Other Pulmonary Conditions

CO poisoning, ARDS, pulmonary contusion, IPF, PE, cor pulmonale.

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◆CO poisoning

•Headache + confusion + enclosed space + NORMAL SpO₂ (CO binds Hb >200x more than O₂)
•Check carboxyhemoglobin level
•100% O₂ via non-rebreather
•Hyperbaric O₂ if pregnancy, neuro symptoms, COHb >25%

•Acute bilateral infiltrates + refractory hypoxemia + PaO₂/FiO₂ ≤300 + normal heart size
•Low tidal volume ventilation (~6 mL/kg PBW) — only strategy proven to improve mortality
•PEEP to prevent alveolar collapse
•Target SpO₂ 88–95% (avoid O₂ toxicity)
•Permissive hypercapnia tolerated
•Treat underlying (sepsis, etc.)

•Pulmonary contusion: blunt trauma + patchy alveolar opacities + hypoxia → supportive
•Atelectasis: post-op fever + hypoxemia without hypercapnia in first 48 hr → incentive spirometry
•TRALI: <6 hr post-transfusion + noncardiogenic edema → supportive (no diuretics); normal JVP
•TACO: <6 hr post-transfusion + cardiogenic edema + ↑JVP/HTN → diuretics
•Decompression sickness: after rapid scuba ascent + neuro/pulm sx → hyperbaric O₂
•PE: cancer + recent surgery + sudden dyspnea → CTPA
•Idiopathic pulmonary fibrosis: progressive dyspnea + dry cough + basilar peripheral honeycombing → pirfenidone, nintedanib
•Sarcoidosis: observe if asymptomatic; steroids if symptomatic or organ-threatening
•Asbestosis: pleural plaques + lower-lobe fibrosis → highest risk = bronchogenic CA (not mesothelioma)
•Pancoast tumor: smoker + apical mass + shoulder pain + Horner syndrome

•Low-dose CT annually (NOT CXR or sputum cytology)
•Age 50–80, ≥20 pack-years, current smoker or quit within 15 years (USPSTF 2021)
•Stop when age >80, ≥15 years since quitting, or life-expectancy-limiting illness
•Lung-RADS classification for nodule follow-up

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