Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Airway obstructions are usually encountered in…

A

The pre-hospital setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common cause of airway obstruction

A

The tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Different types of airways

A

Oral airway
Nasal airway
Laryngeal Mask Airway (LMA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

Foreign body aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of FB aspiration

A

Post-obstructive atelectasis

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you do for a FB aspiration?

A

REMOVE IT (duh)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

______ supersedes all else in trauma

A

Airway

May need nasal intubation if significant facial fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Important considerations for airways in trauma situations

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do you intubation burn victims immediately

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

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

A

LeFort I - the mustache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Facial fracture above nasal bone

A

LeFort II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Facial fracture around orbits

A

LeFort III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

LeFor II and III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs of basilar skull fracture

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

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

A

Release of immune mediators —> respiratory compromise and CV collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Common causes of anaphylaxis
``` Antibiotics ASA and NSAIDs Shellfish, nuts, eggs, milk Hymenopytera stings Grasses ```
26
Clinical features of anaphylaxis
``` Onset in seconds to hours Angioedema Tightening sensation in throat and chest Laryngeal swelling and bronchial spasm, hoarseness, stridor, wheezing Respiratory distress and apnea ```
27
Diagnosis of anaphylaxis is usually...
CLINICAL ``` Remember to check: Airway BP SaO2 (or SpO2) Lungs ```
28
How to treat anaphylaxis?
``` 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 ```
29
What are the two types of Epinephrine used in anaphylaxis?
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
30
What are the two different types of antihistamines used in anaphylaxis?
H1 blockers - diphenhydramine (Benadryl) at least 50 mg or hydroxyzine H2 blockers - cimetidine (Zantac)
31
Why do you need to use both H1 blockers and H2 blockers when treating anaphylaxis?
B/c histamine release affects BOTH
32
An eruption similar to urticaria but with larger edematous areas that involve both dermis and SC structures, frequently involving the head and neck
Angioedema
33
Onset of angioedema is typically ______, with resolution within ______
Onset - minutes to hours Resolution - hours to days
34
What are the two categories of causes of angioedema?
Hereditary - insufficient synthesis of C1-esterase inhibitor (rare, autosomal dominant) Acquired - ie from ACE inhibitors
35
How is angioedema treated?
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
36
Bilateral, rapidly spreading submandibular cellulitis, usually originating from the 2nd or 3rd molars
Ludwig’s Angina | Angina = suffocating sensation
37
SSx of Ludwig’s Angina
``` TONGUE ELEVATED Hard, firm induration of the floor of the mouth Perforation edema Pain Trismus (lock jaw) MEDIASTINITIS (bad sign if present) ```
38
Management of Ludwig’s Angina
Surgery*** Awake fiber optic nasal intubation Sometimes awake tracheostomy
39
What is a retropharyngeal abscess?
A localized collection of pus in the retropharyngeal space, or trauma related hematoma in the same space Good thing it’s rare
40
Common cause of the rare retropharyngeal abscess
``` Mixed gram (-) and anaerobic bacteria Tonsillitis Otitis media Pharyngeal trauma Odynophagia ```
41
SSx of retropharyngeal abscess
``` Fever Odynophagia Neck swelling Drooling Torticollis Meningismus Cervical LAD Stridor Airway obstruction ```
42
How to diagnose retropharyngeal abscess
Often clinical Soft tissue lateral neck x-rays (looking for gas or a mass) CT neck
43
Patients with retropharyngeal abscesses are susceptible to...
Laryngospasm —> obstruction
44
How to treat retropharyngeal abscess
Airway management Antibiotics Admission and surgical drainage
45
An infection of the supraglottic structures including the epiglottis, lingual tonsillar area, epiglottis folds and false vocal cords
Epiglottitis - it’s an emergency!
46
Epidemiology facts about epiglottis
Age 2-7 (before H. influenza B vaccine) Seen occasionally in adults HIB, Strep, Staph (not 100% protected by vaccine) Rare
47
SSx of epiglottitis
``` Abrupt onset over several hours Fever STRIDOR Toxic appearance Dysphagia, odynophagia DROOLING TRIPOD POSITION**** Altered LOC Cyanosis Airway obstruction ```
48
What should you never do if you suspect epiglottitis?
Never stick a tongue blade in their throat - call for an emergency ENT consult b/c very unstable
49
What is the name of the xray finding associated with epiglottis? 🐝🐝🐝🐝🐝🐝🐝🐝
Thumb sign
50
How to treat epiglottitis?
IMMEDIATE ENT CONSULT to control airway Abx once airway is secure - 3rd gen cephalosporin (ie Ceftriaxone)
51
A usually benign, self limited inflammatory condition of the trachea below the level of the vocal cords (subglottic)
Croup (Laryngotracheobronchitis)
52
Croup is usually caused by...
Parainfluenza virus
53
Epidemiology of croup
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
SSx of Croup
``` 2-3 day Hx of URI Low grade fever Gradual worsening “barking seal” cough, esp at night Stridor Dyspnea Retractions Tachypnea ```
55
The younger the croup patient, the more likely they are to...
Develop respiratory distress
56
How to diagnose croup
Usually clinical PA CXR shows “steeple sign”, but not very sensitive or specific
57
How do you treat croup?
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
Respiratory emergency caused by Bordetella pertussis, a gram negative aerobe
Whooping cough
59
Why do we need a DPT booster after 10 years
Does not give complete protection from whooping cough after about 10 years
60
Who is most at risk of whooping cough?
Unvaccinated infants and toddlers
61
SSx of whooping cough
``` 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
What is the gold standard for diagnosing whooping cough?
Nasopharyngeal swab But can also do PCR - shorter turn-around time May see leukocytosis with lymphocytosis
63
What public health concerns do we have regarding whooping cough?
HIGHLY CONTAGIOUS IN EARLY STAGE Risk of sudden infant death and airway compromise in unvaccinated children Need to treat unprotected contacts (Erythromycin/Azithromycin)
64
Lower respiratory tract infections usually start with...
URI, which then progresses lower
65
Sx of lower respiratory tract infections
Dyspnea Hypoxemia Apnea Acute respiratory failure
66
A clinical syndrome in infancy characterized by rapid respiration, chest retractions, and wheezing
Bronchiolitis (RSV is most common cause) More in winter Male > Female 0-2 years with peak at 2-6 months
67
What is the pathophysiology of bronchiolitis?
Bronchiolar obstruction from submucosal edema and mucous plugging —> bronchoconstriction
68
When should you order an X-ray for patients with bronchiolitis?
``` Increased temperature Choking Asymmetric chest exam Respiratory distress Sudden deterioration ```
69
SSx of bronchiolitis (RSV)
``` Runny nose, sneezing Low grade fever Dyspnea Tachypnea Intercostal retractions Wheezing Cyanosis Apnea ```
70
Dx of bronchiolitis is...
Clinical CXR show hyperinflated lungs Pulse ox shows hypoxia Viral cultures/fluorescent monoclonal antibody testing of NP swabs
71
Treatment of bronchiolitis
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
_______ are not indicated in cases of bronchiolitis
Steroids - because it’s viral Unless underlying asthma, steroids are useless here
73
Asthma is a condition characterized by ...
Paroxysmal attacks of reversible bronchospasm, mucous plugging, and inflammation of the tracheobronchial tree
74
SSx of acute asthma exacerbation
``` 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
Treatment for acute asthma exacerbation
Airway management Oxygen Beta 2 agonists (SVN albuterol) Steroids (PO prednisone/prelone or IV Solumedrol) Anticholinergics (Neb of Atrovent - ipratropium bromide)
76
The decision about whether to admit or discharge a patient having an acute asthma exacerbation should be made within...
1 hour
77
Usual protocol for treatment order in asthma
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
What is Status Asthmaticus?
FEV1 that does not increase to greater than 40% of predicted value with treatment Patient who develops major complications like pneumothorax
79
How do you treat status asthmaticus
Beta agonists, high dose steroids, and oxygen ADMIT
80
Inflammation of the lung caused by infection which causes the alveoli to become filled with pus so that air is excluded
Pneumonia
81
SSx of PNA
``` Fever Cough Dyspnea Pleuritic CP Resp failure ```
82
Dx of PNA
``` Auscultation CXR Pulse ox Blood gases CBC Blood cultures Sputum gram stain, C&S ```
83
Treatment of PNA
``` Airway management O2 Abx Beta 2 agonists Analgesics ```
84
Any breech of the lung surface or chest wall allowing air to enter the pleural cavity, causing lung to collapse
Pneumothorax
85
SSx of pneumothorax
Chest pain on the side of the collapsed lung Dyspnea Occasionally cough - but absence of other URI Sx
86
What distinguishes a Tension pneumothorax?
``` Decreased breath sounds Tachycardia Tachypnea Tracheal deviation to the opposite side Hypotension Cyanosis Marked respiratory distress CXR ```
87
Treatment of pneumothorax is based on...
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
What interventions are used for patients with pneumothorax?
Needle decompression for tension pneumothorax Simple aspiration Tube thoracostomy (Chest tube)

EMED Unit 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions