5 - Respiratory Distress

Question 1

Dyspnea

Answer 1

Subjective feeling - described as “shortness of breath,” “not getting enough air”

Question 2

Tachypnea

Answer 2

Rapid breathing

Question 3

Orthopnea

Answer 3

Dyspnea when recumbent

Question 4

Paroxysmal nocturnal dyspnea

Answer 4

Orthopnea that wakes you up at night

Question 5

Trepopnea

Answer 5

Dyspnea associated with only one of the several recumbent positions

Question 6

Trepopnea can occur with:

Answer 6

Unilateral diaphragmatic paralysis

Ball-valve airway obstruction

Surgical pneumonectomy

Question 7

Platypnea

Answer 7

The opposite of orthopnea - dyspnea in the UPRIGHT position

Weird, right?

Results from the loss of abdominal wall muscular tone

Question 8

Hyperpnea

Answer 8

Essentially hyperventilation, and is defined as minute ventilation in excess of metabolic demand

Question 9

Evidence of impending respiratory failure:

Answer 9

Marked tachypnea and tachycardia
Stridor
Accessory muscle use
One-to-two-word sentences
Agitation
Lethargy
AMS

GIVE OXYGEN

Question 10

An S3 gallop and interstitial edema on CXR strongly suggests ____ _____ as the cause of dyspnea

Answer 10

Heart failure

Question 11

Which sxs are NOT useful in discriminating between cardiac and pulmonary causes?

Answer 11

Wheezing
DOE
Orthopnea
PND
Leg edema 

Conversely, the absence of these sxs does not r/o HF

Question 12

ABG is more sensitive for detecting impaired gas exchange but cannot evaluate:

Answer 12

Work of breathing

Question 13

Bedside US can identify:

Answer 13

Pleural effusion
Pneumo
Cardiac tamponade
Cardiac functional abnormalities
Pulmonary consolidation
Intravascular volume status

Question 14

Txt goals for severe dyspnea

Answer 14

PaO2 > 60 mmHg

And/or

SaO2 (or SpO2) >/= 90%

Txt the underlying d/o

Question 15

What is hypoxia?

Answer 15

Insufficient delivery of oxygen to the tissues

Question 16

What is hypoxemia?

Answer 16

Abnormally low arterial oxygen tension (< 60mmHg)

Question 17

MC cause of hypoxia?

Answer 17

Hypoxemia

Question 18

Hypercapnia is exclusively caused by:

Answer 18

Alveolar hypoventilation

Question 19

Hypercapnia

Answer 19

PaCO2 > 45mmHg

Question 20

Hypercapnia never results from:

Answer 20

Increased CO2 production alone

Many causes include: rapid shallow breathing, small tidal volumes, underventilation of the lung, or reduced respiratory drive

Question 21

Sxs of hypercapnia depend on:

Answer 21

The absolute value of PaCO2 and its rate of change

Question 22

Acute elevations in CO2 result in:

Answer 22

Increased ICP
HA
Confusion
Lethargy

If severe: seizures, coma, CV collapse (PaCO2 > 100mmHg)

Question 23

Chronic hypercapnia?

Answer 23

May actually be well-tolerated (as opposed to acute hypercapnia)

Question 24

Can you send a hypercapneic patient home?

Answer 24

Generally, they should be admitted

Exceptions being chronic COPD’ers who are baseline hypercapneic AND stable, can probably be discharged

Question 25

Wheezing

Answer 25

“Musical” adventitious lung sounds produced by airflow through the central and distal airways

Prolonged duration (typically > 80 milliseconds)

Question 26

Rhonchi

Answer 26

Lower frequency, usually secretions - able to clear

Question 27

Crackles or rales

Answer 27

Short duration, suggests air popping through fluid

Question 28

Wheezing is usually associated with:

Answer 28

Lower airway dz such as asthma, COPD, muscular spasm, inflammation

Question 29

Upper airway obstruction causes:

Answer 29

Stridor - loudest during inspiration (as opposed to wheezing, which is typically louder during expiration)

Question 30

Cyanosis

Answer 30

Bluish hue of skin and mucous membranes 2/2 an increased amount of deoxyhemoglobin

Question 31

Is cyanosis a sensitive indicator of the state of arterial oxygenation?

Answer 31

Nope

It’s determined by the amount of reduced Hb in the blood, NOT the amount of oxygenated HB

Question 32

Central cyanosis results from

Answer 32

Inadequate pulmonary oxygen exchange

Question 33

Peripheral cyanosis results from

Answer 33

Vasoconstriction or diminished peripheral blood flow

Question 34

Causes of central cyanosis:

Answer 34

High altitude

Hypoventilation (cyanosis common in opiate OD)

V/P mismatch (as in APE)

Right-to-left shunt

Question 35

Causes of peripheral cyanosis

Answer 35

Reduced cardiac output

Cold extremities

Maldistribution of blood flow: distributive shock

Arterial or venous obstruction

Question 36

Hgb causes of cyanosis?

Answer 36

Methemoglobinemia (hereditary or acquired)

Sulfhemoglobinemia (acquired)

Carboxyhemoglobinemia

Question 37

Sensitive sites for assessing central cyanosis?

Answer 37

Tongue and buccal mucosa

Question 38

What is pseudocyanosis?

Answer 38

A bluish or slate-gray skin discoloration due to drugs (chlorpromazine, minocycline, amiodarone, nicorandil) or heavy metals (gold, silver)

Lips/mucus membranes are NORMAL

Discoloration doesn’t blanch with pressure

The discoloration tends to be more intense in sun-exposed areas

Question 39

What’s up with methemoglobinemia?

Answer 39

In methemoglobinemia, pulse oximetry will read 80% to 85% regardless
of the oxygen level, thereby often overestimating the true oxygen saturation (it may be lower, but pulse oximetry will not read lower)

Question 40

What’s up with carboxyhemoglobinemia?

Answer 40

The pulse ox reads carboxyhemoglobin as oxyhemoglobin, reporting a higher percentage for O2 sat (think CO poisoning - in a pt with CO poisoning, a standard pulse oximeter is useless)

Question 41

In central cyanosis, oxygen from ABG will be:

Answer 41

Low

Question 42

In peripheral cyanosis, oxygen from ABG will be:

Answer 42

Normal

Question 43

If you give oxygen to your centrally cyanotic patient and they don’t improve, suggests:

Answer 43

Impaired circulation (shock)

Abnormal Hb

Or

Pseudocynanosis

Question 44

Asthma

Answer 44

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