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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
Q

Danazol

A

increases synthesis of C1-esterase inhibitor for angioedema

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26
Q

Ecallantide

A

kallikrein inhibitor for angioedema

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27
Q

Icatibant

A

bradykinin receptor antagonist for angioedema

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28
Q

Bilateral, rapidly spreading submandibular cellulitis, usually originates from 2nd/3rd molars

A

Ludwig’s angina

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29
Q

What does “angina” mean in Ludwig’s angina?

A

Suffocating

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30
Q

Ludwig’s Angina presentation

A 
Tongue elevated
Pain, trismus 
Perioral edema
Induration of floor of mouth
Mediastinitis
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31
Q

What can be seen on CT of Ludwig’s angina?

A

gas gangrene

narrowing/deformation of airway

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32
Q

Ludwig’s angina treatment

A

Surgery:

Awake fiberoptic nasal intubation
Awake tracheostomy

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33
Q

Causes of a retropharyngeal abscess

A

mixed G- and anaerobic bacteria
tonsillitis
otitis media
pharyngeal trauma

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34
Q

retropharyngeal abscess presentation

A 
*odynophagia*
Fever, drooling
Neck swelling
Torticollis
Meningismus
Cervical LAD
Stridor
Airway obstruction
35
Q

Diagnosis of retropharyngeal abscess

A

Clinical diagnosis

Imaging shows:

Soft tissue lateral neck x-ray: gas or mass

CT neck

36
Q

retropharyngeal abscess treatment

A

Airway management
Antibiotics
Admission→ surgical drainage

37
Q

Epiglottitis is….

A

Emergency infection of the supraglottic structures: epiglottis, lingual tonsillar area, epiglottic folds, false vocal cords

38
Q

Who gets epiglottitis?

A

Generally rare
Ages 2-7 before HIB vaccines
Adults (v rare)

39
Q

Causes of epiglottitis

A

HIB
Strep
Staph

40
Q

Epiglottitis presentation

A 
Abrupt onset (hours)
Fever, stridor
Toxic appearance
Dysphagia Odynophagia
Drooling, tripod
Cyanosis
Altered LOC
Airway obstruction
41
Q

Diagnosis of epiglottitis

A

Best clinical due to tenuous airway

Soft tissue lateral neck xray (if stable) → thumb sign

Never use tongue blade in throat

42
Q

Epiglottitis tx

A

Immediately control airway

3rd generation cephalosporin once airway is secured: Ceftriaxone (Rocephin)

43
Q

Croup

A

Benign, self limited inflammatory condition of trachea below level of vocal cords (subglottic)

44
Q

Croup aka

A

laryngotracheobronchitis

45
Q

Cause of croup
Age group
Time of year

A

Parainfluenza virus, RSV
6mos-3 years, up to 15 years
Winter

46
Q

Croup presentation

A 
2-3 day history of URI
Low grade fever
Barking seal cough (esp at night) 
Stridor, dyspnea
Retractions, Tachypnea
47
Q

Croup diagnosis

A

Clinical diagnosis

PA CXR→ steeple sign
not sensitive or specific

48
Q

Croup tx

A

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
Q

Whooping cough aka

A

Pertussis

50
Q

Whooping cough is…
Caused by:
Seasonality:
Seen in:

A

Bordetella pertussis: G- aerob

Cycles every 4-5 years

DPT vax doesn’t protect after 10 years
Highest risk: unvaccinated infants and toddlers

51
Q

Whooping cough symptoms

A

URI symptoms (early)
No fever
Paroxysms of coughing (late) → post-tussive vomiting
Inspiratory stridor (young)

52
Q

Whooping cough tx

A

Highly contagious→ treat unprotected contacts→ erythromycin/azithromycin

Risk of sudden infant death and airway compromise (unvaccinated)

53
Q

Diagnose whooping cough..

A

Leukocytosis (>20K)

Lymphocytosis

Gold standard: nasopharyngeal swab on special culture media

PCR (quicker)

54
Q

How do lower respiratory tract infections occur, and what general symptoms might be seen?

A

URI moves to lower respiratory tract

dyspnea
hypoxemia
apnea
acute respiratory failure

55
Q

Most common lower respiratory tract infection

A

Bronchiolitis

56
Q

Bronchiolitis is…

A

Submucosal edema→ bronchial obstruction
Mucous plugging
Bronchoconstriction

57
Q

Who gets bronchiolitis and at what time of year?

A

Infancy, M>F
0-2 years, peak 2-6 months

winter

58
Q

Bronchiolitis symptoms

A 
Rapid respiration
Chest retractions
Wheezing
Runny nose, sneezing
Low grade fever
Dyspnea, tachypnea
Intercostal retractions
Cyanosis, Apnea
59
Q

Bronchiolitis diagnosis

A

Clinical diagnosis

Pulse ox→ hypoxia

Viral cultures/fluorescent monoclonal antibody

60
Q

When to order a CXR for bronchiolitis?

What will it show?

A 
Increased temp
Choking
Asymmetric chest exam
Respiratory distress
Sudden deterioration

Shows hyper-inflated lungs

61
Q

Bronchiolitis can be treated at home with observation if….

A

Non-toxic
RR<40
no retractions or hypoxia

62
Q

If bronchiolitis is too severe to observe at home…

A 
Airway management, support
Admit
Oxygen
Beta 2 agonists
NO steroids
63
Q

If a bronchiolitis patient is intubated or severely ill

A

Ribavirin

64
Q

Asthma presentation

A

+/- Auscultate wheezing (see quiet chest)
Accessory muscles or nasal flaring
Altered LOC

65
Q

“Quiet chest”

A

Asthma
hypoventilation due to inflammation
Don’t be foooooooled

66
Q

Asthma treatment

A

Airway management, O2

B2 agonists: nebulized SVN albuterol→ bronchodilation

Steroids:
→ PO: Prednisone, prelone
→ IV: Solumedrol

Anticholinergics: nebulized atrovent-ipratropium bromide

67
Q

SVN means

A

Small volume nebulizer

68
Q

Decision to admit or discharge asthma

A

Must be made within 1 hour

69
Q

What could cause an acute exacerbation of asthma?

A

Underlying infection

Underlying factors

70
Q

Clinical decision making for acute exacerbation of asthma?

A 
Admit or discharge?
Baseline respiratory distress? 
Vulnerable population?
Improvement with SVN?
Able to follow up? Follow instructions?
71
Q

Acute exacerbation of asthma treatment

A

Stacked SVN:
.5 cc albuterol in 2.5 cc normal saline
3 tx q 30 minutes

+/- Steroids

72
Q

Status asthmaticus is defined as

A

Respiratory failure

FEV1 that doesn’t increase to >40% predicted with treatment

73
Q

Major complication of status asthmaticus

A

Pneumothorax

74
Q

Status asthmaticus tx

A

Beta agonists
High dose steroids
O2
ADMIT

75
Q

Pneumonia definition

A

Inflammation of the lung caused by infection which causes the alveoli to become filled with pus→ excludes air

76
Q

Pneumonia presentation

A

Fever, cough
Dyspnea
Pleuritic chest pain
Respiratory failure

77
Q

Pneumonia diagnosis

A 
Auscultate
CXR
ABG, pulse ox
CBC, blood culture
Sputum gram stain, C+S
78
Q

Pneumonia management

A 
Airway management
O2
Abx
B2 agonists
Analgesics
79
Q

Pneumothorax presentation

A

Chest pain on side of collapsed lung

Dyspnea, +/- Cough

80
Q

Pneumothorax diagnosis

A 
Decreased breath sounds
tachypnea, tachycardia
Hypotension, cyanosis
Marked resp distress
Tracheal deviation to opposite side
CXR shows absence of lung markings
81
Q

Pneumothorax tx if <15-20% involvement

A

observation

repeat CXR in 48 hours

82
Q

Pneumothorax tx if >20% involvement

A

Intervention
Simple aspiration
Tube thoracostomy

83
Q

Tension pneumothorax intervention if >20% involvement

A

needle decompression at 5th intercostal space, mid-axillary line

Unit 1 Emerg/Surg (10 decks)

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