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Surgery and Emergency Med > Airway Mgmt > Flashcards

Airway Mgmt Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

6 ways to dx respiratory failure

A

pt appearance

hypoxemia

hypercarbia

respiratory exhaustion

use of accessory muscles

retractions

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2
Q

airway obstruction can be ___ or ___

A

partial or complete

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3
Q

___ will often progress to ___ if not cleared

A

partial progress to complete

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4
Q

from time of complete obstruction to onset of brain damage is how long

A

4 min

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5
Q

most common cause of airway obstruction

A

?????? fill in from lecture

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6
Q

who should do airway management

A

most experienced practitioner available

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7
Q

types of airways (3)

A

oral

nasal

laryngeal mask airway

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8
Q

signs of foreign body aspiration

A

persistent cough UNILATERAL WHEEZING

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9
Q

are there always URI symptoms with foreign body aspiration?

A

not always

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10
Q

increased or decreased breath sounds in foreign body aspiration in a toddler

A

decreased

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11
Q

are foreign body aspirations always seen on CXR in toddler

A

nopeeee

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12
Q

post-obstructive foreign body aspiration in toddler complications

A

atelectasis, pneumonia

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13
Q

foreign body aspiration which mainstem is most common (but not always)

A

right mainstem

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14
Q

most common location of foreign bodies

A

right lung

usually right main bronchus, but sometimes lower lobe bronchus

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15
Q

other possible locations of foreign bodies

A

larynx - 3%

tracheal/carina - 13%

left lung - 23%

bilateral - 2%

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16
Q

what kind of airway trauma occurs in burn center

A

airway edema

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17
Q

what kind of airway trauma occurs in ER

A

LeForte fractures

basilar skull fractures

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18
Q

what two le forte fractures are likely to have cribfriform fracture

A

2 and 3

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19
Q

in what facial fractures do you have absolutely no nasal airways

A

2 and 3

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20
Q

CSF from nose and/or ears

raccoon eyes

battle’s sign - bruising of the mastoid

what kind of fracture

A

Basilar skull

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21
Q

describe how anaphylaxis and acute allergic reactions can lead to respiratory depression?

A

release of immune mediators - respiratory compromise and cardiovascular collapse

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22
Q

Pathophysiology of anaphylaxis and acute allergic reactions

A

antigen-antibody binds to mast cells

IgE-mediated histamine release

increased vascular permeability, vasodilation

bronchial constriction

increased mucous gland secretion

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23
Q

Common causes of anaphylaxis

A

antibiotics

ASA and NSAIDS

Shellfish, nuts, eggs, milk

Hymenopytera (bee) stings, grasses

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24
Q

onset for anaphylaxis

A

seconds to hours

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25
Q

clinical symptoms of anaphylaxis

A

angioedema, tightening sensation in throat and chest

laryngeal swelling and bronchial spasm

hoarseness, stridor, wheezing

respiratory distress and apnea

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26
Q

dx of anaphylaxis

A

clinically

check ABCs - airways, blood pressure, SaO2, lungs (immediately)

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27
Q

tx of anaphylaxis

A

airway management

oxygen

epi if severe HYPOtension

antihistamines

beta-2 agonists

steroids

endotracheal intubation

surgical airway

IV bolus if hypotensive

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28
Q

tx of anaphylaxis

epinephrine

IV dosage

SC dosage

A

IV: .3-.5 mg of 1:10,000

SC: .3-.5 mg of 1:1,000 (.01 mg/kg to .3 mg)

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29
Q

what antihistamines are used in tx of anaphylaxis

A

H1 - diphenhydramine or hydroxyzine

H2 - cimetidine

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30
Q

what beta 2 agonist is used in tx of anaphylaxis

A

albuterol

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31
Q

what steroid is used to tx anaphylaxis

A

methylprednisolone

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32
Q

an eruption similar to urticaria but with larger edematous areas that involve both dermis and SC structures and frequently involving head and neck

A

angioedema

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33
Q

onset of angioedema

A

minutes to hours

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34
Q

resolution of angioedema

A

hours to days

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35
Q

causes of angioedema

A

hereditary

acquired

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36
Q

hereditary causes of angioedema

A

insufficient synthesis of C1-esterase inhibitor (rare - autosomal dom)

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37
Q

acquires causes of angioedema

A

ACE-inhibitors

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38
Q

tx of angioedema

A

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

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39
Q

3 drugs used to tx angioedema

A

Danazol

ecallantide

icatibant

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40
Q

which drugs increases synthesis of C1-esterase inhibitor

A

Danazol

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41
Q

bilateral rapidly spreading submandibular cellulitis

A

ludwig’s angina

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42
Q

what molars does ludwig angina originate from

A

2nd or 3rd molars

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43
Q

angina =

A

suffocating sensation

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44
Q

signs and symptoms of Ludwig’s angina

A

tongue elevated

hard, firm induration of floor of mouth

perioral edema

pain

trismus

mediastinitis

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45
Q

management of Ludwig’s Angina

A

surgery

awake fiberoptic nasal intubation

sometimes awake tracheostomy

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46
Q

localized collection of pus in the retropharyngeal space

rare

A

retropharyngeal abscess

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47
Q

5 causes of retropharyngeal abscess

A

mixed gram negative and anaerobic bacteria

tonsillitis

otitis media

pharyngeal trauma

odynophagia (classic symptom)

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48
Q

classic symptom of retropharyngeal abscess

A

odynophagia (painful swallowing)

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49
Q

signs and symptoms of retropharyngeal abscess

A

fever

odynophagia

neck swelling

drooling

torticollis

meningismus

cervical adenopathy

stridor

airway obstruction

50
Q

dx of retropharyngeal abscess

A

clinical usually

soft tissue lateral neck x ray looking for gas, mass

CT of neck

51
Q

tx of retropharyngeal abscess

A

airway mgmt

antibx

admission

surgical drainage

52
Q

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

A

epiglottitis

53
Q

is epiglottitis an emergency

A

YES

54
Q

most common ages of epiglottitis

A

2-7 (before H. flu B vaccine)

can be seen OCCASIONALLY in adults

55
Q

what organisms are assoc with epiglottitis

A

HIB, strep, staph

56
Q

signs and symptoms of epiglottitis

A

abrupt onset over several hours

fever

stridor

toxic appearance

dysphagia

odynophagia

drooling

tripod position

altered level of consciousness

cyanosis

airway obstruction

57
Q

dx of epiglotitis

A

clinically due to tenuous airway

58
Q

what should you never do with epiglottitis

A

stick a tongue blade in throat

59
Q

when should you NEVER stick a tongue blade in throat

A

epiglottitis is suspected

60
Q

what can you do with epiglottitis if stable for dx

A

soft tissue lateral neck xray

61
Q

thumb sign assoc with

A

epiglottitis

62
Q

tx of epiglottitis

A

immediate attn to control airway

antibiotics once airway is secured

63
Q

what antibiotics used to tx epiglottitis

A

3rd generation cephalosporin (Ceftriaxone)

64
Q

usually benign, self-limited inflammatory condition of trachea BELOW level of vocal cords (subglottic) caused by parainfluenza virus

A

croup (laryngotracheobronchitis)

65
Q

age range for those affected by croup

A

6 mos to 3 yrs (most common) up to 15 y/o

66
Q

winter/summer for croup

A

winter

67
Q

RSV may be assoc with

A

croup

same with parainfluenza

68
Q

Signs and symptoms of croup

A

2-3 day hx of URI

low grade fever

gradual worsening “barking seal cough” esp at night

stridor

dyspnea

retractions

tachypnea

69
Q

croup dx

A

clinical

PA CXR showing steeple sign

70
Q

steeple sign on PA CXR assoc with

A

croup (but not super specific or sensitive)

71
Q

tx of croup

A

airway mgmt

cool mist

o2 if needed

nebulized epi (must observe for 3-4 mos after tx)

steroids

72
Q

what steroids are used to tx croup

doses too

A

prednisolone 1 mg/kg

dexamethasone: .15 to .6 mg/kg IM or PO (max of 10 mg) and lasts up to 56 hours

73
Q

is whooping cough a respiratory emergency

A

yes?

74
Q

bug that causes whooping cough

A

bordatella pertussis - a gram negative aerobe

75
Q

vaccine does or does not give complete protection after 10 years

A

does not

76
Q

what vaccine with whooping cough

A

DPT

77
Q

who is at highest risk for whooping cough

A

unvaccinated infants and toddlers

78
Q

signs and symptoms of whooping cough

A

URI symptoms in early stage

no fever

paroxysms of coughing in later stage

inspiratory stridor in younger pts

POST TUSSIVE VOMITING

79
Q

two things assoc with post-tussive vomiting with whooping cough

A

increased WBC (over 20k)

increased lymphocytes

80
Q

dx of whooping cough - gold standard

A

nasopharyngeal swab on special culture media

81
Q

why would you do PCR for whooping cough

A

faster turn around time

82
Q

when is whooping cough the most contagious

A

early stage

83
Q

what are risks assoc with whooping cough

A

risk of sudden infant death and airway compromise in unvaccinated children

84
Q

who should be tx and with what - whooping cough

A

unprotected contacts

erythromycin/azithromycin

85
Q

usually start with URI and progresses

A

lower respiratory tract infections

86
Q

symptoms of lower respiratory tract infections

A

dyspnea

hypoxemia

apnea

acute resp failure

87
Q

bronchiolitis AKA

A

RSV

88
Q

a clinical syndrome in infancy characterized by:

rapid respiration
chest retractions
wheezing

A

bronchiolitis (RSV)

89
Q

bronchiolitis occurs when and in whom

A

winter

male > female

0-2 y/o, peak at 2-6 mos

90
Q

most common cause of bronchiolitis

A

RSV

91
Q

pathophys of bronchiolitis

A

bronchiolar obstruction from submucosal edema and mucous plugging

bronchoconstriction

92
Q

when do you order a chest xray with bronchiolitis

A

increased temp

choking

asymmetric chest exam

respiratory distress

sudden deterioration

93
Q

signs and symptoms of RSV bronchiolitis

A

runny nose

sneezing

low grade fever

dyspnea

tachypnea

intercostal retractions

wheezing

cyanosis

apnea

94
Q

dx of bronchiolitis (RSV)

A

clinical

chest xray (hyperinflated lungs)

pulse ox shows hypoxemia

viral cultures and fluorescent monoclonal antibody testing of nasopharyngeal swabs

95
Q

what will you see on cxr with bronchiolitis

A

hyperinflated lungs

96
Q

what will pulse ox show with bronchiolitis

A

hypoxia

97
Q

tx of bronchiolitis

A

airway mgmt

supportive mainly

mild cases can be observed at home

oxygen

beta 2 agonists

steroids not indicated

ribavirin for severely ill or intubated

98
Q

when do you give ribavirin with bronchiolits

A

severely ill or intubated

99
Q

what do you give a kiddo with bronchiolitis if severely ill or intubated

A

ribaviron

100
Q

when can a kiddo with bronchiolitis be observed at home?

A

if they are alert, playful, feeding well, RR less than 50, no retractions, no hypoxia, no sig illness

101
Q

paroxysmal attacks of reversible bronchospasm

mucous plugging

inflammation of tracheobronchial tree

A

asthma

102
Q

signs and symptoms of asthma (acute exacerbation)

A

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

103
Q

tx of asthma acute exacerbation

A

airway mgmt

oxygen

beta 2 agonists (bronchodilators, nebulized albuterol)

steroids

anticholinergics

admission or discharge decision within 1 hour

104
Q

what anticholinergic is given for astham

A

nebulized atrovent-ipratropium bromide

105
Q

what steroids are given with acute exacerbation of asthma

A

PO - prednisone, prelone

IV - solumedrol

106
Q

usual protocol for asthma - acute exacerbation

include when to take peak flow rate

A

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,

107
Q

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

A

status asthmaticus

108
Q

how to tx status asthmaticus

A

beta agonists

high dose steroids

oxygen

ADMIT

109
Q

do you admit status asthmaticus

A

yes

110
Q

inflammation of the lung caused by infection which causes alveoli to become filled with pus so air is excluded

A

pneumonia

111
Q

signs and symptoms of pneumonia

A

fever

cough

dyspnea

pleuritic chest pain

resp failure

112
Q

dx of pneumonia

A

auscultation

CXR

Pulse ox

Blood gasses

CBC

Blood cultures

Sputum gram stain, culture and sensitivity

113
Q

tx of pnuemonia

A

airway mgmt

o2

antibx

beta 2 agonists

analgesics

114
Q

any breech of the lung surface or chest wall allowing air to enter the pleural cavity causing the lung to collapse

A

pneumothorax

115
Q

signs and symptoms of pneumothorax

A

chest pain on side of collapsed lung

dyspnea

occasionally cough - but absence of other URI symptoms

116
Q

dx of tension pneumothorax

A

decreased breath sounds

tachycardia

tachypnea

tracheal deviation to the opposite side

hypotension

cyanosis

marked resp distress

CXR

117
Q

tx of pneumothorax: based on what

A

% of involvement on CXR and pts overall presentation

118
Q

tx of pneumothorax:

less than 15-20% involvement

A

observation only; repeat CXR in 48 hours

119
Q

tx of pneumothorax:

20% +

A

will almost always need intervention

needle decompression for tension pneumothorax

simple aspiration

tube thoracostomy (chest tube)

120
Q

incision for pneumothorax

A

mid axillary incision at 5th intercostal space

121
Q

tube is directed HOW (for pneumothorax)

A

posteriorly and superiorly

Surgery and Emergency Med (6 decks)

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