ED 2 Respiratory Flashcards
current steroid use or recent withdrawal from oral steroids puts you at risk for what?
asthma exacerbation
what is a MAJOR risk factor for death in an asthmatic who’s having an exacerbation?
prior intubations, ICU admissions, exacerbations
what are more mild risk factors for death in an asthmatic who’s having an exacerbation?
use of 2 or more albuterol inhalers in past month
use of air conditioning
at what levels of the following are considered a warning sign in an asthma exacerbation?
1) peak flow
2) PAO2
3) PCO2
4) pulsus paradoxus
1) peak flow less than 100-80
2) PAO2 less than 60 mmHG
3) PCO2 greater than 45 mmHG
4) pulsus paradoxus greater than 20 mmHG
what are the three medications often given during asthma exacerbation?
1) albuterol by nebulizer (beta-2 agonist)
2) steroids PO or IV (equal in time of onset)
3) epinephrine IM
what medication is the standard and MUST be on board in severe asthma exacerbations?
epinephrine
do inhaled corticosteroids play a large role in acute asthma exacerbation?
NO
which medication can be used as an alternative to epinephrine in the case of heart disease?
terbutaline
selective beta2 agonist
less cardiac SE but expensive!
which medication can be used during acute asthma exacerbation, which is safe in pregnancy with very little downside?
magnesium sulfate
which gas is 25 percent as dense as room air is is sometimes used as a nebulizer treatment in acute asthma exacerbation?
helium
set it to rate of 8-10 L/min
a silent chest should make you concerned for what?
status asthmaticus
which acid base disorder will a patient in status asthmaticus have?
severe respiratory acidosis
how do we manage status asthmaticus?
may have to intubate; do not delay once deemed necessary
what do you do if your patient in an asthma exacerbation is pregnant?
do EVERYTHING the same
thin, barrel chest, clubbing of fingers, pursed lips, prolonged expiratory phase are all signs of what?
COPD patient
what are the three tiers of managing COPD exacerbations?
1) medication therapy and supplemental O2
2) positive pressure ventilation
3) intubation
what 3 treatments are given to a patient in moderate-severe COPD exacerbation?
1) ipratroprium bronchidilator by nebulizer or MDI
2) corticosteroids (for all but mild exacerbations) - either prednisone PO for 7-14 days or methylprednisone IV for 7-14 days
3) NIPPV (bipap or cpap)
why do we prefer NIPPV to intubation in our COPD patient?
less invasive
decrease need for intubation
reduce hospital stay
reduce mortality
you can ONLY do NIPPV when a patient is capable of what?
breathing on their own
you should intubate and mechanically ventilate a COPD exacerbation patient should any of these three criteria occur
1) change in mental status
2) increased distress with cyanosis
3) acute deterioration/exhaustion
do everything you can to avoid!
your patient with a COPD exacerbation began producing increased sputum and fever, you decide to RX ABX. what are you going to give?
macrolides or fluoroquinolones outpatient
what is hypercarbia? what does it lead to?
CO2 retention seen in COPD
leads to respiratory acidosis, hyperventilation
why must you be sure to not give too much O2 to your patient with a COPD exacerbation?
can lead to respiratory arrest/depression secondary to loss of hypoxemia-induced ventilatory drive
your young, non-smoking patient presents with emphysema. what should you work up?
alpha1-antitrypsin deficiency syndrome
leads to increased protease tissue destruction (bc alpha1-antitrypsin usually protects lungs from destruction) and emphysema in younger people
what is the mortality rate of untreated pneumonia in a normal host?
30 percent
which three populations of people typically have atypical presentations of pneumonia?
1) elderly
2) alcoholics
3) immune compromised
if your patient with pneumonia requires admission, what are the ABX of choice?
fluoroquinolones
according to lecture this time around, what is the classic triad of PE?
pleuritic chest pain, dyspnea (MC), hemoptysis
what must you do before ordering any labs or imaging for your workup for PE?
determine pre-test probability with a well’s score or PERC rule for PE
who is most at risk for spontaneous pneumothorax?
tall thin man smokers
how will a patient with spontaneous pneumothorax present?
ABRUPT pleuritic chest pain with dyspnea
often tachycardic, tachypneic
when you auscultate a patient with spontaneous pneumothorax, what will you note?
decreased breath sounds
how will you manage the following pneumothorax patients?
1) mild
2) urgent
3) emergent
1) mild = do nothing, repeat x-ray in 24 hours
2) chest tube if urgent
3) needle decompression if emergent
get a thoracic referral!
how does one develop a traumatic pneumothorax? what do we worry most about?
blunt or penetrating trauma
worry about tension pneumothorax
you get a chest x-ray of your patient with traumatic pneumothorax and note a fluid line, whats up?
hemopneumothorax
what will you note on auscultation of your patient with a traumatic pneumothroax?
hyperresonance
tympany
subcutaneous emphysema (snap, crackle, pop)
how do we treat traumatic pneumothorax?
emergent needle decompression; mid-clavicle 2nd intercostal space
chest tube placement to drain blood
