keywords:
Bookmark and Share



Front Back
Types of pleural effusions
  • Transudates
  • Exudates
Define Transudate pleural effusions
  • Formed when disruption in formation and/or removal of pleural fluid occurs
  • The pleural surfaces are not involved in primary pathological process
Major causes of transudates
  • CHF left or right
  • Hepatic hydrothorax
  • Peritoneal dialysis
  • Nephrotic syndrome
PFT finding of pleural effusion
Restrictive
Percent of bacterial pneumonia that is community accquired
30-40%
Pneumonia clinical presentation
  • Increased RR
  • Increased HR, CO, BP
  • PFT- Restrictive
  • Cyanosis
ABG findings for early/advanced pneumonia
  • Early- Acute alveolar hyperventilation with hypoxemia
  • Advanced- acute ventilatory failure with hypoxemia
Pneumonia Physical Assessment
  • May have bronchial BS
  • Fremitus increased
  • Voice sounds increased
  • Percussion dull
  • Whispered pectoriloquy
  • crackles/Ronchi
  • chest expansion decreased
  • pleural friction rub
Pneumonia Clinical Presentation
  • Cough, sputum production, hemoptysis
  • Chest pain
  • CXR density
  • Consolidation/atelectasis
  • Air bronchgrams
  • Pleural effusions
Most common and virulent type of Streptococcal pneumonia
  • Type III most common and virulent
  • 20% mortality
Streptococcal pneumonia etiology
  • Enclosed in thick capsule, non motile
  • Occurs singly, pairs, short chains
  • 80 types- Only 14 cause serious illness
  • Transmitted by aerosol (cough,sneeze)
  • Rarely by indirect contact
Streptococcal pneumonia
Pathophysiology stages
  • Engorgement 4-12hrs
  • Red hepatization 48hrs
  • Grey hepatization 3-8 days
  • Resolution 7-11 days
Staphylococcal Pneumonia
Etiology - Gram +
  • Staph aureus accounts for most infections 3-5% of bacterial pneumonia
  • Transmitted by cough/sneeze or indirect contact
  • Often follows predisposing viral infection
Staphylococcal Pneumonia
Etiology - (Gram +)
  • Exotoxins result in extensive tissue necrosis
  • Causes cavitation/pleural effusions
  • Produces penicillinase - antibiotics of choice methicillin, oxacillin
Klebsiella Pneumoniae
Etiology - (Gram -)
  • Associated w/lobar pneumonia in men over 40- also chronic alcoholics
  • Gram - rods
  • Transmitted by aerosol
  • Transmitted by indirect contact w/freshly contaminated objects
  • Mortality high
Klebsiella Pneumoniae
Etiology - (Gram -)
  • Also called Friedlanders Bacillus
  • Septicemia frequent complication
  • Sputum- Red current jelly like
  • Tx- 3rd Gen antibiotics, cephalosphorins, chloramphenicol
Pseudomonas aeruginosa
Etiology  (Gram-)
  • Highly motile
  • Found in GI tract
  • Sputum green/ sweet smelling
  • Frequent contaminant of aqueous solutions and resp equipment
  • Transmitted by aerosol, direct contact
Influenza virus
Etiology
  • A/B primary cause of resp infections
  • Incubation period 1-3 days
  • Transmission by aerosol
  • Cause mainly URI
  • Young adults very susceptible
Parainfluenza
Etiology
  • Type 1 Croup virus
  • Transmitted by droplet/direct contact
  • Common in children < 2 mo
  • Type 1/2 Fall
  • Type 3 Spring/Summer
Rickettsiae
Etiology
  • Rickettsia Rickesttsii - Rocky Mt Spotted Fever
  • Rickettsia Burnetii- Q fever
  • Transmitted by vectors
Ornithosis (Psittacosis)
Etiology
  • Caused by Chlamydia or Bedsonia
  • Transmitted by birds
  • Aerosol and direct contact
Guillian-Barre Syndrome
Etiology- Population
  • Annual incidence 1.7 per 100,000
  • Uncommon in childhood
  • Higher occurence people > 45 yrs
  • Higher occurence in males/whites
Guillian-Barre Onset
  • Frequently follows mild upper resp infection or GI illness within 1-4 wks
  • Has also occured following immunization against viral infections
Guillian-Barre Early Symptoms
  • Fever, malaise, nausea
  • Tingling, numbness in extremities
  • Feet/lower portions of legs afffected first
Guillian-Barre Symptoms
  • Skeletal muscle paralysis/loss of deep tendon reflexes follow
  • Paralysis is ascending/ develops rapidly often in one day
  • Sensory nerve impairment may be present
  • Gag reflex decreased or absent
  • Swallowing difficult
Guillian-Barre Syndrome Paralysis
  • Progression of paralysis may stop at any point
  • Usually peaks or remains unchanged for days/weeks
  • Improvement begins spontaneously continues for wees/months
Guillen-Barre recovery
  • functional recovery occurs in 85-95%
  • 40% may have minor residual symptoms
Guillen-Barre diagnosis based on :
  • history of symptoms
  • Nature of cerebral spinal fluid
  • Increased protein in CSF
  • Normal cell count
  • Electrodiagnostic studies
Guillen-Barre Nerve Pathophysiology
  • Demyelination,inflammation and edema of peripheral nerves
  • As anotomic alterations increase, nerve impulses to muscles decrease causing paralysis.
Guillen-Barre Respiratory Pathophysiology
  • Inability to mobilize secretions results in : retained secretions, airway obstruction, atelectasis, shunting
  • Paralysis leads to alveolar hypoventilation
  • Hypoxemia/Hypercarbia result
Guillen-Barre clinical presentation
  • RR increased w/hypoxemia
  • HR,BP,CO increased
  • Cyanosis
  • ABG- Acute ventilitory failure w/hypoxemia
  • PFT restrictive
Guillen-Barre chest assessment
  • BS decreased
  • Chest expansion decreased
  • Crackles & ronchi
  • CXR- Normal, increased opacity with atelectasis and/or consolidation
Guillen-Barre Autonomic Nervous System Dysfunction
  • Develops in 50%
  • Involves over/under reaction of sympathetic or parasympathetic systems
  • Heart rate/rhythm abnormalities
  • BP abnormalities
  • May be transient or persist
Guillen-Barre Management
  • Tx is symptomatic and supportive
  • Pt monitored closely in ICU
  • Monitor Vt, VC, spirometry
  • Mobilize secretions
Guillen-Barre Management
  • Corticosteroids
  • Hyperinflation techniques
  • Supplemental O2
Myasthenia Gravis
Etiology
  • More chronic than Guillen-Barre
  • Chronic autoimmune disorder
  • Related to circulating Ab(anti-Ach receptor)
  • Ab blocks Ach from receptor sites
  • Increases breakdown of Ach
  • Destroys receptor sites
Myasthenia Gravis Population Effects
  • Incidence 1/10,000-1/25,000 in US
  • Twice as common in women
  • Peak age women 15-35
  • Peak age men 40-70
Myasthenia Gravis Etiology
  • Thymus gland usually involved
  • Provoked by emotional upset, physical stress,extreme temp change,pregnancy
  • Death is possible in 1st few yrs
  • Death rare after 10 yrs
Myasthenia Gravis response to Tensilon
  • If symptoms improve w/Tensilon it's Myasthenic crisis
  • If not it's cholinergic crisis (Guillen-Barre)
Myasthenia Gravis Clinical Presentation
  • Onset usually gradual
  • Drooping of one or both eyelids followed by double vision
  • Many pts have progression to generalized weakness of skeletal muscle
Myasthenia Gravis Clinical Presentation
  • chewing and swallowing difficult
  • Aspiration potential
  • Speech will worsen
  • Muscle atrophy or pain rare
  • Deep tendon relexes remain intact
Myasthenia Gravis Clinical Presentation
  • RR, HR, BP, CO increased
  • PFT restrictive
  • Cyanosis
Myasthenia Gravis Chest findings
  • BS, chest expansion decreased
  • CXR normal or opacity w/consolidation and atelectasis
Myasthenia Gravis Tx
  • Cholinesterase inhibitors- Tensilon
  • Corticosteroids
  • ACTH
  • Thymectomy
Myasthenia Gravis Tx
  • Mobilization of secretions
  • hyperinflation techniques
  • Supplemental O2
  • Mech ventilation for acute or impending ventilatory failure
x of y cards