest probability to rule OUT a PE: Age < 50HR < 100O2% on RA ≥ 95%No hx of VTENo trauma or surger…
Published	09/08/2024	If any PERC criteria are positive, order a {{c1::D dimer}}
Published	09/08/2024	*D dimer is very {{c1::sensitive}} but not {{c1::specific}}. If it is negative, you can confidently rule out a PE
Status	Last Update	Fields