Phase 2 - PowerPoint PPT Presentation

Loading...

PPT – Phase 2 PowerPoint presentation | free to download - id: 6dba42-YWY4Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Phase 2

Description:

Phase 2 Stephen Lau & George Lam The Peer Teaching Society is not liable for false or misleading information Fever Pleuritic Chest Pain Haemoptysis Sputum ... – PowerPoint PPT presentation

Number of Views:12
Avg rating:3.0/5.0
Slides: 48
Provided by: Alice166
Learn more at: http://www.peerteaching.com
Category:
Tags: basics | phase

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Phase 2


1

Respiratory
  • Phase 2
  • Stephen Lau George Lam

The Peer Teaching Society is not liable for false
or misleading information
2
Outline
  • Pulmonary Embolism
  • Pneumothorax
  • Pneumonia
  • Pleural Effusion

The Peer Teaching Society is not liable for false
or misleading information
3
Pulmonary Embolism
  • Causes of PE
  • Thrombus (DVT, ?)
  • ?
  • ?
  • ?

The Peer Teaching Society is not liable for false
or misleading information
4
Pulmonary Embolism
  • Causes of PE
  • Thrombus (DVT, AF)
  • Fat
  • Air
  • Bacterial Vegetation (EC)

The Peer Teaching Society is not liable for false
or misleading information
5
Pulmonary Embolism
  • Causes of VTE
  • ?
  • ?
  • ?

The Peer Teaching Society is not liable for false
or misleading information
6
Pulmonary Embolism
  • Causes of VTE
  • Change in Blood Flow
  • Immobility ? Post-Op, Paralysis
  • Obesity
  • Pregnancy
  • Change in Blood Vessel
  • Smoking
  • HTN
  • Change in Blood Constituent
  • Dehydration
  • Malignancy
  • High Oestrogen
  • Polycythaemia
  • Nephrotic Syndrome
  • Inherited ? Protein C/S Deficiency, Factor VLeiden

The Peer Teaching Society is not liable for false
or misleading information
7
Pulmonary Embolism
  • Classification of Clinical Presentation

The Peer Teaching Society is not liable for false
or misleading information
8
Pulmonary Embolism
  • Classification of Clinical Presentation
  • Acute ? Sudden
  • Massive ? Cardiogenic Shock (SBP lt 90 mmHg or ?
    40 mmHg for gt 15 min)
  • Submassive ? No Shock
  • Chronic ? Gradual P HTN

The Peer Teaching Society is not liable for false
or misleading information
9
Pulmonary Embolism
  • Sx Submassive

The Peer Teaching Society is not liable for false
or misleading information
10
Pulmonary Embolism
  • Sx Submassive
  • Acute SOB ?
  • Pleuritic Chest Pain ?
  • Cough ?
  • Haemoptysis ?
  • Wheeze ?
  • Tachycardia ?
  • Tachypnoea ?

The Peer Teaching Society is not liable for false
or misleading information
11
Pulmonary Embolism
  • Sx Submassive
  • Acute SOB ? ? PaO2 /? PaCO2 (due to V/Q mismatch
    opening of AV collaterals)
  • Pleuritic Chest Pain ? Inflammatory Rxn Irritates
    Parietal Pleura
  • Cough ? ?Fluid Extravasation
  • Haemoptysis ? Lung Infarction
  • Wheeze ? Bronchospasm
  • Tachycardia ? ? PaO2 /? PaCO2
  • Tachypnoea ? ? PaCO2

The Peer Teaching Society is not liable for false
or misleading information
12
Pulmonary Embolism
  • Sx Massive

The Peer Teaching Society is not liable for false
or misleading information
13
Pulmonary Embolism
  • Sx Massive
  • Shock Sx ?
  • ? JVP ?
  • Accentuated P2 ?

The Peer Teaching Society is not liable for false
or misleading information
14
Pulmonary Embolism
  • Sx Massive
  • Shock Sx ? ? LV Pre-Load ? CO
  • ? JVP ? RHF
  • Accentuated P2 ? Delayed RV Emptying

The Peer Teaching Society is not liable for false
or misleading information
15
Pulmonary Embolism
  • 70 y/o man day 4 post-THR developed sudden-onset
    SOB and pleuritic chest pain 2h ago. SOB occurs
    at rest and worse on exertion. No associated leg
    pain/swelling, cough, haemoptysis or wheeze.
  • No PMH asthma/COPD, DVT/PE. 20 Pack Years.
  • Ex
  • T 37.0, HR 110, BP 120/80, RR 24, SaO2 93.
  • JVP 2 cm. HS normal, no Murmur.
  • Trachea central. Scattered creps _at_ lung base.
  • Mild calf tenderness.

The Peer Teaching Society is not liable for false
or misleading information
16
Pulmonary Embolism
  • 70 y/o man day 4 post-THR developed sudden-onset
    SOB and pleuritic chest pain 2h ago. SOB occurs
    at rest and worse on exertion. No associated leg
    pain/swelling, cough, haemoptysis or wheeze.
  • No PMH asthma/COPD, DVT/PE. 20 Pack Years.
  • Ex
  • T 37.0, HR 110, BP 120/80, RR 24, SaO2 93.
  • JVP 2 cm. HS normal, no Murmur.
  • Trachea central. Scattered creps _at_ lung base.
  • Mild calf tenderness.

The Peer Teaching Society is not liable for false
or misleading information
17
Pulmonary Embolism
  • DDx
  • Submassive PE ?
  • PTX ?
  • Acute Pulmonary Oedema/ARDS ?
  • Pneumonia ?
  • Sepsis ?
  • MI ?
  • Arrhythmia ?

The Peer Teaching Society is not liable for false
or misleading information
18
Pulmonary Embolism
  • DDx
  • Submassive PE ? D-Dimer, Leg USS
  • PTX ? CXR
  • Acute Pulmonary Oedema/ARDS ? CXR
  • Pneumonia ? FBC, CXR
  • Sepsis ? FBC, Lactate, Blood Culture, CXR
  • MI ? ECG
  • Arrhythmia ? ECG

The Peer Teaching Society is not liable for false
or misleading information
19
Pulmonary Embolism
  • Ix
  • FBC
  • LFT ? ?Liver Mets/Ca
  • UE ? ?Renal Function (?Shock)
  • Clotting ? ?Hypercoagulable
  • D-Dimer
  • ABG
  • Blood Culture
  • CXR
  • Leg USS
  • ECG

The Peer Teaching Society is not liable for false
or misleading information
20
Pulmonary Embolism
  • Ix
  • D-Dimer
  • If ve, next step?
  • If ve?
  • ABG
  • PaO2
  • PaCO2
  • CXR
  • 3 Signs
  • ECG
  • What is the pathognomonic arrhythmia?

The Peer Teaching Society is not liable for false
or misleading information
21
Pulmonary Embolism
  • Ix
  • D-Dimer
  • If ve, next step? CTPA or V/Q Scan
  • If ve? Not PE
  • ABG ? T1RF
  • PaO2 ? Low
  • PaCO2 ? Low
  • CXR COMMONLY NORMAL
  • Decreased Vascular Markings
  • Dilated PA
  • Wedge-Shaped Infarction
  • Pleural Effusion
  • ECG
  • What is the pathognomonic arrhythmia?
  • S1Q3T3 ? Deep S (I), Q (III), T Inversion (III)

The Peer Teaching Society is not liable for false
or misleading information
22
Pulmonary Embolism
  • Mx of Submassive PE (SBP gt 90 mmHg)
  • Initial
  • Long-Term

The Peer Teaching Society is not liable for false
or misleading information
23
Pulmonary Embolism
  • Mx
  • Initial
  • O2
  • 1) LMWH SC (Enoxaparin, Dalteparin)
  • / Fondaparinux
  • / UFH
  • 2) IVC Filters
  • Long-Term
  • Mobilization
  • TED Stockings
  • Warfarin PO for 3 Months ? INR 2-3

The Peer Teaching Society is not liable for false
or misleading information
24
Pulmonary Embolism
  • Causes of PE
  • Risk Factors for VTE ? Virchows Triad
  • Clinical Presentation
  • Acute ? Massive/Submassive
  • Chronic
  • DDx of Acute SOB
  • Ix of Acute SOB
  • Ix Results of PE
  • Mx of Submassive PE

The Peer Teaching Society is not liable for false
or misleading information
25
Pneumothorax
  • Types

The Peer Teaching Society is not liable for false
or misleading information
26
Pneumothorax
  • Types
  • Tension
  • Non-Tension
  • Spontaneous
  • Primary ? No Lung Pathology (but probably small
    blebs)
  • Secondary ? Lung Pathology (esp. COPD bullae)
  • Traumatic

The Peer Teaching Society is not liable for false
or misleading information
27
Pneumothorax
  • 2 Symptoms
  • 4 Examination Signs of Non-Tension PTX
  • Which Side has PTX?

The Peer Teaching Society is not liable for false
or misleading information
28
Pneumothorax
  • 2 Symptoms
  • SOB
  • Pleuritic Chest Pain
  • 4 Examination Signs of Non-Tension PTX
  • Tracheal Deviation Towards Side
  • ? CE Affected Side
  • ? PN
  • ? BS
  • Which Side has PTX?
  • Left

The Peer Teaching Society is not liable for false
or misleading information
29
Pneumothorax
  • Mx of Small Primary Spontaneous PTX?
  • Mx of Large Primary Spontaneous PTX?
  • Mx of Small Secondary Spontaneous PTX?
  • Mx of Large Secondary Spontaneous PTX?
  • Where Do You Stick the Cannula?

The Peer Teaching Society is not liable for false
or misleading information
30
Pneumothorax
  • Mx of Small Primary Spontaneous PTX?
  • Observe
  • Mx of Large Primary Spontaneous PTX?
  • 1) Aspiration
  • 2) Chest Drain
  • Mx of Small Secondary Spontaneous PTX?
  • 1) Aspiration
  • 2) Chest Drain
  • Mx of Large Secondary Spontaneous PTX?
  • Chest Drain
  • Where Do You Stick the Cannula?
  • 2nd Intercostal Space, Mid-Clavicular Line

The Peer Teaching Society is not liable for false
or misleading information
31
Pneumonia - Basics
  • Signs and Symptoms of Acute Lower Respiratory
    Tract Infection.
  • Radiographic Change

The Peer Teaching Society is not liable for false
or misleading information
32
Pneumonia - Basics
  • Causative Organisms
  • Pathogens
  • Streptococcus pneumoniae
  • Klebsiella pneumoniae
  • Haemophillus influenzae
  • Staphlylococcus aureus
  • Pseudomonas aeruginosa
  • Atypical Pathogens
  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
  • Legionella pneumophillia

The Peer Teaching Society is not liable for false
or misleading information
33
Types of Pneumonia
  • Hospital and Community Acquired
  • Hospitalization for more than 2 days in the last
    90 days
  • IV therapy, chemotherapy, or wound care in last
    30 days
  • Residence in care home or long term care
  • Attendance in hospital in the last 30 days.

The Peer Teaching Society is not liable for false
or misleading information
34
Clinical Evaluation - Symptoms
  • Fever
  • Pleuritic Chest Pain
  • Haemoptysis
  • Sputum Production ( purulent)
  • Dyspnea
  • Cough
  • Fever/Rigors

The Peer Teaching Society is not liable for false
or misleading information
35
Clinical Evaluation - Signs
  • Febrile
  • Raised Respiratory Rate
  • Reduced SpO2
  • Crackles
  • Bronchial Breathing
  • Dullness on percussion

The Peer Teaching Society is not liable for false
or misleading information
36
Diagnosis - Investigations
  • Bloods
  • ABG
  • FBC
  • CRP
  • WCC Differential
  • Anaemia
  • U/E
  • LFT

The Peer Teaching Society is not liable for false
or misleading information
37
Diagnosis - Investigations
  • Scoring System
  • Confusion
  • Urea
  • Respiratory Rate
  • Blood Pressure lt90mmHg systolic
  • lt65 years of age
  • Imaging
  • CXR

The Peer Teaching Society is not liable for false
or misleading information
38
Treatment
  • Antibiotics
  • Amoxicillin / Flucoxacillin (if S. aureus
    suspected)
  • Oxygen
  • Fluids
  • Analgesia

The Peer Teaching Society is not liable for false
or misleading information
39
Pneumonia Clinical Scenario 1
  • A 54-year-old smoker with multiple comorbidities
    (diabetes, hypertension, coronary artery disease)
    presents with a 2-day history of a productive
    cough with yellow sputum, chest tightness, and
    fever. Physical examination reveals a temperature
    of 38.3C (101F), BP of 150/95 mmHg, heart rate
    of 85 bpm, and a respiratory rate of 20 breaths
    per minute. His oxygen saturation is 95 at rest
    lung sounds are distant but clear, with crackles
    at the left base. CXR reveals a left lower lobe
    infiltrate.

The Peer Teaching Society is not liable for false
or misleading information
40
Pleural Effusion - Basics
  • Fluid that occupies the space between the
    visceral and parietal pleural
  • Transudate
  • Disruption of hydrostatic and oncotic forces
    across pleural membrane
  • Exudate
  • Increases permeability of the pleural surface

The Peer Teaching Society is not liable for false
or misleading information
41
Pleural Effusion - Basics
  • Common Causes of Transudate
  • Heart Failure
  • Cirrhosis
  • Hypoalbuminaemia
  • Peritoneal Dialysis
  • Nephrotic Syndrome
  • Hypothyroidism

The Peer Teaching Society is not liable for false
or misleading information
42
Pleural Effusion - Basics
  • Common Causes of Exudate
  • Pneumonia
  • Malignancy
  • Pulmonary Infarction (Embolism)
  • Autoimmune
  • Pancreatitis
  • TB

The Peer Teaching Society is not liable for false
or misleading information
43
Pleural Effusion - Symptoms
  • Shortness of Breath on Exertion
  • Cough
  • Pleuritic Pain
  • PMHx of smoking, asbestos exposure
  • PMHx of any previously mentioned diseases

The Peer Teaching Society is not liable for false
or misleading information
44
Pleural Effusion - Signs
  • Dullness to percussion
  • Tracheal centrality
  • Vocal Fremitus
  • Asymmetric Chest Expansion
  • Reduced Breath Sounds

The Peer Teaching Society is not liable for false
or misleading information
45
Diagnosis - Investigations
  • CXR PA/Lateral
  • Thoracentesis (Chest Drain)
  • Diagnostic in up to 75 of cases
  • Protein
  • LDH
  • Cholesterol
  • Cytology
  • Glucose
  • RBC/WBC/pH
  • Cultures
  • Pleural Ultrasound
  • FBC/CRP/Culture

The Peer Teaching Society is not liable for false
or misleading information
46
Treatment
  • Treat the cause
  • Thoracentesis
  • Pleurodesis

The Peer Teaching Society is not liable for false
or misleading information
47
Pleural Effusion Clinical Case 1
  • A 70-year-old women presents with slowly
    increasing dyspnoea. She cannot lie flat without
    feeling more short of breath. She has a history
    of HTN and osteoarthritis, and she has been
    taking NSAIDs with increasing frequency over the
    previous few months. On physical examination, she
    appears dyspnoeic at rest, her BP is 140/90 mm
    Hg, and pulse is 90 bpm. Her jugular venous
    pressure is elevated to the angle of the jaw. The
    left lung field is dull to percussion with
    decreased air entry basally. Crackles are heard
    in the right lung field and above the line of
    dullness on the left. Lower extremities have
    pitting oedema to the knee.

The Peer Teaching Society is not liable for false
or misleading information
About PowerShow.com