Airway Mgmt Flashcards
6 ways to dx respiratory failure
pt appearance
hypoxemia
hypercarbia
respiratory exhaustion
use of accessory muscles
retractions
airway obstruction can be ___ or ___
partial or complete
___ will often progress to ___ if not cleared
partial progress to complete
from time of complete obstruction to onset of brain damage is how long
4 min
most common cause of airway obstruction
?????? fill in from lecture
who should do airway management
most experienced practitioner available
types of airways (3)
oral
nasal
laryngeal mask airway
signs of foreign body aspiration
persistent cough UNILATERAL WHEEZING
are there always URI symptoms with foreign body aspiration?
not always
increased or decreased breath sounds in foreign body aspiration in a toddler
decreased
are foreign body aspirations always seen on CXR in toddler
nopeeee
post-obstructive foreign body aspiration in toddler complications
atelectasis, pneumonia
foreign body aspiration which mainstem is most common (but not always)
right mainstem
most common location of foreign bodies
right lung
usually right main bronchus, but sometimes lower lobe bronchus
other possible locations of foreign bodies
larynx - 3%
tracheal/carina - 13%
left lung - 23%
bilateral - 2%
what kind of airway trauma occurs in burn center
airway edema
what kind of airway trauma occurs in ER
LeForte fractures
basilar skull fractures
what two le forte fractures are likely to have cribfriform fracture
2 and 3
in what facial fractures do you have absolutely no nasal airways
2 and 3
CSF from nose and/or ears
raccoon eyes
battle’s sign - bruising of the mastoid
what kind of fracture
Basilar skull
describe how anaphylaxis and acute allergic reactions can lead to respiratory depression?
release of immune mediators - respiratory compromise and cardiovascular collapse
Pathophysiology of anaphylaxis and acute allergic reactions
antigen-antibody binds to mast cells
IgE-mediated histamine release
increased vascular permeability, vasodilation
bronchial constriction
increased mucous gland secretion
Common causes of anaphylaxis
antibiotics
ASA and NSAIDS
Shellfish, nuts, eggs, milk
Hymenopytera (bee) stings, grasses
onset for anaphylaxis
seconds to hours
clinical symptoms of anaphylaxis
angioedema, tightening sensation in throat and chest
laryngeal swelling and bronchial spasm
hoarseness, stridor, wheezing
respiratory distress and apnea
dx of anaphylaxis
clinically
check ABCs - airways, blood pressure, SaO2, lungs (immediately)
tx of anaphylaxis
airway management
oxygen
epi if severe HYPOtension
antihistamines
beta-2 agonists
steroids
endotracheal intubation
surgical airway
IV bolus if hypotensive
tx of anaphylaxis
epinephrine
IV dosage
SC dosage
IV: .3-.5 mg of 1:10,000
SC: .3-.5 mg of 1:1,000 (.01 mg/kg to .3 mg)
what antihistamines are used in tx of anaphylaxis
H1 - diphenhydramine or hydroxyzine
H2 - cimetidine
what beta 2 agonist is used in tx of anaphylaxis
albuterol
what steroid is used to tx anaphylaxis
methylprednisolone
an eruption similar to urticaria but with larger edematous areas that involve both dermis and SC structures and frequently involving head and neck
angioedema
onset of angioedema
minutes to hours
resolution of angioedema
hours to days
causes of angioedema
hereditary
acquired
hereditary causes of angioedema
insufficient synthesis of C1-esterase inhibitor (rare - autosomal dom)
acquires causes of angioedema
ACE-inhibitors
tx of angioedema
airways mgmt
supportive
plasma concentrate of C1-esterase inhibitor
epi, antihistamines, steroids
danazol - increase syn of C1-esterase inhibitor
ecallantide - Kallikrein inhibitor
Icatibant - bradykinin receptor antag
3 drugs used to tx angioedema
Danazol
ecallantide
icatibant
which drugs increases synthesis of C1-esterase inhibitor
Danazol
bilateral rapidly spreading submandibular cellulitis
ludwig’s angina
what molars does ludwig angina originate from
2nd or 3rd molars
angina =
suffocating sensation
signs and symptoms of Ludwig’s angina
tongue elevated
hard, firm induration of floor of mouth
perioral edema
pain
trismus
mediastinitis
management of Ludwig’s Angina
surgery
awake fiberoptic nasal intubation
sometimes awake tracheostomy
localized collection of pus in the retropharyngeal space
rare
retropharyngeal abscess
5 causes of retropharyngeal abscess
mixed gram negative and anaerobic bacteria
tonsillitis
otitis media
pharyngeal trauma
odynophagia (classic symptom)
classic symptom of retropharyngeal abscess
odynophagia (painful swallowing)
signs and symptoms of retropharyngeal abscess
fever
odynophagia
neck swelling
drooling
torticollis
meningismus
cervical adenopathy
stridor
airway obstruction
dx of retropharyngeal abscess
clinical usually
soft tissue lateral neck x ray looking for gas, mass
CT of neck
tx of retropharyngeal abscess
airway mgmt
antibx
admission
surgical drainage
an infection of the supraglottic structures including epiglottis, lingual tonsillar area, epiglottic folds, and false vocal cords
epiglottitis
is epiglottitis an emergency
YES
most common ages of epiglottitis
2-7 (before H. flu B vaccine)
can be seen OCCASIONALLY in adults
what organisms are assoc with epiglottitis
HIB, strep, staph
signs and symptoms of epiglottitis
abrupt onset over several hours
fever
stridor
toxic appearance
dysphagia
odynophagia
drooling
tripod position
altered level of consciousness
cyanosis
airway obstruction
dx of epiglotitis
clinically due to tenuous airway
what should you never do with epiglottitis
stick a tongue blade in throat
when should you NEVER stick a tongue blade in throat
epiglottitis is suspected
what can you do with epiglottitis if stable for dx
soft tissue lateral neck xray
thumb sign assoc with
epiglottitis
tx of epiglottitis
immediate attn to control airway
antibiotics once airway is secured
what antibiotics used to tx epiglottitis
3rd generation cephalosporin (Ceftriaxone)
usually benign, self-limited inflammatory condition of trachea BELOW level of vocal cords (subglottic) caused by parainfluenza virus
croup (laryngotracheobronchitis)
age range for those affected by croup
6 mos to 3 yrs (most common) up to 15 y/o
winter/summer for croup
winter
RSV may be assoc with
croup
same with parainfluenza
Signs and symptoms of croup
2-3 day hx of URI
low grade fever
gradual worsening “barking seal cough” esp at night
stridor
dyspnea
retractions
tachypnea
croup dx
clinical
PA CXR showing steeple sign
steeple sign on PA CXR assoc with
croup (but not super specific or sensitive)
tx of croup
airway mgmt
cool mist
o2 if needed
nebulized epi (must observe for 3-4 mos after tx)
steroids
what steroids are used to tx croup
doses too
prednisolone 1 mg/kg
dexamethasone: .15 to .6 mg/kg IM or PO (max of 10 mg) and lasts up to 56 hours
is whooping cough a respiratory emergency
yes?
bug that causes whooping cough
bordatella pertussis - a gram negative aerobe
vaccine does or does not give complete protection after 10 years
does not
what vaccine with whooping cough
DPT
who is at highest risk for whooping cough
unvaccinated infants and toddlers
signs and symptoms of whooping cough
URI symptoms in early stage
no fever
paroxysms of coughing in later stage
inspiratory stridor in younger pts
POST TUSSIVE VOMITING
two things assoc with post-tussive vomiting with whooping cough
increased WBC (over 20k)
increased lymphocytes
dx of whooping cough - gold standard
nasopharyngeal swab on special culture media
why would you do PCR for whooping cough
faster turn around time
when is whooping cough the most contagious
early stage
what are risks assoc with whooping cough
risk of sudden infant death and airway compromise in unvaccinated children
who should be tx and with what - whooping cough
unprotected contacts
erythromycin/azithromycin
usually start with URI and progresses
lower respiratory tract infections
symptoms of lower respiratory tract infections
dyspnea
hypoxemia
apnea
acute resp failure
bronchiolitis AKA
RSV
a clinical syndrome in infancy characterized by:
rapid respiration
chest retractions
wheezing
bronchiolitis (RSV)
bronchiolitis occurs when and in whom
winter
male > female
0-2 y/o, peak at 2-6 mos
most common cause of bronchiolitis
RSV
pathophys of bronchiolitis
bronchiolar obstruction from submucosal edema and mucous plugging
bronchoconstriction
when do you order a chest xray with bronchiolitis
increased temp
choking
asymmetric chest exam
respiratory distress
sudden deterioration
signs and symptoms of RSV bronchiolitis
runny nose
sneezing
low grade fever
dyspnea
tachypnea
intercostal retractions
wheezing
cyanosis
apnea
dx of bronchiolitis (RSV)
clinical
chest xray (hyperinflated lungs)
pulse ox shows hypoxemia
viral cultures and fluorescent monoclonal antibody testing of nasopharyngeal swabs
what will you see on cxr with bronchiolitis
hyperinflated lungs
what will pulse ox show with bronchiolitis
hypoxia
tx of bronchiolitis
airway mgmt
supportive mainly
mild cases can be observed at home
oxygen
beta 2 agonists
steroids not indicated
ribavirin for severely ill or intubated
when do you give ribavirin with bronchiolits
severely ill or intubated
what do you give a kiddo with bronchiolitis if severely ill or intubated
ribaviron
when can a kiddo with bronchiolitis be observed at home?
if they are alert, playful, feeding well, RR less than 50, no retractions, no hypoxia, no sig illness
paroxysmal attacks of reversible bronchospasm
mucous plugging
inflammation of tracheobronchial tree
asthma
signs and symptoms of asthma (acute exacerbation)
progressive dyspnea
chest tightness
wheezing
cough
obvious resp distress
auscultation of wheezes
use of accessory muscles or nasal flaring
altered LOC
“quiet chest” - don’t be fooled
tx of asthma acute exacerbation
airway mgmt
oxygen
beta 2 agonists (bronchodilators, nebulized albuterol)
steroids
anticholinergics
admission or discharge decision within 1 hour
what anticholinergic is given for astham
nebulized atrovent-ipratropium bromide
what steroids are given with acute exacerbation of asthma
PO - prednisone, prelone
IV - solumedrol
usual protocol for asthma - acute exacerbation
include when to take peak flow rate
stacked SVN tx with bronchodilators:
.5 cc albuteral in 2.5 cc normal saline, 3 tx given every 30 minutes
peak flow rate before 1st and after 3rd tx
is steroid tx needed? look for underlying infection,
FEV1 that does not increase to greater than 40% of predicted value with tx
status asthmaticus
how to tx status asthmaticus
beta agonists
high dose steroids
oxygen
ADMIT
do you admit status asthmaticus
yes
inflammation of the lung caused by infection which causes alveoli to become filled with pus so air is excluded
pneumonia
signs and symptoms of pneumonia
fever
cough
dyspnea
pleuritic chest pain
resp failure
dx of pneumonia
auscultation
CXR
Pulse ox
Blood gasses
CBC
Blood cultures
Sputum gram stain, culture and sensitivity
tx of pnuemonia
airway mgmt
o2
antibx
beta 2 agonists
analgesics
any breech of the lung surface or chest wall allowing air to enter the pleural cavity causing the lung to collapse
pneumothorax
signs and symptoms of pneumothorax
chest pain on side of collapsed lung
dyspnea
occasionally cough - but absence of other URI symptoms
dx of tension pneumothorax
decreased breath sounds
tachycardia
tachypnea
tracheal deviation to the opposite side
hypotension
cyanosis
marked resp distress
CXR
tx of pneumothorax: based on what
% of involvement on CXR and pts overall presentation
tx of pneumothorax:
less than 15-20% involvement
observation only; repeat CXR in 48 hours
tx of pneumothorax:
20% +
will almost always need intervention
needle decompression for tension pneumothorax
simple aspiration
tube thoracostomy (chest tube)
incision for pneumothorax
mid axillary incision at 5th intercostal space
tube is directed HOW (for pneumothorax)
posteriorly and superiorly
