Emphysema
PF | PF ÷ Serum TP | PF ÷ Serum LDH | PF LDH |
---|---|---|---|
Transudate | < 0.5 | < 0.6 | < 2/3 Serum LDH upper limit |
Exudate | > 0.5 | > 0.6 | > 2/3 Serum LDH upper limit |
Obstructive | Restrictive | |
---|---|---|
TLC | ↑ | ↓ |
FEV1 | ↓ | ↓ |
FVC | - | ↓ |
FEV1/FVC | ↓ | - |
Disease | Etiology |
---|---|
Asthma | Hypersensitivity |
Chronic bronchitis | Smoking |
Centriacinar emphysema | Smoking |
Panacinar emphysema | α1-antitrypsin deficiency |
Central bronchiectasis | Allergic bronchopulmonary aspergillosis (ABPA) |
Peripheral bronchiectasis | Cystic fibrosis Primary ciliary dyskinesia Immunodeficiency |
Asthma | Attacks | Awakenings | SABA Uses | FEV1 | FEV1/FVC |
---|---|---|---|---|---|
Intermittent | < 2 days/week | ≤ 2/month | ≤ 2 days/week | > 80% | Normal |
Mild persistent | 2 ~ 7 days/week | 3 ~ 4/month | 2 ~ 7 days/week | > 80% | Normal |
Moderate persistent | Daily | > 1/week | Daily | 60 ~ 80% | ↓ < 0.05 |
Severe persistent | Throughout | Daily | Throughout | < 60% | ↓ > 0.05 |
Mechanism | Medication |
---|---|
β2 agonists | Albuterol Salmeterol Formoterol |
M antagonists | Ipratropium Tiotropium |
NF-κB inhibitors | Corticosteroids |
LOX inhibitors | Zileuton |
LTD4 antagonists | Montelukast Zafirlukast |
Mast cell inhibitors | Cromolyn Nedocromil |
IgE inhibitors | Omalizumab |
Stage | Severity | FEV1 |
---|---|---|
1 | Mild | > 80% |
2 | Moderate | 50 ~ 80% |
3 | Severe | 30 ~ 50% |
4 | Very severe | < 30% |
Type | Deposit | Location | Findings | Associations |
---|---|---|---|---|
Asbestosis | Asbestos | Lung base | Calcified pleural plaques Ferruginous bodies | Bronchogenic carcinoma Mesothelioma |
Coal worker's disease | Coal dust | Lung apex | - | - |
Silicosis | Silica | Lung apex | Eggshell calcifications | Tuberculosis |
Berylliosis | Beryllium | Hilum | Hilar adenopathy | - |
Type | Location | Paraneoplastic Syndromes |
---|---|---|
Small cell carcinoma | Central | ACTH & SIADH Lambert-Eaton myasthenic syndrome Paraneoplastic myelitis/encephalitis |
Squamous cell carcinoma | Central | PTHrP |
Adenocarcinoma | Peripheral | - |
Large cell carcinoma | Peripheral | β-hCG |
Criteria | Points |
---|---|
DVT symptoms/signs | 3 |
Clinical suspicion | 3 |
Tachycardia | 1.5 |
Immobilization | 1.5 |
Previous PE/DVT | 1.5 |
Hemoptysis | 1 |
Malignancy | 1 |
Score | Risk | Management |
---|---|---|
0 ~ 1 | Low | D-dimer |
2 ~ 6 | Intermediate | CT angiography V/Q scan Bedside echocardiography |
≥ 7 | High | Treatment |
Infection | Pathogens | Management |
---|---|---|
Epiglottitis | Haemophilus influenzae | Antibiotics Intubation |
Laryngotracheobronchitis [Croup] | Parainfluenza virus | Corticosteroids Nebulized epinephrine |
Bronchitis Bronchiolitis | Virus | Supportive care |
Pneumonia | Any | Antimicrobials |
Patient | Antibiotics |
---|---|
CAP & Outpatient | Amoxicillin Macrolides / Doxycycline |
CAP & Outpatient & Complicated | Amoxicillin & (Macrolides / Doxycycline) Fluoroquinolones |
CAP & Inpatient | Anti-pneumococcal β-lactams & (Macrolides / Doxycycline) Fluoroquinolones |
CAP & Inpatient & Complicated | Anti-pneumococcal β-lactams & Fluoroquinolones |
HAP | Anti-MRSA & Anti-pseudomonal β-lactams & Fluoroquinolones |
Type | PaO2 | PaCO2 | A-a Gradient | Etiology |
---|---|---|---|---|
1 | ↓ | - | ↑ | V/Q mismatch |
2 | ↓ | ↑ | - | Hypoventilation |
3 | ↓ | ↑ | ↑ | Mixed |
4 | ↓ | ↑ | - | Sepsis |
Sequence | Control | Trigger | Mode |
---|---|---|---|
Continuous mandatory | Presure (PC) Volume (VC) | Time | Assist-control ventilation (ACV) |
Intermittent mandatory | Presure (PC) Volume (VC) | Time Patient | Synchronized intermittent mandatory ventilation (SIMV) |
Continuous spontaneous | - | Patient | Pressure support ventilation (PSV) |
Parameter | Normal Adult Range | Weaning Threshold |
---|---|---|
Respiratory Rate (RR) | 14 ~ 18 | < 40 |
Tidal Volume (VT) | 5 ~ 7 mL/kg | 5 mL/kg |
Rapid shallow breathing index (RSBI) = RR ÷ VT | < 50/min/L | < 105/min/L |
PF Ratio = PaO2 ÷ FiO2 | > 400 | > 200 |
Max Inspiratory Pressure | < -90 cm H2O | < -25 cm H2O |