emDocs - January 26, 2017 - Author: Simon E - Edited by: Koyfman A and Long B
Key Pearls
- Airway and breathing => keep in mind, there is a 70% mortality associated with an acute ILD exacerbation; intubated patients most commonly perish in the ICU.
- In the hemodynamically unstable patient, perform an EKG + bedside US.
- Hemodynamic instability in the setting of an ILD exacerbation results from progressive hypercapnia and subsequent hypoxia with cardiovascular collapse.
- In the stable patient, elicit a thorough history – patients with IPF, IPF associated with a connective tissue disease, chronic hypersensitivity pneumonitis, desquamative interstitial pneumonia, and asbestosis may experience acute exacerbations.
- Initiate an evaluation to rule out cardiac pathology, pulmonary infection, aspiration, pulmonary embolism, and medication effect.
- If the aforementioned evaluation identifies an ALI without etiology => presume ILD exacerbation, initiate broad-spectrum antibiotics, consult pulmonology, and admit to the ICU.
- HRCT is a great chest imaging modality, but if concerned for PE, obtain CTPA.