lung procedures and diagnostics

need to add rest of infectious disease stuff

sputum induction

patient inhales saline mist to cause deep cough

bronchoscopy

bronchoscope removes sputum or diseased lung tissue

gastric washing

tube inserted into stomach samples gastric secretions that contain sputum that has been coughed into throat then swallowed

sputum culture indication

identify pathogens associated with LRI

sputum culture controversy

normal flora within lungs and mouth can contaminate it

improving sputum culture quality

squamous cells collected, obtain specimen prior to abx, rinse mouth, don’t eat prior, inoculate immediately

sputum sample number

2 high quality collections on day 1 and day 2

sputum samples steps

take deep breaths in and out, rinse mouth, take deep breath and cough as deeply as possible (should feel it in stomach), spit phlegm into container directly

bronchoalveolar leavage

bronchoscope and saline solution is used to collect lung specimens performed under conscious sedation

bronchoalveolar lavage ADR

fever, hypoxia, PTX

bronchoalveolar lavage indication

collect lung specimens for infection/cancer

staph CXR

cavitary lesions and lung abscesses

staph aureus colonizes…?

nasal passages

strep pneumo colonizes…?

nasal cavities, sinuses

strep pneumo infections

MCC CAP, rhinosinusitis, otitis media, mastoiditis

klebsiella colonizes…?

oropharynx, GI

klebsiella infections

nosocomial infections, pneumonia with currant jelly sputum, 3rd MCC UTI

h. flu infections

2nd MCC CAP

h. flu populations

immunocompromised, age extremes, pulmonary disease

h. flu considerations

spleen issues/sickle cell since bacteria can be encapsulated

pseudomonas infections

MCC of nosocomial infection in immunocompromised, respiratory, ear, eye, skin

chlamydia pneumoniae infections

atypical/walking pneumonia

chlamydia pneumonia gold standard diagnostic

micro immunofluorescence

mycoplasma pneumoniae infection

MCC atypical pneumonia in young adults

mycoplasma pneumoniae dx

atypical pattern and patchy infiltrates on CXR, fried egg colonies

TB dx

purified protein derivative (skin test), blood test interferon gamma release assay, CXR with miliary, cavitary patterns, sputum test

TB gram stain method and result

ziehl-neelsen stain showing up as bright red

TB screening

PPD skin, IRGA

TB suspected tests

CXR, sputum test, HIV serology

miliary TB CXR result

systemic disease

reactivation TB CXR result

cavitary leasions

primary TB CXR result

classic middle/lower lobe consolidation

if CXR shows TB then

collect 3 sputum samples

acid fast bacilli smear benefit

fast and inexpensive

mycobacterial culture benefit

98% specificity, required for TB diagnosis

NAAT for TB benefit

better than acid fast but not as good as culture

pneumothorax size for chest tube

greater than 20%

chest tube indications

PTX, pleural effusion

small PTX size

≤3 cm at apex or ≤2 cm at hilum

large PTX size

>3 cm at apex or >2 cm at hilum

small PTX tx

oxygen and observe

large PTX tx

chest tube

thoracentesis indication

collect fluid for diagnostics or remove fluid to alleviate symptoms

tests done on pleural fluid

cell count, diff, pH, protein, LDH, glc, cholesterol

pleural effusion patho

abnormal fluid within pleural space

pleural effusion causes

altered membrane permeability, reduction of oncotic/hydrostatic pressure, increased capillary permeability

3 organs responsible for fluid overload

liver, kidneys, heart

altered membrane permeability cause

malignancy

reduction of oncotic/hydrostatic pressure causes

cirrhosis, nephrotic syndrome, CHF

increased capillary permeability causes

pancreatitis, infection

bloody pleural fluid meaning

trauma, malignancy

purulent pleural fluid meaning

empyema

milky pleural fluid meaning

chylothorax (disruption of thoracic duct)

black pleural fluid meaning

aspergillus niger, malignant melanoma, SCLC

low pH pleural fluid meaning

empyema

low glucose pleural fluid meaning

empyema

high triglycerides pleural fluid meaning

chylous

transudative pleural effusion

imbalance of hydrostatic and oncotic pressure in pulmonary capillaries

transudative pleural effusion causes

MCC CHF, nephrotic syndrome, cirrhosis, hypoalbuminemia

exudative pleural effusion

inflammatory disorders cause increased capillary permeability

exudative pleural effusion causes

malignancy, infection, pancreatitis, TB, PE

light’s rule

at least one of the following means exudative:

pleural fluid protein ratio ≥0.5

pleural fluid LDH ratio ≥0.6

pleural fluid LDH > 2/3 upper limit of normal LDH

pleural effusion history

alcohol induced cirrhosis, CHF, infection, weight loss, occupation (think asbestos)

pleural effusion symptoms

SOB, CP, cough

pleural effusion PE

dull to percussion, decreased tactile fremitus, asymmetric lung expansion, diminished/absent breath sounds at lung bases

pleural effusion dx

CXR with meniscus sign, labs, thoracentesis

pleural effusion management

thoracentesis, chest tube, treat underlying cause

empyema dx

pH <7.2, glucose <40