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EMED Unit 1 > 2 Airway and Respiratory Emergencies > Flashcards

2 Airway and Respiratory Emergencies Flashcards

1
Q

How do we diagnose respiratory failure?

A

What does the patient look like?

Do they have hypoxemia? Hypercabia?

Are they tachypnic? Tachycardic?

Signs of respiratory exhaustion

Use of accessory muscles

Retractions

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2
Q

_________ will often progress to ________ if not cleared

A

Partial airway obstruction —> complete airway obstruction

Complete will progress to respiratory arrest if not cleared

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3
Q

From time of complete obstruction to onset of brain damage is about _______.

A

4 minutes (FRC with 21% oxygen - b/c the lung holds 2L but only 21% of it is O2)

If you’re already on 100% O2 you have a little more time (why we pre-oxygenate before intubating)

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4
Q

Airway obstructions are usually encountered in…

A

The pre-hospital setting

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5
Q

Most common cause of airway obstruction

A

The tongue

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6
Q

When invasive airway management must be used, who should do it?

A

The most experienced practitioner - who has the most experience intubating?

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7
Q

Different types of airways

A

Oral airway
Nasal airway
Laryngeal Mask Airway (LMA)

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8
Q

What types of objects are easy for toddler’s to aspirate?

A

Small vocal cords/glottis, so the object needs to be SMALL

Peanuts
Hot dogs
Small marbles

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9
Q

Persistent cough, unilateral wheezing, decreased breath sounds in a toddler but no URI Sx

A

Foreign body aspiration

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10
Q

Why will you sometimes not see an aspirated FB on CXR?

A

If liquid or organic material, b/c they are radiolucent

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11
Q

Complications of FB aspiration

A

Post-obstructive atelectasis

Pneumonia

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12
Q

Most common location of a FB aspiration?

A

Right mainstem (b/c straighter) - 52%

But not ALWAYS:
Larynx - 3%
Tracheal/carina - 13%
Lower lobe of right lung - 6%
Left lung - 23% 
Bilateral - 2%
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13
Q

What do you do for a FB aspiration?

A

REMOVE IT (duh)

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14
Q

______ supersedes all else in trauma

A

Airway

May need nasal intubation if significant facial fractures

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15
Q

Important considerations for airways in trauma situations

A

LeForte fractures (facial)
Basilar skull fractures (loss of CSF)
Burns (b/c airway edema)

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16
Q

Why do you intubation burn victims immediately

A

Airway edema - intubate early, otherwise you might not be able to

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17
Q

Facial fracture involving separation of the maxilla from the rest of the skull

A

LeFort I - the mustache

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18
Q

Facial fracture above nasal bone

A

LeFort II

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19
Q

Facial fracture around orbits

A

LeFort III

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20
Q

Which types of facial fractures have an increased chance of cribriform fracture?

A

LeFor II and III

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21
Q

What is absolutely contraindicated in patients with LeFort II or III fractures?

A

Nasal airway - b/c they are likely to have a cribriform fracture too

Nobody wants to end up with a breathing tube in their brain

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22
Q

Signs of basilar skull fracture

A

Battle’s sign - bruising of the mastoid
Raccoon eyes
CSF from the nose and/or ears

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23
Q

Anaphylaxis and Acute Allergic Reactions are severe hypersensitivity reactions characterized by…

A

Release of immune mediators —> respiratory compromise and CV collapse

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24
Q

Pathophysiology of anaphylaxis

A

Antigen-antibody binds to MAST CELLS

IgE-mediated HISTAMINE RELEASE

Increased vascular permeability, vasodilation

Bronchial constriction

Increased mucous gland secretion

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25
Q

Common causes of anaphylaxis

A 
Antibiotics
ASA and NSAIDs
Shellfish, nuts, eggs, milk
Hymenopytera stings
Grasses
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26
Q

Clinical features of anaphylaxis

A 
Onset in seconds to hours
Angioedema
Tightening sensation in throat and chest
Laryngeal swelling and bronchial spasm, hoarseness, stridor, wheezing
Respiratory distress and apnea
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27
Q

Diagnosis of anaphylaxis is usually…

A

CLINICAL

Remember to check:
Airway
BP
SaO2 (or SpO2)
Lungs
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28
Q

How to treat anaphylaxis?

A 
AIRWAY MANAGEMENT
Oxygen
Epi if severe hypotension/severe obstruction
Antihistamines
Beta-2 agonists (albuterol)
Steroids (methylprednisolone - not quick)
Endotracheal intubation
Surgical airway
IV bolus if hypotensive
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29
Q

What are the two types of Epinephrine used in anaphylaxis?

A

IV 0.3-0.5 mg of 1:10,000 (1 mg in 10cc)***

SC 0.3-0.5 mg of 1:1,000*** more potent

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30
Q

What are the two different types of antihistamines used in anaphylaxis?

A

H1 blockers - diphenhydramine (Benadryl) at least 50 mg or hydroxyzine

H2 blockers - cimetidine (Zantac)

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31
Q

Why do you need to use both H1 blockers and H2 blockers when treating anaphylaxis?

A

B/c histamine release affects BOTH

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32
Q

An eruption similar to urticaria but with larger edematous areas that involve both dermis and SC structures, frequently involving the head and neck

A

Angioedema

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33
Q

Onset of angioedema is typically ______, with resolution within ______

A

Onset - minutes to hours

Resolution - hours to days

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34
Q

What are the two categories of causes of angioedema?

A

Hereditary - insufficient synthesis of C1-esterase inhibitor (rare, autosomal dominant)

Acquired - ie from ACE inhibitors

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35
Q

How is angioedema treated?

A

Airway management
Supportive
Plasma concentrate of C1-esterase inhibitor
Epi, antihistamines, steroids
DANAZOL - increases the synthesis of C1-esterase inhibitor
Ecallantide - Kallikrein inhibitor
Icatibant - Bradykinin receptor antagonist

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36
Q

Bilateral, rapidly spreading submandibular cellulitis, usually originating from the 2nd or 3rd molars

A

Ludwig’s Angina

Angina = suffocating sensation

37
Q

SSx of Ludwig’s Angina

A 
TONGUE ELEVATED
Hard, firm induration of the floor of the mouth
Perforation edema
Pain
Trismus (lock jaw)
MEDIASTINITIS (bad sign if present)
38
Q

Management of Ludwig’s Angina

A

Surgery***
Awake fiber optic nasal intubation
Sometimes awake tracheostomy

39
Q

What is a retropharyngeal abscess?

A

A localized collection of pus in the retropharyngeal space, or trauma related hematoma in the same space

Good thing it’s rare

40
Q

Common cause of the rare retropharyngeal abscess

A 
Mixed gram (-) and anaerobic bacteria
Tonsillitis
Otitis media
Pharyngeal trauma
Odynophagia
41
Q

SSx of retropharyngeal abscess

A 
Fever
Odynophagia
Neck swelling
Drooling
Torticollis
Meningismus
Cervical LAD
Stridor
Airway obstruction
42
Q

How to diagnose retropharyngeal abscess

A

Often clinical
Soft tissue lateral neck x-rays (looking for gas or a mass)
CT neck

43
Q

Patients with retropharyngeal abscesses are susceptible to…

A

Laryngospasm —> obstruction

44
Q

How to treat retropharyngeal abscess

A

Airway management
Antibiotics
Admission and surgical drainage

45
Q

An infection of the supraglottic structures including the epiglottis, lingual tonsillar area, epiglottis folds and false vocal cords

A

Epiglottitis - it’s an emergency!

46
Q

Epidemiology facts about epiglottis

A

Age 2-7 (before H. influenza B vaccine)
Seen occasionally in adults
HIB, Strep, Staph (not 100% protected by vaccine)
Rare

47
Q

SSx of epiglottitis

A 
Abrupt onset over several hours
Fever 
STRIDOR 
Toxic appearance
Dysphagia, odynophagia
DROOLING
TRIPOD POSITION****
Altered LOC
Cyanosis
Airway obstruction
48
Q

What should you never do if you suspect epiglottitis?

A

Never stick a tongue blade in their throat - call for an emergency ENT consult b/c very unstable

49
Q

What is the name of the xray finding associated with epiglottis?
🐝🐝🐝🐝🐝🐝🐝🐝

A

Thumb sign

50
Q

How to treat epiglottitis?

A

IMMEDIATE ENT CONSULT to control airway

Abx once airway is secure - 3rd gen cephalosporin (ie Ceftriaxone)

51
Q

A usually benign, self limited inflammatory condition of the trachea below the level of the vocal cords (subglottic)

A

Croup (Laryngotracheobronchitis)

52
Q

Croup is usually caused by…

A

Parainfluenza virus

53
Q

Epidemiology of croup

A

Age range 6 months to three years
Can see in patients as old as 15 years
Increased in winter
Mostly PIV, but can also be from RSV

54
Q

SSx of Croup

A 
2-3 day Hx of URI
Low grade fever
Gradual worsening “barking seal” cough, esp at night
Stridor
Dyspnea
Retractions
Tachypnea
55
Q

The younger the croup patient, the more likely they are to…

A

Develop respiratory distress

56
Q

How to diagnose croup

A

Usually clinical

PA CXR shows “steeple sign”, but not very sensitive or specific

57
Q

How do you treat croup?

A

Airway management
COOL MIST
O2 if needed
Nebulized epi (but must observe for 3-4 hours after tx)
Steroids (Prednisolone 1mg/kg, or Dexamethasone 0.15 to 0.6mg/kg IM or PO, lasts up to 56 hours)

58
Q

Respiratory emergency caused by Bordetella pertussis, a gram negative aerobe

A

Whooping cough

59
Q

Why do we need a DPT booster after 10 years

A

Does not give complete protection from whooping cough after about 10 years

60
Q

Who is most at risk of whooping cough?

A

Unvaccinated infants and toddlers

61
Q

SSx of whooping cough

A 
URI symptoms in early stage
Fever usually absent
Paroxysms of coughing in later stage
Inspiratory stridor in younger patients
POST-TUSSIVE EMESIS****
Increased WBCs (>20k)
Increased Lymphocytes
62
Q

What is the gold standard for diagnosing whooping cough?

A

Nasopharyngeal swab

But can also do PCR - shorter turn-around time

May see leukocytosis with lymphocytosis

63
Q

What public health concerns do we have regarding whooping cough?

A

HIGHLY CONTAGIOUS IN EARLY STAGE

Risk of sudden infant death and airway compromise in unvaccinated children

Need to treat unprotected contacts (Erythromycin/Azithromycin)

64
Q

Lower respiratory tract infections usually start with…

A

URI, which then progresses lower

65
Q

Sx of lower respiratory tract infections

A

Dyspnea
Hypoxemia
Apnea
Acute respiratory failure

66
Q

A clinical syndrome in infancy characterized by rapid respiration, chest retractions, and wheezing

A

Bronchiolitis (RSV is most common cause)

More in winter
Male > Female
0-2 years with peak at 2-6 months

67
Q

What is the pathophysiology of bronchiolitis?

A

Bronchiolar obstruction from submucosal edema and mucous plugging —> bronchoconstriction

68
Q

When should you order an X-ray for patients with bronchiolitis?

A 
Increased temperature
Choking
Asymmetric chest exam
Respiratory distress
Sudden deterioration
69
Q

SSx of bronchiolitis (RSV)

A 
Runny nose, sneezing
Low grade fever
Dyspnea
Tachypnea
Intercostal retractions
Wheezing
Cyanosis
Apnea
70
Q

Dx of bronchiolitis is…

A

Clinical

CXR show hyperinflated lungs
Pulse ox shows hypoxia
Viral cultures/fluorescent monoclonal antibody testing of NP swabs

71
Q

Treatment of bronchiolitis

A

Airway management
Primarily supportive

Mild cases (alert playful, feeding well, RR<50) can be observed at home, others admitted
Oxygen
Beta 2 agonists

Ribavirin for severely ill or intubated

72
Q

_______ are not indicated in cases of bronchiolitis

A

Steroids - because it’s viral

Unless underlying asthma, steroids are useless here

73
Q

Asthma is a condition characterized by …

A

Paroxysmal attacks of reversible bronchospasm, mucous plugging, and inflammation of the tracheobronchial tree

74
Q

SSx of acute asthma exacerbation

A 
Progressive dyspnea
Chest tightness
Wheezing
Cough
Obvious resp distress
Auscultation of WHEEZES
Use of accessory muscles or nasal flaming
Altered LOC
Don’t be fooled by the “quiet chest”
75
Q

Treatment for acute asthma exacerbation

A

Airway management
Oxygen
Beta 2 agonists (SVN albuterol)
Steroids (PO prednisone/prelone or IV Solumedrol)
Anticholinergics (Neb of Atrovent - ipratropium bromide)

76
Q

The decision about whether to admit or discharge a patient having an acute asthma exacerbation should be made within…

A

1 hour

77
Q

Usual protocol for treatment order in asthma

A

Stacked SVN treatment - 0.5cc albuterol in 2.5 cc NS, 3 treatments given every 30 min

Peak flow rate before 1st and after 3rd treatment

Determine if steroids needed

Look for underlying infection

78
Q

What is Status Asthmaticus?

A

FEV1 that does not increase to greater than 40% of predicted value with treatment

Patient who develops major complications like pneumothorax

79
Q

How do you treat status asthmaticus

A

Beta agonists, high dose steroids, and oxygen

ADMIT

80
Q

Inflammation of the lung caused by infection which causes the alveoli to become filled with pus so that air is excluded

A

Pneumonia

81
Q

SSx of PNA

A 
Fever
Cough
Dyspnea
Pleuritic CP
Resp failure
82
Q

Dx of PNA

A 
Auscultation
CXR
Pulse ox
Blood gases
CBC
Blood cultures
Sputum gram stain, C&amp;S
83
Q

Treatment of PNA

A 
Airway management
O2
Abx
Beta 2 agonists
Analgesics
84
Q

Any breech of the lung surface or chest wall allowing air to enter the pleural cavity, causing lung to collapse

A

Pneumothorax

85
Q

SSx of pneumothorax

A

Chest pain on the side of the collapsed lung
Dyspnea
Occasionally cough - but absence of other URI Sx

86
Q

What distinguishes a Tension pneumothorax?

A 
Decreased breath sounds
Tachycardia
Tachypnea
Tracheal deviation to the opposite side
Hypotension
Cyanosis
Marked respiratory distress
CXR
87
Q

Treatment of pneumothorax is based on…

A

Percentage of involvement on CXR and patient’s overall presentation

<15-20% = observation only, repeat CXR at 48h

20%+ will almost always need intervention

88
Q

What interventions are used for patients with pneumothorax?

A

Needle decompression for tension pneumothorax
Simple aspiration
Tube thoracostomy (Chest tube)

EMED Unit 1 (5 decks)

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