EM Boards Survival Guide: Pulmonary 1

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.

Boards Must-Knows:

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.

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