Airway And Respiratory Emergencies 🌬 (Shelby🐈) Flashcards by Lauren F

Do you know the signs and symptoms of asthma? You should. Byt here is a list anyway just in case.

Progressive dyspnea

Chest tightness

WHEEZING

Cough

Obvious respiratory distress

Use of accessory muscles or nasal flaring

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What is a retropharyngeal abscess

Is it common?

A localized collection of pus in the retropharyngeal space

RARE

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What is the gold standard for diagnosing whooping cough

Nasopharyngeal swab on special culture media

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Who ususally gets Epiglottitis?

2-7 year olds before H. Influenza B vaccine

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What is “status asthmaticus”

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

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course/cough is indicitive of _______ respiratory infections

Fine/ wheezing is indicitive of ________ repiratory infections

Cough = UPPER

Wheezing = LOWER

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What is the treatment for a pneumothorax with 15-20% involvement on CXR

Observation only

Repeat CXR in 48 hours

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What is the medication treatment for Angioedema

Because obviously airway management and supportive care are first!

Plasma concentrate of C1-esterase inhibitor

Epinephrine, Antihistamine, Steroid

Danazol

Ecallantide

Icatibant

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What is the management of Ludwig’s Angina

Awake fiberoptic nasal intubation

(Sometimes) awake tracheostomy

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What sign would be indicitive of a FRONTAL basilar skull fracture

Raccoon eyes

CSF from the nose/ ears

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Croup is usually a clinical diagnosis but the super hot radiologist is on duty again so you decide to send the kid down to x-ray (a little radiation on a baby never hurt anyone right? RIGHT???) what would you expect to see on the x-ray

Steeple sign

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You started your asthma patient in the ER on the saline albuterol treatments but now you have to determine if they can go home or if they need to be admitted. What are some things to be considered with this patient?

What was the baseline respiratory distress? (Was it actually a super emergency or did they just come to the ER because they ran out of their rescue inhaler because they don’t have insurance )

Vulnerable population? (Like are they 1000 years old or a baby)

Was their improvement with the SVN saline treatment?

Do they also have like a million co-morbidities?

Can they get follow-up care? (Or are they going to go do meth on the light rail in 3 hours and be back tonight anyway)

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What sign would be indicitive of a MID SKULL Basilar fracture

Battle Signs (bruising of the mastoid)

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What is the CLASSIC symptom of retropharyngeal abscess?

Odynophagia

Painful swallowing

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What is the treatment for ACUTE EXACERBATION of asthma (In the ER because this is an Emed class and this asthma person went to th ER)

Stacked SVN treatments with brochodilators

0.5 cc albuterol in 2.5 cc normal saline - 3 treatments given every 30 minutes

Assess peak flow rate before 1st and after 3rd tx

Determine is steroid therapy is needed 🤷🏼‍♀️

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Ludwig’s Angina can lead to ➡️➡️➡️

Mediastinitis

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What are the 3 types of airways discussed in class

Oral airways

Nasal airways

Laryngeal mask airway

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What is Croup (Laryngotracheobronchitis)

A usually benign, self limited inflammatory condition of the trachea BELOW the level of the vocal cords usually caused by parainfluenza virus

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What type of antihistamine is Cimetidine

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Classic triad of symptoms of Brochiolitis

Rapid respiration

Chest retractions*******

Wheezing

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What is the most common airway emergency?

Airway obstruction

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Other than the “barking seal cough”, what are OTHER signs and symptoms of Croup (Laryngotracheobronchitis)

Low grade fever

Gradual onset

Stridor

Dyspnea

Retractions

Tachypnea

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What is the most common cause of airway obstruction

Tongue 👅👅👅

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What is the treatment for pneumothorax with greater than 20%

Needle depcompression for tension pneumothorax in the pleural cavity

Simple aspiration

Tube thoracostomy (chest tube)

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If you don’t know the symptoms for pneumonia you need to reconsider your life but here they are anyway

Fever Cough Dyspnea Pleuritic chest pain Respiratory failure

What virus is associated with Croup

Parainfluenza virus

A toddler comes into your ER with a persistent cough and unilateral wheezing, what do you think is going on?

foreign body aspiration Toddler has a hotdog stuck in its airway 🌭🌭🌭🌭

A complete airway obstruction will progress to

Respiratory arrest if not cleared

NEVER EVER EVER EVER DO WHAT WITH EPIGLOTTITIS

Stick a tongue blade in their throat

You have a kid come in with runny nose, sneezing, low grade fever, intercostal retractions, wheezing, and cyanosis. You order a chest x-ray because this kid seems to be in some respiratory distress. What would you expect to see?

Hyperinflated lungs

Why do some people who have had the DPT vaccine still get whooping cough

Does not give complete protection after 10 years

What are the signs and symptoms of a pneumothorax

Chest pain on the side of the collapsed lung Dyspnea

Someone having an acute allergic or anaphylaxis reaction will present with

Angioedema Tightening sensation in throat and chest Laryngeal swelling Bronchial spasm Hoarseness Stridor Wheezing Respiratory distress

Locations of foreign body aspirations- ``` Most common? Second most common? Third most common? Fourth? fifth? ```

1. Right lung (59%) 2. Left lung (23%) 3. Trachea/Carina (13%) 4. Larynx (3%) 5. Bilateral (1-2%) Yes I know this doesn’t add up to 100 it adds to 101 but who needs math anyway

When placing a chest tube in a pneumothorax, where do you make the incision?

Mid axillary incision at 5th intercostal space

Unilateral decreased breath sounds + tracheal deviation to the opposite side + respiatory distress + cyanosis + hypotension =

Tension pneumothorax

What is the treatment for Bronchiolitis if the kid does not have any retractions or hypoxia

Supportive, can be observed at home

LeFort fracture 1 = LeFort fracture 2 = LeFort fracture 3 =

1 = just the teeth 👄 2 = above the nose 👃🏽 3. Through the orbital 👀

What is the treatment for unprotected contacts of children who have been diagnosed with whooping cough

Erythromycin/ azithromycin

You have a little kid that DOES NOT have a fever, but has had URI symptoms for the last few days but now has started coughing with a weird inspiratory stridor. What would you expect to see on a CBC? What are you thinking this kid has?

Whooping cough Increased WBCs (>20K) Increased lymphocytes

In the treatment of acute alleric reaction or anaphylaxis, what type of anithistamine is given?

H1 AND H2 ``` H1 = diphenhydramine or hydroxyzine H2 = cimetidine ```

What is the treatment for Bronchiolitis if the kid has retractions and hypoxia

Admit to hospital Oxygen STAT Beta 2 agonists Ribavirin (severely ill or intubated)

Whooping cough CLASSIC symptom they loooooove to test on

POST-TUSSIVE VOMITING 🤮🤮🤮🤮🤮

Can steroids like methylprednisone be used in an acute allergic reaction or anaphylaxis?

Not as an immediate treatment But start right away for long term management - takes a few days to start working

What are the 2 possible causes of angioedema

Hereditary (insufficient synthesis of C1-esterase inhibitor— RARE) Acquired (ACE inhibitors)

You have a patient come in to the ER and they are obviously having an acute allergic reaction but the symptoms are JUUUUUST starting BUT they have some pretty bad hypotension. What’s the medication treatment?

SC 0.3-0.5 mg of 1:1,000 Epi + antihistamine +IV bolus +/- Beta 2 agonist

Which airway emergency in children should you NEVER give steroids to?

Bronchiolitis

You have a patient roll into the ER with a ton of burns. 🔥🔥 What do you do

INTUBATE EARLY Will be muuuuuuch harder to do if they get worse!

What do patients in respiratory distress look like?

Hypoxemia Hypercarbia Respiratory exhaustion Use of accessory muscles Retractions

Diphenhydramine is what type of antihistamine

How do you treat a retropharyngeal abscess if the airway IS compromised

Airway management (DUH) Admit to hostpital 🏥 Antibiotics Surgical drainage

What is epiglottitis?

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

Bronchiolitis is usually caused by

RSV

Your patient comes in complaining of SEVERE ODYNOPHAGIA (painful swallowing) what other signs and symptoms are you going to look for to confirm your suspicion of retrophayngeal abcess?

Fever 🤒 Neck swelling Drooling 🤤 Torticollis Meningismus Cervical adenopathy Stridor Airway obstruction

Which layers of the skin are involved in angioedema

Dermis and subcutaneous structures

You have a kid come in with a lot of the classic signs of epiglottitis (fever, stridor, toxic, dysphagia, tripod position) and you know you can diagnose it clinically but you have a crush on the radiologist on duty and wanna chat with him so you get an x-ray of the kid. What are you expecting to see?

THUMB SIGN ON LATERAL X-RAY | 👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼

Which airway emergency seen in children usually shows hypoxia on a pulse oximetry

Bronchiolitis

What is Bronchiolitis?

Bronchiolar obstruction from submucosal edema and mucus plugging ➡️ brochoconstriction

You suspect a toddler has a foreign body aspiration so you order a chest x-ray. What would you expect to see?

Usually NOTHING

What is the treatment for Croup (Laryngotracheobronchiti)

Airway management Cool mist Nebulized epinephrine Prdnisolone 1mg/kg OR dexamethasone 0.15-0.6 mg/kg IM or PO +/- oxygen

What is the treatment for epiglottitis

IT IS AN EMERGENCY 🚨🚨🚨🚨 IMMEDIATE ATTENTION TO CONTROL THE AIRWAY Once the airway is secured: Ceftriaxone (Rocephin)

What are the indications to get an x-ray for a kid with bronchiolitis

Increased temperature Choking Asymmetric chest exam Respiratory distress Sudden deterioration

What causes whooping cough

Bordetella pertussis | A gram negative aerobe

Where does the infection USUALLY start in Ludwig’s angina

2nd or 3rd molars 🦷🦷🦷

What are the signs of Ludwig’s Angina

TONGUE ELEVATION (airway problems!!!!) Hard, firm induration of the floor of the mouth Perioral edema Trismus PAIN

What can cause a retropharyngeal abscess?

Oral infection Tonsillitis Otitis media Pharyngeal trauma

What is another name for bee sting | which would be super annoying if they used on a test

Hymenopytera sting 🐝

Before any medication administration, what do you HAVE to manage FIRST with someone who has anaphylaxis

Airway management Oxygen

You have a 5 year old kid that is sitting in the TRIPOD POSITION. He is DROOLING. He has a FEVER, STRIDOR, and looks TOXIC. What is your next step?

You can diagnose this kid CLINICALLY with epiglottitis NEVER STICK A TONGUE BLADE IN THE THROAT

Cribiform fractures are most damaging to which cranial nerve

CN I - olfactory

What are some post-obstructive issues with foreign body aspiration in a toddler

Post-obstructive atelectasis Post-obstructive pneumonia

How do you treat a retropharyngeal abscess if the airway is NOT compromised

Antibiotics

Anaphylaxis pathophys process:

Antigen-antibody binds to mast cell ➡️ IgE-mediated HISTAMINE release ➡️ increased vascular permeability, vasodilation ➡️ BRONCHIAL CONSTRICTION ➡️ increased mucus gland secretion (runny nose)

What is Ludwig’s Angina

Bilateral, rapidly spreading submandibular cellulitis 🦠🦠🦠🦠🦠🦠🦠

You have a patient come into the ER with severe anaphylaxis and their symptoms are BAD. They also have severe hypotension. What is the medication treatment?

IV 0.3-0.5 mg of 1:10,000 Epi + antihistamine + IV bolus +/- Beta-2 agonist

Hydroxyzine is what type of antihistamine

Anaphylaxis common causes:

Antibiotics 💉 ASA/NSAIDs 💊 Shellfish 🦐 Nuts 🥜 Eggs 🍳 Milk 🥛 Hymenopytera (Bee) Stings 🐝 Grass 🌱

What is the downside of laryngeal mask airway

Does not protect against aspiration

You notice your patient has a LeForte 2 (or 3) fracture. What is super contraindicated? WHY?

NASAL AIRWAYS!!! Likely to have a CRIBIFORM fracture

A partial airway obstruction will often progress to a

Complete airway obstruction if not cleared

How long does it take from the time of complete airway obstruction to onset of brain damage

4 minutes

If a patient is just breathing regular room air (that is 21% oxygen) and gets an obstruction, their brain will start to die in 4 minutes. You are on your surgery rotation and the CRNA on duty paralyzes the patient and is about to intubate him when the CRNA suddenly overdoses on fentanyl and dies and it’s up to you to intubate the patient, and it’s definitely going to take you more than 4 minutes. Luckily, the CRNA did WHAT to buy you more time for your first intubation attempt?

Preoxygenated the patient with 100% Oxygen so now they have more O2 in their residual volume than they would just breathing room air

What maneuver would you do to prevent a patient’s tongue from obstructing their airway?

Jaw thrust

What might be seen on a CT or MRI of someone’s neck if they have ludwigs angina?

Gas gangrene

Why don’t you give steroids to kids with bronchiolitis?

It’s a virus, not inflammation | RSV virus