CM pulmonary

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CM pulmonary
2011-10-12 13:16:26

Pulmonary objectives
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  1. Sputum cytology
    • Can diagnose or monitor disease
    • Test early in morning
  2. FVC
    • Forced Vital Capacity
    • Low: obstructive
  3. FEV1
    • Forced Expiratory Volume in 1 second
    • Low: obstructive
    • Both FEV1 and FVC low: restrictive
  4. FEV1%
    • Percentage of air exhaled in first second
    • Ration of FEV1 to FVC (FEV1/FVC)
  5. PEFR
    • Peak Expiratory Flow Rate
    • Max flow rate during forced vital capacity
    • If low --> evaluate for obstructive
    • Useful to see if treatment working
  6. FEF
    • Forced Expiratory Flow
    • Divided into quartiles
  7. TLC
    • Total Lung Capacity
    • Can't measure by spirometry because of Residual Volume
    • TLC = FVC + RV
  8. Staging of lung disease (not cancer)
    • Normal: > 85% predicted
    • Mild: >65% < 85%
    • Moderate: >50% <65%
    • Severe: <50%
  9. Interpret PFTs
    • 1) Check FVC
    • 2) Check FVC1
    • 3) If both normal --> test is normal
    • 4) FVC and/or FEV1 low --> likely disease
    • 5) If disease, then go to % for FEV1/FVC
    • FEV1/FVC > 88-90% --> restrictive
    • FEV1/FVC <69% --> obstructive
  10. Cough DDx
    • Post nasal drip
    • Asthma
    • GERD
    • Chronic bronchitis
    • Bronchiectasis
    • Eosinophilic bronchitis
    • ACE inhibitor
    • Cancer
    • Sarcoidosis
    • Aspiration
    • Psychogenic
  11. Ventilation/perfusion ratio (V/Q)
    • Normal: 4:5 (0.8)
    • Measures effectiveness of exchange of CO2 for O2
    • Can be mismatched from
    • Shunting (reduces VQ): O2 not getting to part of lung (shunt or obstruction), more CO2 then O2 and it goes back into circulation
    • Dead space (increases VQ): blood running around with more oxygen, can't get to a damaged part of lung so doesn't exchange for CO2
  12. Acute bronchitis

    Bronchialitis: acute inflammation of small airways
    Bronchiectasis: permanent dilation of bronchi
    Chronic bronchitis: > 3 mos year, at least 2 yrs
    • Viral or bacterial
    • Sx: Sputum, fever, malaise, wheezing, dypsnea

    Tx: Ipratropium bromide, B2 agonists, Macrolide, Cipro, Amoxicillin, Corticosteroids, chest physiotherapy
  13. Acute bronchiolitis

    DDx: pneumonia, chronic lung disease, aspiration, asthma, reactive airway, heart failure
    Sx: constrictive, s/p viral infection, excessive mucus, edema, sloughed epithelial cells in terminal airways causing obstruction and atelectasis, expiratory wheeze, prolonged expiration, accessory muscles, in immunocompromised

    Tx: unresponsive to corticosteroids, respiratory support, ventilator if needed, fluid, antivirals if comorbidities, antibiotics (by sputum) empirically (Amoxicillin, Ampicillin, Tetracyclin or Bactrim)
  14. Acute epiglottitis
    Sx: abrupt onset, rapid progression, fever, sore throat, dysphagia, drooling, hot potato voice, severe obstruction

    Tx: maintain airway, empirical antibiotics (Oxacillin, Nafcillin, Cefazolin, Clindamycin)
  15. Croup

    DDX: bacterial tracheitis, acute epiglottis, peritonsillar or retropharyngeal abscesses, spasmodic croup, angioneurotic edema, upper airway anomalies
    Sx: barking cough, narrowing of trachea in sublottic region, "steeple sign" on x-ray, insiratory stridor, hoarseness

    Tx: corticosteroids, nebulized mist treatment, mist treatments not effective but are comforting, watch for emergent situation with pulse ox or cyanosis
  16. pertussis