Lower Airway Flashcards
Wheezing
Occurs when air enters narrowed or constricted areas of the lungs
Intermittent Asthma
Asthma is considered intermittent if without treatment ANY of the following are true:
- Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
- —Occur on fewer than 2 days/ week
- —Do not interfere with normal activities
- —Nighttime symptoms occur on fewer than 2 days/month
Mild Persistent Asthma
Asthma is considered Mild Persistent if w/o treatment ANY of the following are true:
- -Symptoms occur on more than 2 days/week, but do not occur everyday
- -Attacks interfere with daily activities
- -Nighttime symptoms occur 3-4 times/month
- -Lung function tests are normal when the person is not having an asthma attack. The results of these tests are 80% or more of the expected value and may vary a small amount (PEF varies 20%-30%) from morning to afternoon
Moderate persistent asthma
Asthma is considered Moderate Persistent if w/o treatment ANY of the following are true:
- -Symptoms occur daily. Inhaled short-acting asthma medication is used everyday.
- -Symptoms interfere with daily activities
- -Nighttime symptoms occur more than 1 x/week, but do not happen everyday.
- -Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than 30% from morning to afternoon
Severe persistent asthma
Asthma is considered severe persistent if without treatment ANY of the following are true:
- -Symptoms occur throughout each day.
- -Symptoms severely limit daily physical activities.
- -Night time symptoms occur often, sometimes every night
- -Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to afternoon
Acute Asthma Mild Symptoms
- Increased RR
- Accessory muscles of respiration are NOT used
- HR 95%
Acute Asthma Moderate Symptoms
- Increased RR
- Accessory muscles are typically used
- Suprasternal retractions are present
- Loud expiratory wheezing heard
- Pulsus paradoxus may be present (10-20mmHg)
- O2 sat on room air is 91-95%
Acute Asthma Severe Symptoms
- RR >30
- Accessory muscles are usually used
- Suprasternal retractions are commonly present
- HR > 120
- Loud biphasic (expiratory and inspiratory) wheezing can be heard
- Pulsus paradoxus is often present (20-40 mmHg)
- O2 sat on room air is less than 91%
Pulsus Paradoxus
On inspiration, a drop in systemic arterial pressure greater than 10mmHg.
Asthma Action Plan
- Required by Joint commission for hospital discharge and continuing care
- Environmental controls
- Algorithm for use of long term and rescue meds
- Medication regimens and rescue meds
- Steps to take when treatment is not effective/emergent care
Stepwise approach in treating status asthmaticus
- Supplemental O2- FIRST PRIORITY
- Stacked inhaled bronchodilators (albuterol, levalbuterol)
- Continuous inhaled bronchodilators
- Prednisone or methylprednisolone
- Anticholinergics (ipratropium bromide) - promotes bronchodilation, used in ED to prevent admission
- MgSO4 as bolus
- Terbutaline (controversial) (IV Beta agonist)
- Methylxantines (aminophylline, theophylline)
- Helium-oxygen gas (Heliox) (Controversial)
- Noninvasive ventilation as BiPAP or CPAP for hypoxia
- Intubation and ventilation as a last resort
- Inhaled anesthesia or extracorporeal membrane oxygenation (ECMO) for severe refractory cases
Pneumonia- Definition/Etiology
Infection and inflammation of the lower respiratory tract in association with detectable radiographic changes of the lung parenchyma, interstitial disease. Bacterial or viral.
Pneumonia- Symptoms/characteristics
Prolonged URI, cough, lethargy, decreased appetite, fever, could be low grade or high depending on organism
Pneumonia- Diagnosis
Presence and longevity of symptoms, chest exam, CXR, CBC, CRP, cold agglutins
Pneumonia- Management
Oxygen, antibiotics, fluids, pulmonary toilet, bronchodilators on occasion
Pneumonia- indications for hospitalization
- Hypoxemia- saturation 70 for infants 50 for older children, retractions, nasal flaring, difficulty breathing, apnea, grunting
- Toxic appearance
- Underlying conditions that may predispose to a more serious course of pneumonia
- Complications (effusion/empyema)
- Suspicion or conformation that CAP is due to a pathogen with increased virulence, such as Staph aureus or Group A Strep
Parapneumonic Effusion - Definition/Etiology
Fluid leak into pleural space. Can be compilation of pneumonia.
2 Stages:
- ) Exudative: pleural fluid is free-flowing
- ) Fibrinopurulent: bacterial invasion, white cells and fibrin results in loculation
A parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis.
Parapneumonic Effusion - Symptoms/Characteristics
Persistent cough, hypoxia, lethargy, wheezing, persistent fever
Parapneumonic Effusion - Diagnosis
Lateral xray or ultrasound
CT may be obtained