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Pulmonary OSCE

Terms in this set (49)

Asthma
- Step 1 & 2: Symbicort (budesonide + formoterol) PRN
--- Exercise induced: Cromolyn or Montelukast
- Step 3: Symbicort maintenance + PRN
- Step 4: incr. budesonide

Asthma exacerbation
- Mild/mod: duonebs + Prednisone 40mg x5 days
- Severe: duonebs q20 min, 125 Solu-medrol, 2g Mag, supp O2

COPD
- Gold A: Albuterol PRN + Salmeterol (Serevent)
- Gold B: Salmeterol or Tiotropium (spiriva)
- Gold C: Spiriva
- Gold D: Spiriva or Anora elipta (Umeclidium/Vilanterol) or Advair (salmeterol/fluticasone)

COPD exacerbation
- duonebs + 125 solumedrol + O2 + 2g Mag + abx (Azithro 500 x1, 250 x4 Or Zosyn)

Bronchitis
- mild: observe, resolves in 4-wks
- Tylenol, Dextromethorphan (Robitussin) 20mg q4-hrs PRN
- albuterol INH for wheeze

Bronchiolitis
"Correct abnormalities in O2 & hydration"
- O2 + IVF (persistent hypoxemia)
- Keep O2 >90-92%
- At high risk: Palivizumab ppx

CAP
- Outpatient: Doxy 100mg PO BID x5 days
- OP w/ co-morbidities: Doxy 100mg PO BID & Augmentin 875 BID x5 days
- Inpatient: Rocephin 1-2g IV BID + zpack 500mg IV daily x5 days or 48-72 hours w/out fever

HAP "acquired 48-hrs after admission"
- Cefepime 2g IV q8-hr (no RF for MDRO)
- Cefepime + Levaquin 750mg q24-hr + Vanc 15mg/kg IV q12-hr (RF for MDRO, Pseudomonas & MRSA)

Pneumothorax
- <2cm from lung to chest wall & mild: 10L O2 x6hrs
- >2cm: needle decompression
- >2cm w/ COPD: chest tube

Pulmonary Embolism
- supp O2 + 500cc NS if SBP <90 + norepi 0.1 mcg/kg/min
- heparin 80, 18 + warfarin 2-5
OR
- Apixaban 10?

Pleural effusion "tx is dictated by the precipitating cause"
- D/t CHF: Lasix 40-160 IV
- Infective: Vanc 500mg IV q6 + Zosyn 4.5g q8
- Malignant: thoracentesis + O2

*Thoracentesis for all differentiate transudative vs. exudative*

TB
- suspected: isolation room, CXR, 3 sputum cx's (acid-fast bacilli smear & cx, NAAT)
- Acute initial phase: Rifampin + Isoniazid + Pyrazinamide + Pyridoxine + Ethambutol

Croup
- Mild: Dexamethasone- 0.15-0.6 mg/kg PO once
- Mod: Decadron + racemic epi 2.25% 0.5mL diluted to 2-4ml with NS
- Severe: Decadron + racemic epi + 8-10L O2 blow-by or NRB at 15L

Epiglottitis
- 1st: Intubate
- 2nd: Rocephin 50-75mg/kg/day in divided doses
- 3rd: Supp. O2 + Dexamethasone 0.08-0.3 mg/kg/day PO
- Post-extubation: Augmentin 25-45 mg/kg/day divided doses q12-hr