Thanks to Brian Sun for presenting!
- Complete atelectasis/lung collapse can occur from mucous plugging or endobronchial lesions, look for tracheal deviation towards the side of atelectasis
- Consider atypical Legionella coverage for HCAP in patients with risk factors such as on glucocorticoids, transplant patients, GI symptoms, especially when not improving with standard antibiotics
- Drugs covering Pseudomonas include Imipenem, Meropenem (not ertapenem!), Fluoroquinolones, Aminoglycosides, 4th generation pencillins, and 3/4th generation cephalosporins (Ceftriaxone, Ceftazidime, Cefepime)
MKSAP Question: Understand the difference between between dehydration and hypovolemia – dehydration is defined as loss of free water.
Thanks to Fernando for presenting an interesting case!
- Asthma affects approximately 5% of the population.
- Commonly present in adolescent/young adults, but can also present in the elderly.
- Risk Factors for Asthma Exacerbations: 1) Prior Intubations 2) # of Hospitalizations in Last Year 3) Not on inhaled corticosteroids or PO steroids 4) Tobacco/Polysubstance Abuse 5) Psychosocial Issues 6) Non-compliance 7) Multiple Medical Co-morbidities
- PFTs will demonstrate obstructive airway disease with FEV1/FVC <70%. With bronchodilators, reversibility will be seen.
- FEV1 improvement of 12% with total change >200cc demonstrates reversibility.
- TLC will be elevated.
- DLCO should be normal (Watch out for any false positive and false negative results)
- Antibiotics are not routinely recommended in patients with asthma exacerbation in the absence of a consolidation.
- Beware of a “normal” pCO2 in a patient who is hyperventilating and admitted with asthma exacerbation.
- Treatment of Asthma Exacerbation: Steroids, Short Acting Beta Agonists +/- anticholinergic medications. Needs continual reassessment.