Case Analysis : ' Bronchoscopy Flexible Bronchoscopy '

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Procedures
○ Bronchoscopy 4
– General explanation
□ Flexible bronchoscopy is performed to determine whether there is an underlying cause of infection, such as a growth or inhaled foreign body; a biopsy or fluid sample may be collected
– Indication
□ Severe pneumonia that does not respond to antibiotic treatment
□ Pneumonia of unknown etiology
– Contraindications
□ There are no absolute contraindications
□ Relative contraindications include
□ Coagulopathy
□ Recent myocardial infarction, unstable angina or serious dysrhythmias
□ Tracheal stenosis
□ Asthma
□ If a foreign body is suspected, a rigid bronchoscopy under general anesthesia is preferred
– Interpretation of results
□ Bronchoscopy will help to determine
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atory acidosis (pH < 7.35) with elevated pCO₂ can indicate impending respiratory failure
DIFFERENTIAL DIAGNOSIS
• Most common
○ Nosocomial tracheobronchitis

– Clinical findings are the same as for pneumonia (fever, leukocytosis, purulent secretions), but there is no new lung infiltrate
– Chest radiograph and blood cultures are differentiating
○ Congestive heart failure
– Exertional dyspnea and paroxysmal nocturnal dyspnea are characteristic of heart failure
– Blood tests, chest radiograph and ECG are differentiating
Acute respiratory distress syndrome
– Clinical history is different - acute dyspnea and hypoxemia are developed within hours to days of an inciting event
(trauma, sepsis, drug overdose, acute pancreatitis, aspiration)
– Diagnostic imaging is differentiating

TREATMENT
GOALS
• Cure the infection
• Prevent complications
DISPOSITION
• Admission criteria 1
○ Patients who do not require oxygen therapy or supportive measures are generally treated on an outpatient basis
○ Decision to admit a patient is based on severity of pneumonia
– Age - elderly patients/nursing-home residents are at a higher risk for severe pneumonia and complications
– Presence and severity of comorbid diseases can affect response to treatment and need for supportive measures
– High risk of severe pneumonia and complications can be determined based on
□ Physical examination findings (altered mental status, fever, high pulse and respiratory rate, low blood pressure)
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