Leik Condensed Part 2

1. Pulmonary Emboli- know that this is the most concern with patients who have a history of DVT, atrial fibrillation  Patient ex: ACUTE shortness of breath, may have just flown on airplane and after landing noted shortness of breath, chest tightness. This is an emergency, send them to ER 2. Know that ASTHMA and COPD tx ASTHMA VERSUS COPD SABA SABA ICS LABA LABA LABA LABA ICS KNOW when to increase at each interval of asthma- this is the one they like to include on exam: Step 1 (start SABA) Intermittent asthma (FEV1 80% predicted) • Daytime symptoms less than 2 days/week; nighttime awakenings less than two per month • SABA: Albuterol (Ventolin) metered-dose inhaler as needed Start SABA Step 2 Mild persistent asthma (FEV1 80% predicted). Daytime symptoms more than 2 days/week but not daily. Nighttime awakenings three to four per month Preferred treatment: Low-dose ICS Step 3 (MEMORIZE-MOST ASKED ON EXAM) Moderate persistent asthma (FEV1 60%–80% of predicted daily symptoms): Nighttime awakenings more than one per week (but not nightly) Preferred treatment: Low-dose ICS plus LABA or medium-dose ICS Step 4 Severe persistent asthma (FEV1 60% predicted): Symptoms of asthma throughout the day; nocturnal awakenings nightly Preferred treatment: Medium-dose ICS plus LABA Community-Acquired Bacterial Pneumonia (CAP) “rust-colored sputum” fever and cough think Streptococcus pneumoniae. The top two bacteria in CAP are: • S. pneumoniae • H. influenzae Case study: An older adult presents with sudden onset of a high fever (100.4°F) with chills that is accompanied by a productive cough with purulent sputum (rust-colored sputum seen with streptococcal pneumonia). The patient complains of pleuritic chest pain with coughing and dyspnea. Chest xray is the GOLD STANDARD Tx: Macrolides are preferred. • Azithromycin (Z-Pack) daily × 5 days • Clarithromycin (Biaxin) BID × 7 days -If patient had an antibiotic in previous 3 months or macrolide-resistance (25%): • Doxycycline 100 mg BID × 5 to 7 days • Levofloxacin (Levaquin) 750 mg × 5 days • Azithromycin or clarithromycin plus amoxicillin or Augmentin *****Elderly are high risk for due to comorbidities, BUT they must meet the “CURB-65” criterion for hospital admission (know what components is the CURB 65 FOR EXAM!!!!!) C (confusion) U (blood urea nitrogen 19.6 mg/dL) R (respiration 30 breaths/min) B (blood pressure 90/60 mmHg) AND • 65 years of age or older (each factor is worth 1 point). If score 1, patient should be hospitalized!!!