Pulmonary angiography: sensitive and specific test for PE. Invasive; insert catheter through AC or femoral vein and into pulmonary artery to inject contrast medium.
Spiral (helical) CT scans: used to diagnosis pulmonary embolism.
Ventilation-perfusion (V/Q) lung scan: IV radiosotope given to assess perfusion, inhaled radioactive gas to assess perfusion; ventilation without purfusion suggests pulmonary embolus. Performed if patient cannot have CT scans.
Chest radiograph (x-ray): tumors must be 1cm in size to be detected
Pulmonary function tests: spirometry using a peak flow meter; hard & long exhale, see table 26-12 and -13 on page 517 for values
PET scan: distinguises b/w benign and malignant nodules; uses radioactive glucose preparation because malignant cells take up the glucose
Sputum tests: for c/s to identify organism; observe for color, blood, volume and viscosity.
Skin tests: test for allergic reactions, TB testing.
Bronchoscopy: bronchi visualized through fiberoptic tube; bronchoalveolar lavage (insertion of 30 mL sterile saline injected through scope and withdraw to be examined for cells); for treatment such as laser therapy, electrocautery, cryotherapy and stents.
Lung biopsy: done transbronchially, percutaneously, transthoracic needle aspiration (TTNA – risk for pneumothorax requires CXR post procedure), by video-assisted thoracic surgery (VATS – less invasive and procedure of choice when appropriate), or open lung biopsy; to obtain tissue, cells or secretions for evaluation;
Thoracentesis: Insertion of large-bore needle through chest wall into pleural space to obtain specimens for diagnosis, to remove pleural fluid, or instill meds.
Exercise testing: To diagnose, determine exercise capacity, and for evaluation of disability. Walk as far as possible in 6 minutes, stop when SOB and continue when able.
Types of chest surgeries
Thoracotomy: incision into the thorax
Lobectomy: removal of one lung lobe
Wedge resection: removal of a small lesion
Segmental resection: removal of lung segment
Lung volume-reduction surgery: Removal of lung tissue by multiple wedge excisions.
Decortication: stripping of a fibrous membrane
Pneumonectomy: removal of a lung
Types of pneumonia
Opportunistic: PCP, CMV
Community Acquired: Legionella, staph, strep, flu, mycoplasma
Hospital Acquired: E. coli, staph, strep, enterobacter, klebsiella
Stages of pneumococcal pneumonia
Congestion: outpouring of fluid into alveoli, supports growth/spread of microorganism
Red hepatization: dilation of capilaries, alveoli fill with organisms, neutrophils and fibrin
Grey hepatization: blood flow decreases and leukocytes and fibrin consolidate
Resolution: exudate becomes lysed and process by macrophages, normal lung tissue restored
Disease of the heart with hypertrophy and dilatation of the right ventricle secondary to lung disease. Most common cause is COPD.
Pleural effusion: lung expansion restricted by fluid in pleural space
Empyema: Lung expansion restricted by pus in intrapleural space
Pleurisy: Inflammation of the pleura restricting lung movement
Atelectasis: Presence of collapsed, airless alveoli
Idopathic pulmonary fibrosis: excessive connective tissue in lungs
Kyphoscoliosis: spinal angulation restricting ventilation
Opioid and sedative overdose: central depression of respiratory rate and depth
Muscular dystrophy: paralysis of respiratory muscles
Pickwickian syndrome: excess fat restricts chest wall and diaphragmatic excursion
Pulmonary edema: abnl accumulation of fluid in the alveoli and interstitial spaces of the lungs. (med emergency) (most common cause is left-sided HF)
Primary pulmonary hypertension (PPH): vasoconstriction, remodeling of pulmonary vessel walls, thrombosis in situ combine to cause vascular resistance;