CSE treatments

chronic bronchitis/emphysema, asthma, bronchiectasis

1. typical COPD shit

   1. bronchodilators + ICS (-BAs, -MAs)

      1. asthma: mast cell stabilizers, leukotriene inhibitors, Mg sulf., heliox, subq epi

   2. BHP + pulm rehab (education, nutrition, fluid intake, etc.)

      1. bronchiectasis: lung expansion therapy

   3. smoking cessation

CF

1. typical COPD shit

   1. bronchodilators + ICS

2. MUCOLYTICS (dornase)

3. antibiotics (tobi, colistin, amikacin)

4. airway clearance

   1. CPT + PD

   2. exercise

   3. PEP, HFCWO

   4. forced exp techniques (AD, active cycle, huff coughing)

apnea

1. central

   1. NPPV

2. obstx

   1. nasal CPAP

   2. weight loss

   3. sleep posture

   4. surgery (UPPP, trach)

   5. oral appliances

   6. neck collar

trauma/flail/rib fractures

1. hyperinflation therapy (IS/SMI, IPPB, deep coughing)

2. BHP

3. analgesics

4. severe = stabilization of chest wall, mech vent (PEEP!)

pneumo/hemo: needle vs chest tube

needle = pt unstable

chest tube = >20% and not emergency

treat w/ hyperinflation after remove air, or if on vent, make sure to give PEEP

smoke inhalation

1. 100% FiO2

2. hyperbaric for severe CO

3. bronch

4. hyperinflation

5. meds (-BA, -MA, mucolytics, ICS)

CHF/cor pulmonale

1. NRB

2. hyperinflation

3. meds

   1. diuretics: lasix/furosemide

   2. inotropes: all the d’s (digitalis, digoxin, dobu., dopa)

   3. analgesic: morphine

   4. preload: nitros, morphine

   5. tachycardia: procainamide, metoprolol

PH/PE

1. diuretics

2. blood thinners

   1. apixaban (eqliuis)

   2. fondaparinux (arixtra)

   3. heparin (lovenox) (for PE)

      1. thrombolytics for PE too

   4. rivaroxaban (Xarelto)

   5. warfarin (Coumadin)

3. inotropes

4. NO (for PH)

MI

1. NRB

2. aspirin

3. morphine

4. anti-arryhthmics (amiodarone, procainamide, atropine)

5. nitrates (chest pain)

6. fluids or pressors (dopamine)

stroke, brain injury

TREAT W/I 6H

1. drugs (anticoag, vasodilators, thrombolytic TPA)

2. hyperventilate (high CO2) and do NOT use PEEP

ARDS treatment besides ur normal shit

1. PCAP/PEEP/hyperinflation/RM

2. alternatives for vent

   1. IRV

   2. APRV

   3. PRVC

   4. HFV

immunocompromised

1. infection

   1. pain/fever = ibuprofen

   2. nasal congestion = decongestants

   3. expectorants to thin mucus

2. boosting immune system

   1. Igb

   2. interferon-gamma

   3. growth factor

   4. stem cell transplantation

vents and bariatrics

LPV AND MORE PEEP!

larys

1. careful sxning (bleeding/clots)

2. cool aerosol

head trauma/surgery

1. maintain ~100 PaO2

2. minimize MAP (low PEEP + PIP)

3. Benzos/prop

4. Dilantin: seizures

croup treatment besides normal shit

1. mild

   1. if not responsive to cool mist + racemic epi: use corticosteroids

2. severe + epiglottitis

   1. intubate to T-piece or CPAP

      1. extubation = leak around tube (swelling gone down!)

RSV

ACUTE infection of LOWER tract, most affecting <17o, immunocompromised, chronic disease. hx. can include upper resp infection

treat w/:

1. RSV Igb (respigam) or palivizumab (Synagis)

2. humidity @home + oral decongestants

BPD

1. careful fluid management and diuretics (lung edema)

2. BHP

3. bronchodilators

congenital heart defects

test w/ CXR, echo, pre-post

treat w/ prostaglandins (PDA)

IRDS/hyaline disease

1. signs: <38wk, low APGAR, RDS @birth or w/I few hours

2. treat:

   1. O2 via oxyhood/NC, CPAP (4-6)

   2. surf via 5FR Cath

      1. immediately after birth if <35wk

      2. IRDS diagnosed

         1. remember to change position to increase distribution!

myasthenia crisis

anti cholinesterase! do NOT choose anticholinergics (will reverse this)