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Q4 EM Surg > Airway & Respiratory Emergencies > Flashcards

Airway & Respiratory Emergencies Flashcards

1
Q

2 types of airway obstruction & outcomes

A

partial or complete

partial often->complete if not cleared

complete->respiratory arrest if not cleared

4 mins from complete obstruction to brain damage
(U) in pre-hospital setting

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2
Q

Types of airways

A

oral airways
nasal
laryngeal mask

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3
Q

Foreign body aspiration in a Toddler sxs

A
  • persistent cough, unilateral wheezing
  • NO URI sxs (can be tough)
  • ↓breath sounds
  • often not seen on CXR
  • post-obstructive atelectasis, pneumonia
  • not always down right mainstem
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4
Q

Emergency Room at Trauma Center

A

LeForte fractures

Basilar skull fractures

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5
Q

Burn Center

A

Airway edema

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6
Q

Anaphylaxis & Acute Allergic Rxns

A

Severe hypersensitivity rxn w/ CV collapse & resp comp

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7
Q

Anaphylaxis & Acute Allergic Rxns: Pathophysiology

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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8
Q

Anaphylaxis & Acute Allergic Rxns: (C) causes (4)

A
  • Antibiotics
  • ASA & NSAIDs
  • shellfish, nuts, eggs, milk
  • hymenopytera stings
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9
Q

Anaphylaxis & Acute Allergic Rxns: clinical features (6)

A 
onset: secs to hrs
angioedema
tightening in throat/chest
laryngeal swelling & bronchial spasm, hoarseness, stridor, wheezing
respiratory distress & apnea
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10
Q

Anaphylaxis & Acute Allergic Rxns: Dx

A

clinical

check airway, BP, SaO2, lungs immediately

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11
Q

Dx of anaphylaxis & Acute Allergic Rxns

A

clinical

check airway, BP, SaO2, lungs immediately

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12
Q

Anaphylaxis & Acute Allergic Rxns: Tx (8)

A 
1- airway management
2- oxygen
3- antihistamines: 
H1 (diphenhydramine or hydroxyzine), H2 (cimetidine)
4- Beta2 agonists (albuterol)
5- steroids (methylprednisolone)
6- endotracheal intubation
7- surgical airway
8- If hypoTN: IV bolus and epi
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13
Q

Angioedema

A

(S) to urticaria but w/
LARGER EDEMATOUS AREAS,
INVOLVE BOTH DERMIS & SUBCUTANEOUS,
frequently involving the head & neck

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14
Q

Causes of angioedema (3)

A
  • hereditary or acquired
  • insufficient synthesis of C1esterase inhibitor (rare, autosomal dominant)
  • ACE inhibitors
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15
Q

Tx of angioedema (5)

A

Airway management
Supportive
Plasma concentrate of C1 esterase inhibitor
Epinepherine, antihistamines, steroids
Danazol:↑synthesis of C1 esterase inhibitor

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16
Q

Retropharyngeal Abscess: definition

A
  • a localized collection of pus in the retropharyngeal space

- rare

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17
Q

Retropharyngeal Abscess: caused by (4)

A
  • mixed gram negative & anaerobic bacteria
  • tonsillitis
  • otitis media
  • pharyngeal trauma
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18
Q

Retropharyngeal Abscess: signs & symptoms (9)

A 
"FOND M CATS"
Fever
Odynophagia
Neck swelling
Drooling
Meningismus
Cervical adenopathy
Airway obstruction
Torticollis
Stridor
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19
Q

Retropharyngeal Abscess: dx

A

clinical
soft tissue lateral neck x-rays (gas, mass)
CT Neck

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20
Q

Retropharyngeal Abscess: tx (4)

A

Airway Management
Antibiotics
Admission
Surgical Drainage

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21
Q

Epiglottitis

A

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

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22
Q

Epiglottitis epidemiology

A

age 2-7 before H. influenza B vaccine
stem occasionally in adults
HiB, Strep, Staph (not 100% protected by vaccine)
rare

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23
Q

Signs and Sxs of Epiglottitis

A 
abrupt onset over several hours
fever
stridor
toxic appearance
dysphagia
odynophagia (painful swallowing)
drooling
tripod position
altered LOC
cyanosis
airway obstruction
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24
Q

Epiglottitis dx

A

-best if done clinically due to the tenuous airway
NEVER stick a tongue blade in throat
-soft tissue lateral neck x-ray if very stable

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25
Q

Epiglottitis tx

A

IMMEDIATE attention to control the airway
-Antibiotics once airway is secured
3rd generation cephalosporin

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26
Q

Croup (Laryngotracheobronchitis) description & usual cause

A

(U) benign, self limited inflammatory condition of the trachea below the level of the vocal cords (subglottic),

(U) caused by parainfluenza virus

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27
Q

Croup (Laryngotracheobronchitis) epidemiology

A

age range 6 months to 3 years
can see as old as 15 years
increased in winter

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28
Q

Croup (Laryngotracheobronchitis) signs and sxs

A 
2-3 day history of URI
low grade fever
gradual worsening "barking seal" cough, especially at night
stridor
dyspnea
retractions 
tachypnea
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29
Q

Croup (Laryngotracheobronchitis) Diagnosis

A

Clinical

PA CXR shows “STEEPLE SIGN” (but not very sensitive or specific)

30
Q

Croup (Laryngotracheobronchitis) treatment

A

airway management
cool mist
oxygen if needed
nebulized epinephrine (must observe for 3-4 hours after tx)
steroids: prednisolone 1mg/kg
dexamethasone (Decadron) .15 to .6 mg/kg IM or PO (max 10 mg), lasts up to 56 hrs

31
Q

Whooping Cough: cause, prevention, high risk groups

A

a respiratory emergency
(C): Bordetella pertussis, a gram negative aerobe
cycles every 4 to 5 years
vaccine (DPT) does not give complete protection after about 10 years
-unvaccinated infants & toddlers at highest risk

32
Q

Whooping Cough: signs and symptoms

A 
URI sxs in early stage
fever usually absent
paroxysms of coughing in later stage
inspiratory stridor in younger patients
post-tussive vomiting
33
Q

Whooping Cough diagnosis, transmission, risks, tx

A
  • by nasopharyngeal swab on special culture media
  • highly contagious in early stage
  • risk of SIDS & airway compromise in unvaccinated kids
  • need to pretreat unprotected contacts (Erythromycin/Azithromycin)
34
Q

Bronchiolitis (RSV) def

A

clinical syndrome in infancy characterized by rapid respiration, chest retractions & wheezing

35
Q

Bronchiolitis (RSV) epidemiology

A

Winter
Male>female
0-2 years range (peak 2-6 months)
Respiratory Syncital Virus (RSV): most common cause

36
Q

Bronchiolitis (RSV) pathophysiology

A

bronchiolar obstruction from submucosal edema & mucous plugging

37
Q

Bronchiolitis (RSV) signs & sxs

A 
runny nose, sneezing
low grade fever
dyspnea
tachypnea
intercostal retractions
wheezing
cyanosis
apnea
38
Q

Bronchiolitis (RSV) diagnosis

A

-clinical
-CXR-hyperinflated lungs
pulse oximetry usually shows hypoxia
-viral cultures/fluorescent -monoclonal antibody testing of NP swabs

39
Q

Bronchiolitis (RSV) treatment

A 
Airway management, primarily supportive
Mild cases [alert, playful, feeding well, RR<50, no retractions, no hypoxia, w/no associated significant illness] can be observed at home, 
All others should be admitted
Oxygen
Beta 2 agonists
Ribavirin for severely ill or intubated

NO steroids

40
Q

Asthma definition

A

a condition characterized by paroxysmal attacks of reversible bronchospasm, mucous pluggint and inflammation of the tracheobronchial tree

41
Q

Asthma acute exacerbation signs & symptoms

A
  • progressive dyspnea
  • chest tightness
  • wheezing
  • cough
  • obvious respiratory distress
  • auscultation of wheezes
  • use of accessory muscle or nasal flaring
  • altered LOC
  • don’t be fooled by the “quiet chest”
42
Q

asthma acute exacerbation tx

A

airway management
oxygen
Beta 2 Agonists (bronchodilators): nebulized (SVN) (Albuterol)
Steroids: PO-prednisone, prelone; IV-solumedrol
Anticholinergics: nebulized (atrovent, ipratropium bromide)

admission or discharge decision within 1 hour

43
Q

Usual protocol if asthma acute exacerbation

A

stacked SVN treatments w/bronchodilators:

  • .5 cc albuterol in 2.5 cc normal saline, 3 txs given q 30mins
  • peak flow rate before 1st & after 3rd tx
  • determine if steroid therapy is needed
  • look for underlying infection
44
Q

Asthma acute exacerbation: questions to ask?

A 
admit or discharge?
how much baseline respiratory distress?
vulnerable population?
how much improvement with each SVN?
underlying factors?
able to get follow-up care?
reliable to follow instructions for out-pt tx?
45
Q

COPD & Emphysema: physiological what is going on in both

A

V/Q mismatch=areas of perfusion are not being ventilated

-wCO2 retention, hypoxic drive has long been lost & CO2 drive is being lost, these are very sick patients

46
Q

COPD vs. Emphysema

A

COPD=”blue bloaters”, more bronchospasm & mucus plugging

emphysema=”pink puffers”, more loss of alveolar architecture

(U) some combination

47
Q

Emphysema & COPD epidemiology

A

older population

smokers

48
Q

Emphysema & COPD signs &sxs

A
  • progressive dyspnea, may have been having dyspnea for days before presenting to the ED!
  • chest tightness
  • wheezing
  • cough
49
Q

Emphysema & COPD dx of exacerbation

A
  • obvious respiratory distress
  • wheezing
  • use of accessory muscles
  • altered LOC-ominous
  • don’t be fooled by the “quiet chest”
  • change in sputum production & color
50
Q

Emphysema & COPD tx

A

airway management
oxygen
Beta 2 agonists(bronchodilators):
nebulized (SVN) (albuterol)
Steroids: PO (prednisone, prelone), IV (Solumedrol)
Anticholinergics: nebulized (atrovent-ipratropium bromide)
Antibiotics
Admission or discharge decision within 1 hour
Very hard to extubate

51
Q

Emphysema disposition/admission rate

A

higher admission rate than asthma

  • older population
  • more comorbid conditions
  • more damage to the lungs
52
Q

Pneumonia

A

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

53
Q

Pneumonia signs & sxs (5)

A 
fever
cough
dyspnea
pleuritic chest pain
respiratory failure
54
Q

Pneumonia diagnosis (7)

A 
auscultation
CXR
pulse oximetry
blood gasses
CBC
blood cultures
sputum Gram stain, C&S
55
Q

Pneumonia treatment (5)

A 
Airway management
Oxygen
Antibiotics
Beta 2 agonists
Analgesics
56
Q

Congestive Heart Failure/Pulmonary Edema: definition and cause

A

inability of myocardium to adequately perfuse end-organs->fluid accumulation, arterial vasoconstriction-> further pump failure

most (C) cause=coronary ischemia
most (C) cause of right HF=left HF

57
Q

CHF/PE (C) causes (4)

A
  • MI
  • valvular dysfxn (high output failure w/regurgitant lesions, stenosis lesions get critical very fast)
  • cardiomyopathy (viral)
  • systemic HTN (wall thickening then hypoperfusion
58
Q

CHF/PE signs & sxs (5)

A 
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
fatigue
peripheral edema
59
Q

CHF/PE diagnosis (8)

A 
diaphoresis
tachypnea
tachycardia
pulmonary rales or wheezing
JVD-hepatojugular reflux
hepatomegaly
pitting peripheral edema
pulse oximetry
60
Q

CHF/PE tx (5)

A
  • Airway management
  • Oxygen
  • Vasodilators: nitrates (SL, topical, IV)
  • Diuretics: furosemide (Lasix) 20-40 mg IV
  • Inotropic agents (B1), dobutamine
61
Q

Pneumothorax def

A

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

62
Q

Pneumothorax signs & sxs (3)

A
  • chest pain on side of collapsed lung
  • dyspnea
  • occasionally cough, but absence of other URI symptoms
63
Q

Large pneumothorax dx (8)

A
  • Decreased breath sounds
  • tachypnea
  • tachycardia
  • TRACHEAL DEVIATION TO OPPOSITE SIDE
  • HYPOTENSION
  • cyanosis
  • marked respiratory distress
  • CXR
64
Q

Pneumothorax tx

A

tx based on % involvement on CXR & overall pt presentation
<15-20% involvement: observation only, repeat CXR in 48 hrs

20% or more=intervention

  • needle decompression
  • simple aspiration
  • tube thoracostomy (chest tube)
65
Q

Pulmonary Embolism

A

venous thrombi dislodge & travel to the pulmonary arteries where they cause occlusion
-presenting signs & symptoms depend on how occluded pulmonary vasculature is & pre-existing cardiopulmonary dz

66
Q

PE sxs

A

3 most common: dyspnea (81%), pleuritic chest pain (73%), cough (60%)
other sxs: any type of chest pain, wheezing, chest wall tenderness, anxiety, hemoptysis

67
Q

PE: predisposing factors (6)

A 
immobility (best rest, traction, etc)
heart dz
CA
estrogen therapy
previous DVT or PE
hypercoagulability
68
Q

PE dx work-up

A
  • almost always rule out MI so need ECG, cardiac enzymes
  • pulse ox & ABGs controversial
  • CXR
  • V/Q scan (provides distribution of pulmonary blood flow by visualizing radioactivity after IV injection of radiolabeled albumin microaggregates)
  • D-Dimer
  • CT scan of chest
69
Q

V/Q scan report

A

reported as low, intermediate or high probability
[low or intermediate DOES NOT RULE OUT]
high probability in a pt with strong risk factors->initiate therapy

70
Q

Controversial PE workup

A

do a work-up for LE DVT?

  • serial impedance plethysmography
  • Doppler ultrasonography

gold standard dx test=pulmonary angiography, but it is invasive and risky (morbidity rate of 4%), so RARELY DONE

71
Q

PE tx

A 
supportive care
oxygen therapy
anticoagulation therapy
intensive monitoring
pain relief
surgical embolectomy
vena cava filter (Greenfield filter)

Q4 EM Surg (27 decks)

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