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Unit 1 Emerg/Surg > L2: Airway Emergencies > Flashcards

L2: Airway Emergencies Flashcards

1
Q

Assess every patient that comes in for signs of airway compromise:

A 
appearance
hypoxemia
hypercarbia
respiratory exhaustion
use of accessory muscles
retractions
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2
Q

How long does it take for brain damage to occur in respiratory arrest?

A

4 minutes at 21% O2 (room air)

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3
Q

Most common cause of airway obstruction

A

The patient’s tongue

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4
Q

Types of Airways

A 
oral
nasal
laryngeal mask airway
endotracheal intubation
tracheostomy
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5
Q

Rule of thumb for invasive airway management

A

The most advanced practitioner should do it

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6
Q

Can you see an aspirated foreign body on xray?

A

No

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7
Q

Foreign body aspiration presentation

A

persistent cough
unilateral wheezing
no URI sx
decreased breath sounds

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8
Q

2 complications of foreign body aspiration

A

postobstructive atelectasis

pneumonia

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9
Q

Le Fort I fracture

A

horizontal across maxilla

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10
Q

Le Fort II fracture

A

pyramidal, disrupts inferior orbital rim

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11
Q

Le Fort III fracture

A

transverse

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12
Q

Which kind of facial trauma can’t get nasal airways? Why?

A

Le Fort I and III fractures

Possible cribriform plate fractures, tube could end up in brain

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13
Q

What’s important about airways in burn patients?

A

Even if they look okay, they might have massive swelling later that obstructs airway
MUST intubate ASAP to secure airway

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14
Q

Common anaphylaxis triggers

A 
abx
ASA
NSAIDs
shellfish
nuts
milk
eggs
grass
hymenoptera (bee) stings
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15
Q

Anaphylaxis presentation

A 
Angioedema
Tightening in throat, chest
Laryngeal swelling
Bronchial spasm
Hoarseness
Stridor, wheezing
Respiratory distress
Apnea
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16
Q

Anaphylaxis physiology

A

Hypersensitivity, release of immune mediators→ antigen-IgE-antibody binds to mast cells→ histamine→ increased vascular permeability, vasodilation, bronchial constriction, increased mucous gland secretion→ Respiratory compromise, CV collapse

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17
Q

Important in initial assessment of anaphylaxis

A

Immediately check lungs

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18
Q

Tx of anaphylaxis

A

Airway management, O2

Antihistamines:
H1: diphenhydramine, hydroxyzine
H2: cimetidine

Beta-2 agonists: albuterol

Steroids: methylprednisolone (slow)

Endotracheal intubation/surgical airway

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19
Q

Diphenhydramine

A

H1 antihistamine

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20
Q

Hydroxyzine

A

H1 antihistamine

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21
Q

Cimetidine

A

H2 antihistamine

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22
Q

If a patient is anaphylactic and severely hypotensive

A

Epi: .3-.5 mg
→ IV: 1:10,000
→ SC: 1:1,000 (.1-.3 mg/kg)
IV bolus

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23
Q

Causes of angioedema

A

autosomal dominant insufficiency of C1-esterase inhibitor (rare)

ACE inhibitors (acquired, prevent breakdown of bradykinin)

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24
Q

Angioedema treatment

A

Airway management (nasal airway), supportive

Plasma concentrate of C1-esterase inhibitor

Epi+antihistamines+steroids

Danazol→ increases synthesis of C1-esterase inhibitor

Ecallantide→ kallikrein inhibitor

Icatibant→ bradykinin receptor antagonist

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25
Danazol
increases synthesis of C1-esterase inhibitor for angioedema
26
Ecallantide
kallikrein inhibitor for angioedema
27
Icatibant
bradykinin receptor antagonist for angioedema
28
Bilateral, rapidly spreading submandibular cellulitis, usually originates from 2nd/3rd molars
Ludwig's angina
29
What does "angina" mean in Ludwig's angina?
Suffocating
30
Ludwig's Angina presentation
``` Tongue elevated Pain, trismus Perioral edema Induration of floor of mouth Mediastinitis ```
31
What can be seen on CT of Ludwig's angina?
gas gangrene | narrowing/deformation of airway
32
Ludwig's angina treatment
Surgery: Awake fiberoptic nasal intubation Awake tracheostomy
33
Causes of a retropharyngeal abscess
mixed G- and anaerobic bacteria tonsillitis otitis media pharyngeal trauma
34
retropharyngeal abscess presentation
``` *odynophagia* Fever, drooling Neck swelling Torticollis Meningismus Cervical LAD Stridor Airway obstruction ```
35
Diagnosis of retropharyngeal abscess
Clinical diagnosis Imaging shows: Soft tissue lateral neck x-ray: gas or mass CT neck
36
retropharyngeal abscess treatment
Airway management Antibiotics Admission→ surgical drainage
37
Epiglottitis is....
Emergency infection of the supraglottic structures: epiglottis, lingual tonsillar area, epiglottic folds, false vocal cords
38
Who gets epiglottitis?
Generally rare Ages 2-7 before HIB vaccines Adults (v rare)
39
Causes of epiglottitis
HIB Strep Staph
40
Epiglottitis presentation
``` Abrupt onset (hours) Fever, stridor Toxic appearance Dysphagia Odynophagia Drooling, tripod Cyanosis Altered LOC Airway obstruction ```
41
Diagnosis of epiglottitis
Best clinical due to tenuous airway Soft tissue lateral neck xray (if stable) → thumb sign Never use tongue blade in throat
42
Epiglottitis tx
Immediately control airway 3rd generation cephalosporin once airway is secured: Ceftriaxone (Rocephin)
43
Croup
Benign, self limited inflammatory condition of trachea below level of vocal cords (subglottic)
44
Croup aka
laryngotracheobronchitis
45
Cause of croup Age group Time of year
Parainfluenza virus, RSV 6mos-3 years, up to 15 years Winter
46
Croup presentation
``` 2-3 day history of URI Low grade fever Barking seal cough (esp at night) Stridor, dyspnea Retractions, Tachypnea ```
47
Croup diagnosis
Clinical diagnosis | PA CXR→ steeple sign not sensitive or specific
48
Croup tx
Airway management, cool mist, O2 Nebulized epi→ observe 3-4 hours Steroids: Prednisolone 1mg/kg Dexamethasone .15-.6 mg/kg IM or PO (max 10 mg, lasts 56 hours)
49
Whooping cough aka
Pertussis
50
Whooping cough is... Caused by: Seasonality: Seen in:
Bordetella pertussis: G- aerob Cycles every 4-5 years DPT vax doesn’t protect after 10 years Highest risk: unvaccinated infants and toddlers
51
Whooping cough symptoms
URI symptoms (early) No fever Paroxysms of coughing (late) → post-tussive vomiting Inspiratory stridor (young)
52
Whooping cough tx
Highly contagious→ treat unprotected contacts→ erythromycin/azithromycin Risk of sudden infant death and airway compromise (unvaccinated)
53
Diagnose whooping cough..
Leukocytosis (>20K) Lymphocytosis Gold standard: nasopharyngeal swab on special culture media PCR (quicker)
54
How do lower respiratory tract infections occur, and what general symptoms might be seen?
URI moves to lower respiratory tract dyspnea hypoxemia apnea acute respiratory failure
55
Most common lower respiratory tract infection
Bronchiolitis
56
Bronchiolitis is...
Submucosal edema→ bronchial obstruction Mucous plugging Bronchoconstriction
57
Who gets bronchiolitis and at what time of year?
Infancy, M>F 0-2 years, peak 2-6 months winter
58
Bronchiolitis symptoms
``` Rapid respiration Chest retractions Wheezing Runny nose, sneezing Low grade fever Dyspnea, tachypnea Intercostal retractions Cyanosis, Apnea ```
59
Bronchiolitis diagnosis
Clinical diagnosis Pulse ox→ hypoxia Viral cultures/fluorescent monoclonal antibody
60
When to order a CXR for bronchiolitis? | What will it show?
``` Increased temp Choking Asymmetric chest exam Respiratory distress Sudden deterioration ``` Shows hyper-inflated lungs
61
Bronchiolitis can be treated at home with observation if....
Non-toxic RR<40 no retractions or hypoxia
62
If bronchiolitis is too severe to observe at home...
``` Airway management, support Admit Oxygen Beta 2 agonists NO steroids ```
63
If a bronchiolitis patient is intubated or severely ill
Ribavirin
64
Asthma presentation
+/- Auscultate wheezing (see quiet chest) Accessory muscles or nasal flaring Altered LOC
65
"Quiet chest"
Asthma hypoventilation due to inflammation Don't be foooooooled
66
Asthma treatment
Airway management, O2 B2 agonists: nebulized SVN albuterol→ bronchodilation Steroids: → PO: Prednisone, prelone → IV: Solumedrol Anticholinergics: nebulized atrovent-ipratropium bromide
67
SVN means
Small volume nebulizer
68
Decision to admit or discharge asthma
Must be made within 1 hour
69
What could cause an acute exacerbation of asthma?
Underlying infection | Underlying factors
70
Clinical decision making for acute exacerbation of asthma?
``` Admit or discharge? Baseline respiratory distress? Vulnerable population? Improvement with SVN? Able to follow up? Follow instructions? ```
71
Acute exacerbation of asthma treatment
Stacked SVN: .5 cc albuterol in 2.5 cc normal saline 3 tx q 30 minutes +/- Steroids
72
Status asthmaticus is defined as
Respiratory failure | FEV1 that doesn’t increase to >40% predicted with treatment
73
Major complication of status asthmaticus
Pneumothorax
74
Status asthmaticus tx
Beta agonists High dose steroids O2 ADMIT
75
Pneumonia definition
Inflammation of the lung caused by infection which causes the alveoli to become filled with pus→ excludes air
76
Pneumonia presentation
Fever, cough Dyspnea Pleuritic chest pain Respiratory failure
77
Pneumonia diagnosis
``` Auscultate CXR ABG, pulse ox CBC, blood culture Sputum gram stain, C+S ```
78
Pneumonia management
``` Airway management O2 Abx B2 agonists Analgesics ```
79
Pneumothorax presentation
Chest pain on side of collapsed lung | Dyspnea, +/- Cough
80
Pneumothorax diagnosis
``` Decreased breath sounds tachypnea, tachycardia Hypotension, cyanosis Marked resp distress Tracheal deviation to opposite side CXR shows absence of lung markings ```
81
Pneumothorax tx if <15-20% involvement
observation | repeat CXR in 48 hours
82
Pneumothorax tx if >20% involvement
Intervention Simple aspiration Tube thoracostomy
83
Tension pneumothorax intervention if >20% involvement
needle decompression at 5th intercostal space, mid-axillary line

Unit 1 Emerg/Surg (10 decks)

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