occurs with out trauma

• usually due to rupture of apical bleb
• 1-2 cms in dia.
• in or under visceral pleura
• tall thing individuals
• usually smokers
• 50% will reoccur

occurs where there is lung disease

• usually due to copd
• more life threatening due to less lung reserve
• tx with sclerosing agent and chest tube
• if not healed in 5-6d may need open thoractomy

caused by wound.

• usually with hemithorax
• chest tube (superior removes air, lower removed blood)
• usually vent or trauma related.
• increased CO
• mediastinum shifts to contralateral side.
• needle aspiration at 2nd anterior intercostal space above rib

• sudden, sharp CP-made worse by breathing, coughing, movement.
• asymmetrical chest movement.
• dyspnea
• weak/rapid pulse
• neck vein distension
• tracheal deviation.

• trauma
• rupture of bleb
• neoplasm
• smoking, copd, asthma
• TB
• vigorous exercise
• intubation
• cocaine, crack

• Ph: <7.35 (acidotic)
• PO2: <80
• PCO2: >45

• air without lung marking preipherally
• mediastinal shift to one side
• may need decub. view to small pneumo.

• Aspirate
• if recurrence, thoracostomy

• No air travel
• consider thoractomy if 2 or more spontaneous
• stop smoking
• r/o cocaine use
• out pts repeat xray in 24h.

Sarcoidosis is a disease characterized by the development and growth of tiny clumps of inflammatory cells in different areas of your body. Sarcoidosis can affect virtually any organ, but most commonly it affects your lungs, lymph nodes, eyes and skin.

What ethinic groups are most at risk for developing sarcoidosis?

10x more prevelant in AA and Scandinavians

Onset usually 20-45y

• fever/wt loss/malaise
• dyspena/cough/rales
• splenomegaly
• lymphadenopathy
• skin legions that blanch with pressure
• bulat hilar adenopthy on xray
• 50% of young adults have pulmonary infiltrates
• hypercalcemia

• restrictive lung disease
• aspergillus in pulmonary cavities
• exudative effusiions
• renal stones= hypercal.
• meningitis
• pituitary tumors
• DI
• bells palsy

BIOPSY

You may also consider:

• bronchoscopy
• PFTs
• CXR

• stage 0:  CXR normal
• stage 1:  bilat. hilar adenopathy, PFTs normal, asymptomatic
• stage 2: hilar adenopathy, infiltrates, PFTs show restrictive disease.
• stage 3:  pulmonary infil., PFTs show obstructive and restrive but hilar adenopathy has resovled.
• stage 4:  advanced fibrosis, bullae cysts

• prevent organ damage/relieve symptoms
• indications for tx unclear
• pts with clear lungs and asymptomatic hilar adenopathy usually (70-90%) have complete remission in a few years.
• STEROIDS TX OF CHOICE: Prednisone 40-60mg QD x 6w-6m. Response in 2-4w. Taper dose prevent remission
• Relapse in 20-50% when steroids d/c.

A pulmonary embolus is a blockage of an artery in the lungs by fat, air, blood clot, or tumor cells.

• SOB 90%
• Pleuritic CP 70%
• hemoptosis 30%
• tachy: 96%
• phlebitis 32%
• rales 58%
• 2nd heart sound: 53%
• fever: 53%

• post op, bedrest, stasis
• CHF, copd, dvt, malignancy
• protien c or s deficiency
• OCs
• 30m or > of anesthesia
• left or right ventricular failure

• Hx is crucial
• CXR to r/o other causes
• helical CT angiography
• my be difficult to distingish from pneumonia

• can be normal
• hypoxemia with resp alkalosis
• normal PaO2 in 10%
• NORMAL ABG DOES NOT RULE OUT PE

• heparin x 5d (start with 5,000-20,000 bolus then 1000u/h)
• coumadin for at least 6m
• if preg., no coumadin
• fibrinolysis tx
• IVC filter
• keep INR between 2-3

True or False

Lung CA is the leading cause of deaths in males and females

• Aveolar cell: rarely mets
• Small oat cell: extremely malignant, mets to lymph/bone
• Bronchogenic: mets via lymph
• Large cell: CNS mets

• wt loss
• anorexia
• cough
• SOB
• shoulder, bone pain
• fever, fatigue
• SVC syndrome

• headache, nausea
• dizzy, visual disturbances
• distended neck,thoraic veins
• facial edema
• horners's syndrome: unilat. constricted pupil, ptosis
• CXR: mediastinial mass.

• sputum for cytology
• Bronchoscopy with biopsy
• CXR
• Thoracentesis if effusion
• node bx
• Transbronchial bx

• tumor staging done
• routine labs
• consider ACE level
• PFTs
• CT of liver/brain
• bone marrow if small cell CA
• routine CXR does not affect mortality
• New Ct developed

• if limited disease: Sx
• pneumonectome: need PFTs
• radiation
• chemo
• pain management
• quit smoking

• Means that systemic complaints are more prominent than respiratory complaints. 
• occurs in community setting
• can be viral, mycoplasma, chlamydia

What is Comminity acquired pneumonia (CAP)?

• Young: Strep & mycoplasma, viral
• Old: Strep, legionella, MTB, viral

True or False

>50% of pneumonia cases have no organisms identified.

Legionella pneumonia

• comes from water and soil
• cannot be transmitted person to person
• can be fatal if no tx
• fever, tachypnea, sputum absent
• diarrhea, rash

True or False

CXR finding in the strep pneumonia pt can take up to 6w to return to normal.

• spread my respiratory droplets
• long incubatins period
• gradual onset
• non productive cough
• fever, malase
• Headache, very common
• fine rales
• May have bulging TMs

True or False

Aspiration pneumonia, because it is usually mixed anarobes, is tx with clilndamycin 600-900mg q8h plus a quinalone (levaquin)

• parastic
• inhaled
• no person to person transmission
• usually in HIV, also in chemo pts
• extreme SOB, fever, malaise
• Gold standard of Dx: bronchoalveolar lavage
• Silver stain of sputum
• Bactrim IV drug of choice

• 90% of childhood pneumonia is viral & 5-30% of adults
• seasonal bariatins
• can be mixed with bacterial
• caused by influenza A, B, C., RSV, Herpes, Epstein-barr, Hanta, HIV

• viral throat culture
• viral studies on sputum
• CBC: nml or neutropenic
• CXR
• TX: acyclovir

Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These influenza viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

• Moderate respiratory illness: Temp >100.4 AND one or more of the following: cough, SOB, hypoxia, dyspnea.
• Severe: >100.4, one or more of the above plus CXR evidence of pneumonia, respiratory distress syndrome, or autopsy findings with pneumonia without ID cause

• High fever
• headache
• body aches, malaise
• diarrhea
• dry cough
• spread person to person
• Airborne quickly
• incubation period 2-10d

• N 95
• Isolation
• supportive care
• quarantine
• temperature BID
• spearate BR and bath
• hospital isolation same as TB