Pleura, Mediastinum, and Chest Wall
This lies between the lungs and contains the heart, aorta, great vessels, esophagus, thymus, trachea, bronchi, and lymph nodes. It is separated from the pleural cavity by pleura.
What is the mediastinum
This is the clinical decision tool used to risk stratify a patient for Pulmonary Embolism.
What is the Well's Criteria for PE?
Bonus: In low risk Well's patients, use PERC to determine if the patient requires a d-dimer to rule out PE.
What should be done in Moderate or High Risk Well's patients?
This is the mainstay of treatment to reverse bronchospasm in a patient with asthma.
What is albuterol?
Bonus info:
Can administer via intermittent neb, MDI, or continuous neb
Often ipratropium is added for moderate to severe disease
Prednisone or methylprednisolone oral or IV for persistent symptoms
Mag sulfate for severe exacerbations decreases the need for admission
Epi or terbutaline if air movement is so poor that inhaled albuterol is ineffective
This is the most common bacterial cause of community acquired pneumonia.
What is Streptococcus pneumoniae?
Bonus: Occasionally Haemophilus influenzae or Moraxella catarrhalis are causes as well.
This is the most common cause of pneumomediastinum.
What is iatrogenic (EGD) causes?
This is the PaO2/FiO2 needed to categorize a patient as Severe ARDS and is associated with 45%+ Mortality
What is PaO2/FiO2 <100?
Bonus info:
100-200 Moderate ARDS, mortality 32%
200-300 Mild ARDS, mortality 27%
In a patient with asthma who is intubated and on a ventilator, this phenomenon can cause barotrauma and pneumothorax.
What is breath stacking?
Assess DOPE:
Dislodgement of tube
Obstruction of tube
Pneumothorax
Equipment failure
This is the most common cause of atypical community acquired pneumonia.
What is Mycoplasma pneumoniae?
These are the most common pathogens of an empyema
Pneumococcus and Staphylococcus aureus
Bonus: TB is the leading cause of pleural effusions worldwide
This is the tidal volume range that should be used for lung-protective ventilation in ARDS patients.
What is 4-8 mL/kg of Ideal Body Weight?
Racemic epinephrine should be given in this patient with suspected croup.
What is a patient with stridor at rest?
Bonus info:
Admit patients with persistent stridor at rest (>2 racemic epi is eligible for critical care time), respiratory distress, or hypoxia.
This is the number of hours a patient must be admitted to a hospital or intubated for a patient to be considered to have Nosocomial pneumonia (previously called healthcare-associated pneumonia.
What is 48 hours?
Bonus info: Consider antibiotic coverage for pseudomonas and MRSA. Antibiotic coverage may include Vancomycin/Zosyn or Vancomycin/Cefepime
This is the ultrasound mode used that demonstrates "barcode sign" or "seashore sign" when identifying pneumothorax
Bonus info:
Can identify lung point to see the edge where the pneumothorax begins
What are nitrates such as nitroglycerin?
Bonus: Avoid interventions that decrease preload such as intubation or high PEEP
This is a pulmonary disease of prematurity that increases with decreasing gestational age and decreasing birth weight. It is caused by the underdeveloped premature lung and may be worsened by oxygen toxicity and mechanical ventilation.
It presents as increasing oxygen requirements, pulmonary edema, airway reactivity, infection, or pneumothorax.
What is bronchopulmonary dysplasia (BPD)?
This pneumonia pathogen is associated with diarrhea and hyponatremia.
What is Legionella?
Bonus: Treat with macrolides (azithromycin) or fluoroquinolones (levofloxacin)
This is the Pleural:Serum LDH cutoff for an exudative pleural effusion per Light's Criteria
What is >0.6?
Bonus facts:
Pleural:Serum protein >0.5
Pleural LDH >2/3
In the setting of trauma, this will present with hypoxemia, neurologic abnormalities, and petechial rash and is a diagnosis of exclusion. It does not have definitive treatments.
What is Fat embolism?
This pathology is notable for frequent Pseudomonal infections and thick secretions, chronic sinusitis, pancreatitis, meconium ileus, bowel obstructions, cholelithiasis, and male infertility.
What is cystic fibrosis?
Bonus info: autosomal-recessive condition caused by mutation in the CF transmembrane conductance regulator
What is the Paroxysmal stage (2 to 4 weeks)?
Bonus info:
Catarrhal stage (1-2 weeks ), nonspecific URI sx and mild cough, greatest infectivity
Convalescent stage (2 or more months), cough decreasing in severity
May see petechiae on face/palate from prolonged valsalva
Infants can present with apneic/cyanotic episodes
Azithromycin can reduce infectivity but not disease severity or duration unless given in the first week. Give PEP to household contacts, infants, women in third trimester, immunocompromised, severe asthmatics