1. - Pulmonary Embolism may present with Atelectasis, effusion, hemoptysis, of only SOB (Sortness Of Breath)
2. Extubate when pt. has normal CNS Physical exam, PEEP=5, & FiO2=30%,
3. a/w any of the following: increase RBC, CHF, or cor pulmonale
4. Hx. of vomiting, bedridden, foreign body aspiration
   1. S/S of infection=Fever or change in sputum color
      1. Dx. Aspiration Pneumonia
         1. Rx. Clindamycin
   2. NO S/S of Infection
      1. Dx. Aspiration Pneumonitis
         1. Rx. Supportive
5. SUDDEN SOB
   1. CXR=small linear bands, or wedge-shaped densities,morbidity, raised diaphragm, unaffected side show hyper-inflation
      1. Dx. Atelectasis
   2. CXR=lobar infiltrate
      1. Dx. Pneumonia
   3. Hx. of sever stress, trauma, or infection
      1. CXR=Diffuse Bilateral infiltration & pulmonary capillary wedge pressure less than 18 mmHg, & PaO2/FiO2 ration, is less than 200
         1. Dx. Adult Respiratory Distress Syndrome
            1. Rx. underlaying cause & I.V. Fluids & Ventilation
            2. 1st Ventilation setting: FiO2 70%, PEEP 9cmH2O, Tidal volume less than 6ml/Kg, plateau pressure less than 30
            3. after achieving normal or slightly acidic pH, a pulse ox. = 90%, PaO2=60
            4. 2nd: Adjust Ventilation setting to : PEEP= 5cm H2O, FiO2 around 50%
      2. ANY or NO CXR finding w/ CLINCAL SUSPECION from Hx. of immobility, surgery, fracture, child delivery, Infection, drug abuse, CA, or DVT,P.E.: SOB w/ Clear chest
         1. Dx. Pulmonary Embolization
            1. Inv. 1st: after CXR (PA & Lat. ) do a V/Q scan 2nd: do am U/S at the site of DVT if present 2ed: do spiral CT 3ed: Venography with LMWH (usu. NOT needed)
            2. Rx.
            3. Stable
            4. Heparin & Warfarin
            5. Unstable (Shock or hypoxia)
            6. Thrombolytic drugs
            7. Recurrent PE
            8. Infe. Vena. Cap filter
6. chronic SOB = pulmonary function test
   1. FEV1/FEV=less than 80%, & Residual lung capacity = more than 100
      1. Dx. Obstructive lung disease
         1. Chronic Cough, & cough with induced expiration
            1. hx. any type of allergy or family hx. of asthma
            2. Dx. Asthma
            3. Rx. admit if pt scores 40% lower then his/her normal peak flow score
            4. Rx. is based on number of S/S attacks per week during day, or per month during the night
            5. Day 1/w or night 1/m= Dx. mild
            6. Rx. Fast acting beta2 agonist e.g Abuterol (inh) PRN
            7. Day 2-6/w or might 2-4/m=Dx. moderate
            8. Rx. ADD = inhaled steroid OR Cromolyn OR Leukotriene antagonist
            9. Daily or night more than 5/ week=Dx. moderate-persistaent
            10. Rx. ADD long-acting beta2 agonist e.g salmeterol (inh.)
            11. continuous day or night S/S =Dx. severe
            12. Rx. ADD Predinisone(PO)
            13. Peak flow meter is 40% less then the pt. usually preforms, or pt. not responding to repeated Albuterol
            14. Rx. Admit to hospital & Hydrocortisone (IV) may need intubation
            15. hx. repeated infection or smooking
            16. Chronic infections
            17. Dx. COPD
            18. Inv. ABG and CXR wtih any new complain even after Dx.
            19. O2 Saturation 88% or less
            20. Rx. Home O2
            21. PaO2 55 or less
            22. O2 sat. is 89%
            23. PaO2 56 to 59
   2. Normal patient = FEV1/FEV=80%, & Residual lung capacity = 80 to 100, Diffusing Capacity of carbon monoxide (DLCO) is 80-100%
      1. Normal DLCO
         1. COPD,Asthma, Musculoskeletal disease, obesity
      2. DLCO less than 80%
         1. Emphysema
         2. Interstitial Lung Disease
   3. FEV1/FEV= MORE than 80%, & Residual lung capacity = LESS than 80
      1. Dx. Restrictive lung disease
         1. Dx. Obesity
         2. Dx. Kyphosis
         3. Dx. Scoliosis
         4. Dx. Intersitial Lung Disease
            1. Job Hx involving heavy lifting, building and getting dirty
            2. E.g. Construction worker, ship yard, plumbing, or mining
            3. Dx. Asbestosis
            4. Job. Hx. related to art or painting
            5. E.g. pottery, or sand blasting
            6. Dx. Silicosis
            7. job Hx. related to electronics & computers
            8. E.g. computer or light bulb industry
            9. Dx. Brolyosis
            10. Subtopic 3
7. EKG= Rt. axis deviation, CXR= prominent pulmonary arteries
   1. No Disease Hx.
      1. Primary Pulmonary HTN
         1. Rx. Ca Channel Blocker & Warfarin
   2. Hx. chronic lung, hart, thrombotic, or connective tissue disease
      1. Secondary Pulmonary HTN
8. Migratory Pulmonary Infiltration
   1. Dx. Loeffler's Syndrom
   2. 1/w or 1/m
9. childbearing age Female; CXR= reticulonodular infiltration plural effusion of Pneumothorax
   1. Dx. Lymphangioleiomyomatosis
      1. Rx. Steroids(PO)