
Asthma Exacerbation
Rapid Review
- Background
- Diffuse airway inflammation characterized by bronchial hyperresponsiveness and reversible airflow obstruction.
- Acute exacerbations can be caused by viral infections, allergens, tobacco, or emotional factors
- Signs/Symptoms
- Dyspnea, cough, chest tightness. May present in respiratory failure.
- (+) expiratory wheezing, (+) tripod positioning
- Diagnosis
- Clinical diagnosis in emergency setting
- Formal diagnosis made with spirometry
- Treatment
- Nebulizers (albuterol/ipratropium), steroids, +/- magnesium, +/- epinephrine.
- May require NIPPV or intubation
Pearls
Deep Dive

Pleural Effusion
Rapid Review
- Background
- Accumulation of excess fluid between the pleural space outside of the lungs.
- May be transudative (due to fluid shifts) or exudative (due to infection, malignancy, etc.)
- Signs/Symptoms
- Dyspnea, pain with inspiration
- (+) decreased breath sounds, (+) decreased tactile fremitus, (+) dullness to percussion
- Diagnosis
- CXR (shows blunting of costophrenic angle). Chest CT/US can also be used.
- Thoracentesis is the gold standard. Light criteria used to differentiate transudative vs exudative effusion.
- Treatment
- Thoracentesis or tube thoracostomy (depending on size and etiology)
- Diuresis helpful if due to CHF
Pearls

Pneumonia (Bacterial)
Rapid Review
- Background
- Acute inflammation of the lungs caused by bacterial infection (typically S. pneumonia)
- Signs/Symptoms
- Symptoms: Fever/chills, cough, dyspnea, rigors, pleuritic chest pain
- Signs: Rust-colored sputum, tachycardia, rales/rhonchi
- Diagnosis
- Clinical findings, (+/-) CXR
- Treatment
- Antibiotics
- Outpatient (doxycycline or azithromycin)
- Inpatient (Ceftriaxone + azithromycin or fluoroquinolone)
- Antibiotics
Pearls
Deep Dive

Pneumothorax
Rapid Review
- Background
- Accumulation of free air in the pleural space, causing partial or complete collapse of the lung.
- Can be spontaneous (blebs, COPD, TB), iatrogenic (central line, thoracentesis), or traumatic (blunt/penetrating trauma)
- Signs/Symptoms
- Symptoms: dyspnea, ipsilateral chest pain
- Signs: (+) hyperresonance, (+) diminished breath sounds, (+) decreased tactile fremitus
- Diagnosis
- CXR (absent lung markings along periphery)
- Treatment
- Small pneumothorax (<15%) can be observed
- Large pneumothorax (>15%) require thoracostomy
Pearls
Deep Dive

Pulmonary Embolism
Rapid Review
- Background
- Occlusion of pulmonary arteries by thrombi that typically originate from the lower extremities or pelvis
- Signs/Symptoms
- Symptoms: Dyspnea (most common), pleuritic chest pain, syncope
- Signs: (+) tachypnea, (+) tachycardia, (+) hypotension
- Diagnosis
- CT PE is the gold standard
- CXR may show “westermark sign” or “Hampton hump”
- Treatment
- O2, anticoagulation (heparin, LMWH), hemodynamic support (fluids, pressors)
- Thrombolytics for unstable patients.
Pearls
Deep Dive