Western States Pediatric Pulmonary Case Conference
|
|
- Cathleen Preston
- 8 years ago
- Views:
Transcription
1 Western States Pediatric Pulmonary Case Conference Sunil Kamath MD Mentor: Daneli Salinas MD
2 History of Present Illness 8 year old African American female with a history of chronic cough for 2 years presents to the CHLA ED with fever (102.4), abdominal pain, and hemoptysis for 1day Hemoptysis First episode Brown/red tinged mucus
3 Pertinent History Chronic cough: Began 2 years prior to admission (PTA) Waxing and waning course Wet cough with associated chest congestion When productive, sputum was yellow/green Usually treated by PMD with antibiotics for bronchitis Occasional wheezing No respiratory distress or hospitalizations Diagnosed with asthma 3 months PTA Started on budesonide daily and albuterol as needed No improvement in symptoms
4 Pertinent History 3 weeks PTA patient diagnosed with Scarlet fever (fever, red eyes, sore throat, rash with subsequent desquamation, and + throat test ) Treated with Amoxicillin Review of systems: Rare snoring Sweats at night but does not soak the sheets No travel outside of the country No apnea or cyanosis No sinusitis or otitis media No fevers, body aches, or joint pain No hematuria No weight loss
5 Pertinent History Birth History Full term normal spontaneous vaginal delivery No complications Surgeries: none No known drug allergies Family History: No history of cardiopulmonary disease Social History: Lives with great-grandma(adopted mom), grandma, godmother, 5yo biological brother also adopted by this family, and an uncle No pets or smokers Uncle was incarcerated 2 years ago for a few months
6 Physical Exam Temp HR RR BP SpO C 146 beats per minute 26 breaths per minute 129/72 mmhg 98 % breathing room air Height 128cm (25-50%) Weight 24kg (10-25%) BMI 15kg/m 2 (10-25%)
7 Physical Exam GENERAL HEENT NECK THORACIC CAGE LUNGS: HEART ABDOMEN EXTREMITIES SKIN lying in bed eating in no apparent distress normocephalic/atraumatic; TM clear bilaterally; no nasal polyps no tonsillar hypertrophy trachea is midline + cervical lymphadenopathy (<1cm, mobile, non-tender) symmetric rise decreased aeration in the left lower lobe no wheezes, crackles, or rhonchi regular rate and rhythm no murmurs, rubs, or gallops soft, non-tender, nondistended no HSM mild clubbing no cyanosis or edema; 2+ pulses dry hypopigmented patches on face and back
8
9
10 Labs WBC HGB K/uL 12.2 g/dl HCT 34.8 % PLT 272 K/uL Segs 71 % Bands 16 % Lymph 10 % Eos 0 % Chem 8 ESR CRP WNL 100 mm/hr 21.1 mg/dl
11 What is your assessment and plan? Summary: 8 year old African American female with a history of chronic cough for 2 years presents with fever, abdominal pain, and hemoptysis for 1day. Cervical lymphadenopathy Decreased breath sounds in the left lower lobe Mild clubbing CXR with infiltrates Elevated white count and inflammatory markers
12 Infectious: Differential Diagnosis: chronic cough with hemoptysis MTB, NTM, bacterial pneumonia, etc.. Bronchiectasis secondary to: cystic fibrosis, PCD, or chronic infection Rheumatologic disease: Goodpasture's syndrome, Wegners granulomatosis, SLE, JRA Cardiac: Pulmonary hypertension, mitral stenosis, chronic heart failure Idiopathic pulmonary hemosiderosis
13 Evaluate for infectious etiologies: Diagnostic Plan resp culture, fungal culture, AFB x3, sputum AFB PCR, PPD, HIV Ab, cocci, histo, ASO, mycoplasma titers ECHO Sweat Cl test Complete PFTs CT chest w/ and w/o contrast Bronchoscopy with BAL Evaluate for Rheumatic etiologies
14 Results ECHO Normal CBG 7.44/28//19 Sweat Cl 12 and 19 meq/l NBT Normal QUIGs Normal Complement Normal ACE Normal Smith Ab Negative RNP Ab Negative Glomerular BMAb Negative C-ANCA Negative P-ANCA Negative ANA Negative PPD AFB ASO HIV Ab Quant, Tb Gold Aspergillus RAST Histo Ag urine Cocci Ab Blastomyces Ab Negative Negative X3 Negative Non-reactive Intermediate Negative Negative Negative Negative Mycoplasma Ab IgG ( ) Mycoplasma Ab IgM ( ) Respiratory Culture Strep Pneumoniae
15 PFT FVC 101 %predicted FEV1 97 %predicted FEF25-75% 118 %predicted VC 97 %predicted RV 112 %predicted TLC 101 %predicted N2 Delta/L 1.1% DLCO/VA 6 ml/mhg/min/l O2 sat 98% P ET CO2 34 torr
16
17
18 Chest CT Bilateral areas of poorly defined ground glass nodularity Area of dense consolidation in the left lower lobe Possible areas of underlying interstitial lung disease
19 Bronchoscopy Bronchoscopy Results Nasal cilia brush biopsy Insufficient sample BAL cytopathology BAL Fluid Respiratory Culture Fungal Culture Viral Culture TB PCR Respiratory Viral Panel Trachea and mainstem bronchi normal. Very mild mucosal erythema. Secretions were thin and clear. Few Macrophages and epithelial cells in a mucinus background. No evidence of viral inclusions or microorganisms. Hazy Light Pink RBC 1920 WBC 90 (Segs 38%, Lymph 11%, Mono 32%) Strep Viridans Negative Negative Negative Negative
20 Hospital Course HD#1 HD#2 HD#3 HD#4 HD#5 Started on Ceftriaxone and Azithromycin Fevers resolved Hemoptysis and cough improving Bronchoscopy performed Patient is doing well and clinically stable for discharge Do we know what caused this patient s illness? Should we send her home? What is the next step? HD#11 Thorascopic lung biospy of the left lower lobe
21
22
23 Lung Biospy Results ORGANIZING PNEUMONIA FIBROBLASTIC PLUGS MILD CELLULAR INTERSTITIAL PNEUMONITIS MILD CHRONIC BRONCHIOLITIS RECENT HEMORRHAGE NO VASCULITIS NO GRANULOMAS FEW EOSINOPHILS
24 Lung Biospy Results H&E FIBROBLASTIC FOCI Trichrome RECENT HEMORRHAGE
25 Management Cryptogenic Organizing Pneumonia (COP) Solumedrol 15mg/kg/dose IV Q month for 3-6 months Discharge plan: Xopenex HFA twice a day Calcium and Vitamin D Will need stress dose of steroids for illnesses Follow up: Received second month of steroids Cough improved No hemoptysis First follow up appointment this month
26 Epidemeology: 6-7/1000 Mean age 58years Etiology: Cryptogenic Organizing Pneumonia (COP) Clinical Atlas of Interstitial Lung Disease. Sharma. 2006
27 Clinical Symptoms: May mimic community-acquired PNA Mild fever, nonproductive cough, sweats, anorexia, fatigue, weight loss, and mild dyspnea Hemoptysis is rare Cryptogenic Organizing Pneumonia Physical Exam: Inspiratory crackles Wheezing and clubbing are rare Labs: Neutrophilia, ESR, CRP
28 Cryptogenic Organizing Pneumonia PFT Mild restrictive disease w/o obstruction DLCO CXR bilateral, bibasilar, peripheral, and sometimes migratory patchy alveolar pattern HRCT consolidation and ground-glass pattern
29 Cryptogenic Organizing Pneumonia BAL moderate increase of lymphocytes, neutrophils, and eosinophils Histopathology excessive proliferation of granulation tissue within small airways(i.e., proliferative bronchiolitis) and alveolar ducts chronic inflammation in surrounding alveoli
30 Cryptogenic Organizing Pneumonia Treatment: Steroids (3-6 months) Prednisone 1-2mg/kg/day Methylprednisolone 15-30mg/kg/day Qmonth Immune modulators Outcome Complete disappearance of infiltrates in 65-85% Rx with steroids Relapses are common
31 Bronchiolitis Obliterans vs Cryptogenic Organizing Pneumonia Steroids Poor response Good response Outcome Poor Good Pediatric Respiratory Medicine. Taussig. 2008
32 BO vs COP Mosaic hypoluciencies indicative of air trapping Patchy consolidation and ground-glass opacities Williams KM et al. JAMA. 2009;302.No3.: Clinical Atlas of Interstitial Lung Disease. Sharma. 2006
33 BO vs COP Bronchial airway lumen obliteration by submucosal fibrosis Loose plugs of connective tissue in an alveolar duct ( )and adjacent alveolar spaces Pediatric Respiratory Medicine. Taussig Lynch D A et al. Radiology 2005;236:10-21
34 References 1. Epler GR, Colby TV, McLoud TC, et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med. Jan ;312(3): Cordier JF. Cryptogenic organising pneumonia. Eur Respir J. 2006;28(422). 3. Kwan, Ali. Bronchiolitis Obliterans Organizing Pneumonia. Emedicine. 4. King T. Cryptogenic Organizing Pneumonia. Uptodate. 5. Al-Ghanem Sara, Al-Jahdali Hamdan, Bamefleh, Khan Ali Nawaz. Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review. Annals of Thoracic Medicine. Vol3. Iss 2. Aptril-June White KA, Ruth-Sahd LA. Bronchiolitis obliterans organizing pneumonia. Crit Care Nurse. 2007; 27: Epler GR. Bronchiolitis obliterans organizing pneumonia. Arch Intern Med. Vol 161. Jan 22, 2001.
35 THANK YOU
Radiological Findings in BO
Radiological Findings in BO BO-Meeting 2016 Schloss Johannisberg Geisenheim - Rheingau Germany Dr. Simon Martin Department of Diagnostic and Interventional Radiology University Hospital Frankfurt Bronchiolitis
More informationRecurrent or Persistent Pneumonia
Recurrent or Persistent Pneumonia Lower Respiratory Tract Dr T Avenant Recurrent or Persistent Pneumonia Definitions Recurrent pneumonia more than two episodes of pneumonia in 18 months Persistent pneumonia
More informationDiagnosis & Treatment Of Cough
Diagnosis & Treatment Of Cough a.diagnosis : - Details History - Physical Examination - Investigation b. Treatment of cough Detail history provides valuables clues for etiology of the cough - Acute or
More informationMarilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
More informationTests. Pulmonary Functions
Pulmonary Functions Tests Static lung functions volumes Dynamic lung functions volume and velocity Dynamic Tests Velocity dependent on Airway resistance Resistance of lung tissue to change in shape Dynamic
More informationOccupational Lung Disease. David Perlman, MD
Occupational Lung Disease David Perlman, MD What causes occupational lung diseases? Breathing bad stuff into your lung Mechanism of particle deposition Large particles (>0.5μM) Impaction Gravitational
More informationSeptember 2008 [KT 168] Sub. Code: 2063 M.D. DEGREE EXAMINATION Branch XVII Tuberculosis and Respiratory Diseases NON-TUBERCULOSIS CHEST DISEASES Common to Part II Paper II - (Old /New/Revised Regulations)
More informationPulmonary Complications of Cancer Therapy. Marc B. Feinstein, MD Pulmonary Division Memorial Sloan-Kettering Cancer Center
Pulmonary Complications of Cancer Therapy Marc B. Feinstein, MD Pulmonary Division Memorial Sloan-Kettering Cancer Center Tobacco About 85% of lung cancers occur in current/former smokers. Tobacco causes
More informationRespiratory Concerns in Children with Down Syndrome
Respiratory Concerns in Children with Down Syndrome Paul E. Moore, M.D. Associate Professor of Pediatrics and Pharmacology Director, Pediatric Allergy, Immunology, and Pulmonary Medicine Vanderbilt University
More informationwritten by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd
written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd What Is COPD? COPD stands for chronic obstructive pulmonary disease. There are two major diseases included in
More informationDefending the Rest Basics on Lung Cancer, Other Cancers and Asbestosis: Review of the B-Read and Pulmonary Function Testing
Defending the Rest Basics on Lung Cancer, Other Cancers and Asbestosis: Review of the B-Read and Pulmonary Function Testing ASBESTOSIS November 2013 Bruce T. Bishop Lucy L. Brandon Willcox & Savage 440
More informationPneumonia Education and Discharge Instructions
Pneumonia Education and Discharge Instructions Pneumonia Education and Discharge Instructions Definition: Pneumonia is an infection of the lungs. Many different organisms can cause it, including bacteria,
More informationASTHMA IN INFANTS AND YOUNG CHILDREN
ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to
More informationLung Cancer. This reference summary will help you better understand lung cancer and the treatment options that are available.
Lung Cancer Introduction Lung cancer is the number one cancer killer of men and women. Over 165,000 people die of lung cancer every year in the United States. Most cases of lung cancer are related to cigarette
More informationPharmacology of the Respiratory Tract: COPD and Steroids
Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart
More informationStreptococcal Infections
Streptococcal Infections Introduction Streptococcal, or strep, infections cause a variety of health problems. These infections can cause a mild skin infection or sore throat. But they can also cause severe,
More informationRespiratory Care Protocols
Respiratory Care Protocols 1 Terms resource utilization? critical pathways? protocols? capitation? managed care? case management? clinical practice guidelines? 2 1 Clinical Practice Guidelines (CPGs) developed
More informationInfluenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus:
Respiratory Disorders Bio 375 Pathophysiology General Manifestations of Respiratory Disease Sneezing is a reflex response to irritation in the upper respiratory tract and is associated with inflammation
More informationPulmonary interstitium. Interstitial Lung Disease. Interstitial lung disease. Interstitial lung disease. Causes.
Pulmonary interstitium Interstitial Lung Disease Alveolar lining cells (types 1 and 2) Thin elastin-rich connective component containing capillary blood vessels Interstitial lung disease Increase in interstitial
More informationRheumatoid arthritis (RA) is a systemic inflammatory disorder which has pleuroparenchymal
Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disorder which has pleuroparenchymal involvement with varied manifestations which includes organizing pneumonia, interstitial fibrosis,
More informationKINDRED HEALTHCARE. Billing & Coding for SNF Physician Visits. KINDRED HEALTHCARE Continue the Care
KINDRED HEALTHCARE Billing & Coding for SNF Physician Visits KINDRED HEALTHCARE Continue the Care 1 SNF CPT Codes Initial Care Services 99304 99305 99306 Subsequent Care Services 99307 99308 99309 99310
More informationINTERSTITIAL LUNG DISEASE Paul F. Simonelli, MD, Ph.D.
INTERSTITIAL LUNG DISEASE Paul F. Simonelli, MD, Ph.D. Definition: Interstitial lung disease (ILD) refers to a broad range of conditions that have common clinical, physiological, and radiological features.
More informationOnline supplements are not copyedited prior to posting.
Functional Impact of a Spectrum of Interstitial Lung Abnormalities in Rheumatoid Arthritis Tracy J. Doyle, MD, MPH; Paul F. Dellaripa, MD; Kerri Batra, MD; Michelle L. Frits, BA; Christine K. Iannaccone,
More informationDermatomyositis and interstitial lung disease. Asmin Tulpule, HMS III November 16, 2009 Core Radiology Clerkship
Dermatomyositis and interstitial lung disease Asmin Tulpule, HMS III November 16, 2009 Core Radiology Clerkship Agenda Presentation of our patient Menu of radiologic tests Basics of interstitial lung disease
More informationBilling and Coding Conference
Billing and Coding Conference February 26 th 2013 Agenda 1. Hospital Medicine Coding Pattern 2. Tips to maximize individual billing 3. Billing audit 4..SPLITSHAREDNPPVISIT 5. Basic Coding Guidelines focus
More informationIdiopathic Pulmonary Fibrosis (IPF) Research
Idiopathic Pulmonary Fibrosis (IPF): Why Early Referral is Critical Even if Your Patient is Not Eligible for a Clinical Trial Idiopathic Pulmonary Fibrosis (IPF) Research Management of IPF requires a confident
More informationPre-Operative Services Teaching Rounds 2 Jan 2011
Pre-Operative Services Teaching Rounds 2 Jan 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu
More information2.06 Understand the functions and disorders of the respiratory system
2.06 Understand the functions and disorders of the respiratory system 2.06 Understand the functions and disorders of the respiratory system Essential questions What are the functions of the respiratory
More informationRestrictive lung diseases
Restrictive lung diseases Characterized by reduced compliance of the lung. Prominent changes in the interstitium (interstitial lung disease). Important signs and symptoms: - Dyspnea. - Hypoxia. - With
More informationChronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways
More informationApril 2015 CALGARY ZONE CLINICAL REFERENCE PULMONARY CENTRAL ACCESS & TRIAGE
April 2015 CALGARY ZONE CLINICAL REFERENCE CENTRAL ACCESS & TRIAGE Introduction Pulmonary consulting services are organized through the Calgary Zone Pulmonary Central Access and Triage (PCAT). Working
More informationMaria Dalbey RN. BSN, MA, MBA March 17 th, 2015
Maria Dalbey RN. BSN, MA, MBA March 17 th, 2015 2 Objectives Participants will be able to : Understand the Pathogenesis of Tuberculosis (TB) Identify the Goals of Public Health for TB Identify Hierarchy
More informationRestrictive vs. Obstructive Disease (Dedicated to my good friend Joe Walsh)
Restrictive vs. Obstructive Disease (Dedicated to my good friend Joe Walsh) The field of medicine has a long history of describing or classifying disease. Pulmonary disease is no different. Although there
More informationLung Disease. Lung Disease Veterinary Specialists of Rochester
Lung Disease Introduction The definition of pneumonia is defined as inflammation in the lungs. This inflammation can happen suddenly (acute) or develop over a more gradual period of time (chronic). Pneumonia
More informationInterstitial lung disease in a rheumatic electrician
Interstitial lung disease in a rheumatic electrician Case history The case presented here concerns a male, born in 1931, who was an electrician for 34 years. He had frequent and close contact with asbestos,
More informationYour Lungs and COPD. Patient Education Pulmonary Rehabilitation. A guide to how your lungs work and how COPD affects your lungs
Patient Education Your Lungs and COPD A guide to how your lungs work and how COPD affects your lungs Your lungs are organs that process every breath you take. They provide oxygen (O 2 ) to the blood and
More informationPLAN OF ACTION FOR. Physician Name Signature License Date
PLAN OF ACTION FOR Patient s copy (patient s name) I Feel Well Lignes I feel short directrices of breath: I cough up sputum daily. No Yes, colour: I cough regularly. No Yes I Feel Worse I have changes
More informationLOEWENBERG SCHOOL OF NURSING LOEWENBERG SCHOOL OF NURSING HEALTH EXAMINATION FORM (FORM 003)
SECTION I: To be completed by STUDENT: Name: DOB: Address: Phone (H): Phone (C): Health History: Please complete the following information: Recent weight loss or gain Fatigue, fever, sweats Difficulty
More informationObjectives COPD. Chronic Obstructive Pulmonary Disease (COPD) 4/19/2011
Objectives Discuss assessment findings and treatment for: Chronic Obstructive Pulmonary Disease Bronchitis Emphysema Asthma Anaphylaxis Other respiratory issues Provide some definitions Chronic Obstructive
More informationPulmonary Associates of Richmond
Pulmonary Associates of Richmond Name: Address One: City: Home Phone#: Work Phone#: Cell Phone#: State: Zip: Sex: Social Security Number: Referring Doctor: of Birth: Employer: Primary Care Doctor: Employment
More informationDisease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200
GUIDE TO ASBESTOS LUNG CANCER What Is Asbestos Lung Cancer? Like tobacco smoking, exposure to asbestos can result in the development of lung cancer. Similarly, the risk of developing asbestos induced lung
More informationDate: Referring Facility: Phone#: Anticipated Patient Needs (Please check appropriate boxes and include details within referral paperwork)
Barbara McInnis House Initial Referral Form Please fill form out completely. Include additional forms if prompted. Fax to Admissions Department. Follow up with a phone call. Patient Name: DOB: Gender:
More informationCOPD It Can Take Your Breath Away www.patientedu.org
written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org What Is COPD? COPD stands for chronic obstructive pulmonary disease. There are 2 major diseases included in COPD:
More informationCystic Lung Diseases. Melissa Price Gillian Lieberman, MD Advanced Radiology Clerkship Beth Israel Deaconess Medical Center November, 2008
Cystic Lung Diseases Melissa Price Gillian Lieberman, MD Advanced Radiology Clerkship Beth Israel Deaconess Medical Center November, 2008 How do we define a cyst of the lung? Hansell DM, Bankier AA, MacMahon
More informationInterstitial Lung Diseases ACOI Board Review 2013
Interstitial Lung Diseases ACOI Board Review 2013 Thomas F. Morley, DO, FACOI, FCCP, FAASM Professor of Medicine Director of the Division of Pulmonary, Critical Care and Sleep Medicine UMDNJ-SOM Restrictive
More informationSARCOIDOSIS. Signs and symptoms associated with specific organ involvement can include the following:
SARCOIDOSIS Sarcoidosis is a disease that occurs when areas of inflammation develop in different organs of the body. Very small clusters of inflammation, called granulomas, are seen with sarcoidosis. They
More informationThe Aged Lung per se and Chronic Pulmonary Diseases in and around the Aged Lung
Special Article* The Aged Lung per se and Chronic Pulmonary Diseases in and around the Aged Lung Takashi Nakamura I. Introduction Professor of the First Department of Internal Medicine, School of Medicine,
More informationCystic Fibrosis. Cystic fibrosis affects various systems in children and young adults, including the following:
Cystic Fibrosis What is cystic fibrosis? Cystic fibrosis (CF) is an inherited disease characterized by an abnormality in the glands that produce sweat and mucus. It is chronic, progressive, and is usually
More informationPericardial Effusion. By Nancy Liao
Pericardial Effusion By Nancy Liao 24 y/o female with history of metatropic dysplasia presents with 2 weeks of dry progressive cough, dyspnea, increased work of breathing, somnolence, exhaustion, and diffuse
More informationDepartment of Surgery
What is emphysema? 2004 Regents of the University of Michigan Emphysema is a chronic disease of the lungs characterized by thinning and overexpansion of the lung-like blisters (bullae) in the lung tissue.
More informationAsthma in Infancy, Childhood and Adolescence. Presented by Frederick Lloyd, MD Palo Alto Medical Foundation Palo Alto, California
Asthma in Infancy, Childhood and Adolescence Presented by Frederick Lloyd, MD Palo Alto Medical Foundation Palo Alto, California Major Health Problem in Childhood Afflicts 2.7 million children in the USA
More informationCERVICAL MEDIASTINOSCOPY WITH BIOPSY
INFORMED CONSENT INFORMATION ADDRESSOGRAPH DATA CERVICAL MEDIASTINOSCOPY WITH BIOPSY You have decided to have an important procedure and we appreciate your selection of UCLA Healthcare to meet your needs.
More informationKey Facts about Influenza (Flu) & Flu Vaccine
Key Facts about Influenza (Flu) & Flu Vaccine mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching
More informationRESPIRATORY VENTILATION Page 1
Page 1 VENTILATION PARAMETERS A. Lung Volumes 1. Basic volumes: elements a. Tidal Volume (V T, TV): volume of gas exchanged each breath; can change as ventilation pattern changes b. Inspiratory Reserve
More informationCardiovascular diseases. pathology
Cardiovascular diseases pathology Atherosclerosis Vascular diseases A disease that results in arterial wall thickens as a result of build- up of fatty materials such cholesterol, resulting in acute and
More informationEmergency Scenario. Chest Pain
Emergency Scenario Chest Pain This emergency scenario reviews chest pain in a primary care patient, and is set up for roleplay and case review with your staff. 1) The person facilitating scenarios can
More informationTHINGS THAT LOOK LIKE ASTHMA. Robert W Hostoffer, DO, FACOP, FAAP, FACOI,FCCP Program Director: Conjoint Allergy/Immunology Fellowship Cleveland,Ohio
THINGS THAT LOOK LIKE ASTHMA Robert W Hostoffer, DO, FACOP, FAAP, FACOI,FCCP Program Director: Conjoint Allergy/Immunology Fellowship Cleveland,Ohio ASTHMA SYMPTOMS Wheezing Cough Dyspnea Nocturnal cough,
More informationThe patient s response to therapy within the first hour in the Emergency Room is one of the most reliable ways to predict need for hospitalization.
Emergency Room Asthma Management Algorithm The Emergency Room Asthma Management Algorithm is to be used for any patient seen in the Emergency Room with the diagnosis of asthma. (The initial history should
More informationWhooping Cough. The Lungs Whooping cough is an infection of the lungs and breathing tubes, both of which are parts of the respiratory system.
Whooping Cough Introduction Whooping cough is a serious bacterial infection of the lungs and breathing tubes. It is also called pertussis. About 16 million cases of whooping cough happen worldwide each
More informationPediatric Latent TB Diagnosis and Treatment
Date Updated: April 2015 Guidelines Reviewed: 1. CDC Latent TB Guidelines 2. Harborview Pediatric Clinic Latent TB Management, 2010 3. Pediatric Associates Latent TB Guidelines, 2013 4. Seattle Children
More informationInpatient Rotations Goals and Objectives Third and Fourth Years
Inpatient Rotations Goals and Objectives Third and Fourth Years Faculty: Members of the LSU Department of Pediatrics Goal: To develop competency in caring for, and supervising care of, infants, children,
More informationSore Throat. Definition. Causes. (Pharyngitis; Tonsillopharyngitis; Throat Infection) Pronounced: Fare-en-JY-tis /TAHN-sill-oh-fare-en-JY-tis
Sore Throat (Pharyngitis; Tonsillopharyngitis; Throat Infection) Pronounced: Fare-en-JY-tis /TAHN-sill-oh-fare-en-JY-tis by Jennifer Lewy, MSW En Español (Spanish Version) Definition A sore throat is the
More information1584 Wesleyan Drive FORM A Norfolk, VA 23504 Phone: (757) 455-3108 Health History immunization & Physical Form
Mail completed form to: Marlin Health Services 1584 Wesleyan Drive FORM A Norfolk, VA 23504 Phone: (757) 455-3108 Health History immunization & Physical Form Virginia State law (code 23-7.5) requires all
More informationPTE Pediatric Asthma Metrics Reporting Updated January 2015
PTE Pediatric Asthma Metrics Reporting Updated January 20 Introduction: The Maine Health Management Coalition s (MHMC) Pathways to Excellence (PTE) Program is preparing for its next round of PTE Pediatric
More informationGastric Banding and Smoking
The Hidden Cost of Gastric Banding Wai Kuen Chow Physician Advanced Trainee Concord Repatriation Hospital 18th May 2009 Introduction Laparoscopic Gastric Banding Preferred weight loss surgery for morbid
More informationPULMONARY HEMORRHAGE COMPLICATING PULMONARY ARTERIAL ANEURYSMS IN A YOUNG FEMALE WITH BEHCET S DISEASE
PULMONARY HEMORRHAGE COMPLICATING PULMONARY ARTERIAL ANEURYSMS IN A YOUNG FEMALE WITH BEHCET S DISEASE Roman Czubatyj M.D Diego Vasquez M.D Rheumatology Fellows 2 WSU/DMC/HFH YOUR PATIENT 28 year old female,
More informationRoswell Ear, Nose, Throat, & Allergy 342 W. Sherrill Lane Suite A, Roswell, New Mexico 88201 (575)-622-2911 Fax: (575)-622-2598
Roswell Ear, Nose, Throat, & Allergy 342 W. Sherrill Lane Suite A, Roswell, New Mexico 88201 (575)-622-2911 Fax: (575)-622-2598 Patient Registration Form: (Please Print all Pertinent Information) Last
More informationJ. A. HILDES NORTHERN MEDICAL UNIT DEPARTMENT OF COMMUNITY HEALTH SCIENCES AND DEPARTMENT OF PEDIATRICS AND CHILD HEALTH FACULTY OF MEDICINE
J. A. HILDES NORTHERN MEDICAL UNIT DEPARTMENT OF COMMUNITY HEALTH SCIENCES AND DEPARTMENT OF PEDIATRICS AND CHILD HEALTH FACULTY OF MEDICINE Recommendations for Evidence-Based Care for Bronchiolitis 2005
More informationPreoperative Laboratory and Diagnostic Studies
Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no
More informationLEARNING OUTCOMES. Identify children at risk of developing TB disease. Correctly manage and refer children suspected of TB. Manage child contacts
TB in Children 1a TB IN CHILDREN 2 LEARNING OUTCOMES Identify children at risk of developing TB disease Correctly manage and refer children suspected of TB Manage child contacts 3 TB Infection and Disease
More information3 Rd Year Medical Student Lecture Series. Rheumatology Cases. N. Lawrence Edwards, MD
3 Rd Year Medical Student Lecture Series Rheumatology Cases N. Lawrence Edwards, MD Case Study #1 32 yo WF accountant with 6 months of bilat finger and wrist pain and swelling. Morning stiffness involving
More informationHIV and Hepatitis B CoInfection
HIV and Hepatitis B CoInfection Douglas G. Fish, MD June 3, 2014 44 yo male with AIDS who had fallen out of care and returned in October 2013 Last seen in November 2012 CD4 at that time 340 cells/cmm HIV
More informationCPT codes are for information only; consult your payer organization for reimbursement information.
CPT codes are for information only; consult your payer organization for reimbursement information. Coverage for Spirometry/Oximetry Spirometry is a component of pulmonary function testing (PFTs). PFTs
More informationPulmonary Disorders. Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD)
RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Pulmonary Disorders Chronic Obstructive Pulmonary Disease (COPD) Characterized by decreased expiratory airflow Reduction in expiratory
More informationJAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557
FIGHTING PAIN. TOUCHING LIVES. JAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557 Personal Information Emergency Contact Today s Date: Name: Patient: Realtionship: Birth Date: Age: Sex:
More informationMedicare C/D Medical Coverage Policy
Nebulizer Medications Origination: June 17, 2009 Review Date: October 21, 2015 Next Review: October, 2017 Medicare C/D Medical Coverage Policy DESCRIPTION Nebulizer medications are used to prevent and
More informationPulmonary Patterns VMA 976
Pulmonary Patterns VMA 976 PULMONARY PATTERNS Which pulmonary patterns are commonly described in veterinary medicine? PULMONARY PATTERNS Normal Alveolar Interstitial Structured/Nodular Unstructured Bronchial
More informationSwine Flu and Common Infections to Prepare For. Rochester Recreation Club for the Deaf October 15, 2009
Swine Flu and Common Infections to Prepare For Rochester Recreation Club for the Deaf October 15, 2009 Supporters Deaf Health Community Committee Members Julia Aggas Cathie Armstrong Michael McKee Mistie
More informationPulmonary Complications from Lung Cancer Treatment, Part 1: Chemotherapy-Induced Pneumonitis by Dr. Gerard Silvestri, Medical University of South Carolina Dr. West: Hello, and welcome to our webinar with
More informationCanine Chronic Bronchitis Lisa Shearer DVM, DVSc, Diplomate ACVIM (internal medicine)
Canine Chronic Bronchitis Lisa Shearer DVM, DVSc, Diplomate ACVIM (internal medicine) Chronic bronchitis (CB) is defined as a daily cough for greater than two months in which other causes of cough, such
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE. Includes: Bronchitis (chronic and acute) Emphysema
THE BASICS OF BREATHING: Assessment & Treatment Approaches for the Patient with COPD Jocelyn Alexander, MA CCC-SLP Director of Program Development Therapy Partners of Ohio LEARNER OBJECTIVES: Identify
More informationCough, as a leading symptom, would certainly be in the top 10 of reasons for seeing a GP.
COUGH Cough, as a leading symptom, would certainly be in the top 10 of reasons for seeing a GP. A cough in a child seems to cause more concern, even when it has not been present very long, whereas in adults
More informationLOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH:
LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH: DRIVERS LICENSE NUMBER: STATE: EMAIL ADDRESS: MARITAL STATUS: ( ) SINGLE ( )
More informationBetter Breathing with COPD
Better Breathing with COPD People with Chronic Obstructive Pulmonary Disease (COPD) often benefit from learning different breathing techniques. Pursed Lip Breathing Pursed Lip Breathing (PLB) can be very
More informationGeneral Thoracic Surgery ICD9 to ICD10 Crosswalks. C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
ICD-9 Code ICD-9 Description ICD-10 Code ICD-10 Description 150.3 Malignant neoplasm of upper third of esophagus C15.3 Malignant neoplasm of upper third of esophagus 150.4 Malignant neoplasm of middle
More informationDiagnostics: Page 2 of 5
Proteinuria Proteinuria is a condition in which there are increased amounts of protein in the urine. There are a number of different diseases which can result in proteinuria. In the early stages of the
More informationUSC Pediatric Residency Program Quality Improvement Pre-Program Self Assessment
USC Pediatric Residency Program Quality Improvement Pre-Program Self Assessment 1. Have you had previous experience in quality improvement (QI)? Yes No 2. How many formal quality improvement projects have
More informationHEALTH EFFECTS. Inhalation
Health Effects HEALTH EFFECTS Asbestos can kill you. You must take extra precautions when you work with asbestos. Just because you do not notice any problems while you are working with asbestos, it still
More informationBASIC INFORMATION ABOUT HIV, HEPATITIS B and C, and TUBERCULOSIS Adapted from the CDC
BASIC INFORMATION ABOUT HIV, HEPATITIS B and C, and TUBERCULOSIS Adapted from the CDC HIV What are HIV and AIDS? HIV stands for Human Immunodeficiency Virus. This is the virus that causes AIDS. HIV is
More informationChemotherapy Side Effects Worksheet
Page 1 of 6 Chemotherapy Side Effects Worksheet Medicines or drugs that destroy cancer cells are called cancer chemotherapy. It is sometimes the first choice for treating many cancers. Chemotherapy differs
More informationRheumatoid Arthritis. Nicole Klett,, M.D.
Rheumatoid Arthritis Nicole Klett,, M.D. Rheumatoid Arthritis Systemic Chronic Inflammatory Primarily targets the synovium of diarthrodial joints Etiology likely combination genetic and environmental Diarthrodial
More informationExploring the Role of Vitamins in Achieving a Healthy Heart
Exploring the Role of Vitamins in Achieving a Healthy Heart There are many avenues you can take to keep your heart healthy. The first step you should take is to have a medical professional evaluate the
More informationTuberculosis and You A Guide to Tuberculosis Treatment and Services
Tuberculosis and You A Guide to Tuberculosis Treatment and Services Tuberculosis (TB) is a serious disease that can damage the lungs or other parts of the body like the brain, kidneys or spine. There are
More informationStandard of Care: Pulmonary Physical Therapy Management of the patient with pulmonary disease
BRIGHAM & WOMEN S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Pulmonary Case Type / Diagnosis: This standard of care applies to any patient with obstructive or restrictive
More informationTUBERCULOSIS PLEURAL EFFUSION - MANAGEMENT
TUBERCULOSIS PLEURAL EFFUSION - MANAGEMENT Introduction : ETB 15-20% Pleural effusion 20% in non HIV Under reporting because of AFB negative in fluid In HIV patients: EPTB 20% PTB + EPTB 50% Pleural Effusion
More informationSubject ID: Subject Initials Date completed Interviewer. Person answering questions. 1 yes 2 no
COAST III Childhood Origins of ASThma Asthma Allergy Symptoms COAST 3 year visit Subject ID Subject ID: Subject Initials Date completed Interviewer Person answering questions 99. This form was completed
More informationLeader's Resource. Note: Both men and women can have an STD without physical symptoms.
Leader's Resource Information on Sexually Transmitted Diseases (STDs) Signs and Symptoms of STDs Note: Both men and women can have an STD without physical symptoms. Any of the following can indicate to
More informationA Guide to MANAGING. breathe easy
A Guide to MANAGING Respiratory Infections breathe easy A Guide to MANAGING Respiratory Infections breathe easy Copyright 2008 Conrad & Associates, LLC All Rights Reserved No part of this book may be reproduced
More informationSmall cell lung cancer
Small cell lung cancer Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The lungs are a pair of cone-shaped breathing organs that are found within
More informationIs it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine
Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of
More information