EM Boards Survival Guide: Pulmonary 1
- Sep 13th, 2018
- Alex Koyfman
Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)
emDocs will be providing you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system.
1) ARDS: Know etiologies (sepsis #1). Know definition and classic X-ray. Know ARDSnet vent protocol (small TVs, titrate PEEP to address hypoxemia).
2) Asthma: Know standard therapies; vent management is a must (permissive hypercapnia; avoid breath stacking). Know etiologies/management of post-intubation crash => ventilator dyssynchrony, hypotension, pneumothorax, etc.
3) Bronchitis: MCC of hemoptysis in developed world.
4) COPD: Know therapies and who gets antibiotics. Utility of BiPAP. Vent management and post-intubation crash as per asthma points above.
5) Drowning: Know high-risk populations. Don’t forget about occult trauma, particularly C-spine. Know who is safe to discharge.
6) Pulmonary hypertension: ED presentations and etiologies. Classic EKG, CXR, and Echo.
7) Pneumoconiosis (occupational lung disease): Know classic associations.
8) FB aspiration: Populations at risk => kids / those who aspirate. CXR commonly normal. Consider in recurrent pneumonia patients or sudden wheezing/stridor.
9) Hemoptysis: Bronchitis (#1 developed world) / TB (#1 developing world) / Cancer (MCC massive hemoptysis). Differentiate ENT vs GI bleed vs hemoptysis. Management: bleeding lung down; selectively intubate good lung.
10) Lung cancer: loves to test complications => HyperCa (PTHrp); HypoNa (SIADH); SVC syndrome; Pancoast syndrome.