airway and respiratory emergencies Flashcards
time of complete airway obstruction to brain damage
- 4 minutes
swallowed FB is most likely to be stuck where
right main stem of lung
clinical presentation in toddler
- persistent cough
- unilateral wheezing
- decreased breath sounds
foreign body aspiration
anaphylaxis is mediated by what antibody
IgE -> histamine release
DOC for anaphylaxis if hypotension present
epinephrine
dosage and route for epinephrine in anaphylaxis
- IV 0.3 - 0.5 mg of 1:10,000
- SC 0.3 - 0.5 mg of 1:1,000
what type of antihistamines should be given in anaphylactic shock
- H1 and H2
hereditary cause of angioedema
- insufficient synthesis of C1-esterase inhibitor (rare)
medication associated with angioedema
ACE-inhibitor
function of Danazol in tx of angioedema
- increase the synthesis of C1-esterase inhibitor
causes of retropharyngeal abscess
- tonsillitis
- otitis media
- pharyngeal trauma
*mixed gram negative and anaerobic bacteria
clinical presentation
- fever
- odynophagia: painful swallowing
- neck swelling
- drooling
- torticollis
- cervical adenopathy
- stridor
- airway obstruction
retropharyngeal abscess
how is retropharyngeal abscess diagnosed
- clinical
- soft tissue lateral neck xray
- CT neck
tx of retropharyngeal abscess
- airway management
- abx
- admission
- surgical drainage
an infection of the supraglottic structures including the epiglottis, lingual tonsillar area, epiglottic folds, and false vocal cords
epiglottitis
cause of epiglottitis
- H influenza B, strep, staph
clinical presentation
- abrupt onset over several hours
- fever
- stridor
- dysphagia
- odynophagia
- drooling
- tripod
epiglottitis
what should never be done if you suspect epiglottitis
never stick a tongue blade in throat
how is epiglottitis diagnosed
- clinically
- soft tissue lateral neck xray if very stable
- thumb sign
thumb sign is consistent with
epiglottitis
tx of epiglottitis
- control airway
- abx once airway is secured
- 3rd generation cephalosporin: ceftriaxone
croup: laryngotracheobronchitis
inflammatory condition of the trachea below the level of the vocal cords (subglottic)
croup: laryngotracheobronchitis is usually caused by what pathogen
- parainfluenza virus
- RSV
croup: laryngotracheobronchitis usually affects what age population
- 6 months - three years
- inc in winter
clinical presentation
- 2-3 day h/o URI
- low grade fever
- gradual, worsening “barking seal” cough, especially at night
- dyspnea, retractions, stridor
croup: laryngotracheobronchitis
PA CXR showing steeple sign is consistent with
croup: laryngotracheobronchitis
tx of croup: laryngotracheobronchitis
- nebulized epinephrine (must obsreve for 3-4 hours after tx)
- steriods
- prednisolone
- dexamethasone (decadron)
whooping cough is caused by what pathogen
- bordetella pertussis
- gram neg aerobe
who is at the highest risk for developing whooping cough
- unvaccinated infants and toddlers
clinical presentation
- URI symptoms
- fever usually absent
- coughing
- post-tussive vomiting
whooping cough
how is whooping cough diagnosed
- nasopharyngeal swab: gold standard
- PCR: shorter turn around time
tx of whooping cough
-
erythromycin/azithromycin
- need to tx unprotected contacts too
bronchiolitis is a clinical syndrome in infancy characterized by what 3 things
- rapid respiration
- chest retractions
- wheezing
bronchiolitis is caused by what pathogen
- RSV: respiratory syncitial virus
bronchiolitis most commonly affects what age range
- 0-2 years
- peak 2-6 months
what is bronchiolitis
- bronchiolar obstruction from submucosal edema and mucous plugging
how is bronchiolitis diagnosed
- clinical
- CXR: hyperinflated lungs
- hypoxia
- viral cultures/fluorescent monoclonal antibody testing of nasopharyngeal swabs
treatment of severe bronchiolitis
- admit
- oxygen, beta 2 agonist
- steroids not indicated
- Ribavirin for severely ill or intubated
paroxysmal attacks of reversible bronchospasm
asthma
tx of acute emergent asthma
- beta 2 agonist: albuterol
- steriods: prednisone PO or solumedrol IV
what is the protocol for stacked SVN tx of acute asthma
- 0.5 cc albuterol in 2.5 cc normal saline, 3 treatments given every 30 minutes
- peak flow rate before 1st and 3rd
what is status asthmaticus
- FEV1 that does not increase to greater than 40% of predicted value with treatment
- pt who develops major complications like pneumothorax
tx of status asthmaticus
- admit
- beta agonist
- high dose steroids
- oxygen
clinical presentation
- fever
- cough
- dyspnea
- pleuritic CP
- respiratory failure
PNA
what is a pneumothorax
- any breech of the lung surface or chest wall allowing air to enter the pleural cavity, causing the lung to collapse
treatment for pneumothorax < 15-20% involvement
- observation only
- repeat CXr in 48 hours
treatment for pneumothorax >20% involvement
- needle decompression
- tube thoracostomy: mid axillary incision at 5th interspace, tunnel to 4th rib
- simple aspiration
