CSE

CSE COPD Information gathering key points. - ANS-Dyspnea Barrel chest Digital clubbing Tympanic note BS: wheezing/Diminished. COPD Secondary assessment info Gathering - ANS-CBC Sputum culture Chest x-ray (hyperinflation) Abg Pulmonary function Smoking HX. COPD Decision making. - ANS-Low FiO2 If culture positive choose antibiotic therapy Pulmonary rehab & home care Nebs: saba, laba, anticholinergics, corticosteroids NIPPV Smoking sessation Diet low carb, high fat & protein COPD Critical Management - ANS-100%. FIO2 then titrate Bipap (keep PaO2 50-60torr) Watch for key vocab words. Increases A-P diameter, hyperinflation of lung fields, flattened diaphragm, compensated respiratory acidosis. Chronic bronchitis, Bronchietasis. Information Gathering - ANS-* same constitutional hx as COPD except: BS: rales Chronic Bronchitis, Bronchiectasis Decision making - ANS-choose CT scan (look for key terms in scenario - Tree in winter) Asthma Information gathering - ANS-* same as COPD pt may exhibit Tachycardia & Pulsus Paradoxus during exacerbation Asthma Decision Making - ANS-O2 Bronchial Hygiene Nebs Costicosteriods Leukotriene INH Immunomodulatiors Peak Flow Monitoring Heliox Mag sulfate Trauma (chest/surgical) Info Gathering - ANS-Hemoptysis, Brusing, BS: Dim, Cyanosis, Flail Chest, Hyperresonant & Typanic notes. Trauma (chest/surgical) Desision Making - ANS-pain management Oxygen therapy Hyperinflation therapies (IS, IMT, IPPB) Peumothorax cxr terms- look for key words such as hyperluncency and absent vascular markings. Trauma (chest/surgical) Hemothorax - ANS-BS: Dim or Absent on affected area, Chest pain, Tachypenic, Dull and Flat Percussion note Choose: CBC, ABG, CXR, (key words Increased Radiodensity) Trauma (chest/surgical) Hemothorax: Decision Making - ANS-Thoracentesis, Hyperinflation Therapy S/P Chest Tube Placement Pt may require Mechanical Ventilation Trauma (chest/surgical) CONTINUES...