Management of Bronchospasm / Laryngospasm Flashcards

1
Q

Signs of bronchospasm in an intubated patient:

A
1. Increased peak airway
pressures.
2. Wheezing on lung exam.
3. Increased expiratory time.
4. Increased ETCO2 with
upsloping ETCO2 waveform.
5. Decreased tidal volumes if pressure control.
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2
Q

Bronchospasm treatment: Vent changes

A
  1. Increase to 100% O2, high flow.
  2. Change I:E ratio to allow for adequate exhalation.

patients who develop sudden
hypotension may be air-trapping – disconnect
patient from the circuit to allow for complete exhalation.

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3
Q

Troubleshooting problems that may present similar to bronchospasm

A

Rule out problems with ETT via auscultation & suction
catheter (mainstem intubation, kinked ETT, mucus plug)

Rule out anaphlyaxis

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4
Q

Bronchospasm treatment: Inhaled agents

A

Give a Beta 2 agonist (albuterol, multiple puffs required)

and possibly an anticholinergic (Ipratropium).

consider nebulized racemic epi

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5
Q

Bronchospasm treatment: IV meds

A
  • If severe consider epinephrine (start with 10 mcg IV and escalate, monitor for tachycardia and hypertension)
  • Consider ketamine: 0.2 – 1.0 mg/kg IV
  • Consider hydrocortisone 100 mg IV.
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6
Q

Nerve associated with Laryngospasm

A

Superior Laryngeal N.

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7
Q

Treatment of laryngospasm

A

forward displacement of the jaw and positive pressure ventilation with 100% oxygenation is often effective in breaking spasm

  • hypoxia and hypercarbia that develop will decrease postsynaptic potentials and brainstem output to the superior laryngeal nerve
  • laryngospasm will eventually cease as hypercarbia and hypoxia develop
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8
Q

Treatment of severe laryngospasm

A

may require small doses (20mg IV) of Sux and re-intubation

Sux may be given IM (40-60mg) or SL

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9
Q

Bronchospasm: differential dx

A

Is this anaphylaxis?!

Discontinue potential allergens: muscle relaxants, latex, antibiotics, protamine, blood products, contrast, chlorhexidine…

  • Give fluid bolus
  • Give Epi at escalating doses 10mcg-100 mcg IV
  • Start epi infusion
  • consider additional IV access and invasive monitors
  • H1 antagonist (diphenhydramine 25-50 IV)
  • H2 antagonist (Ranitidine 50 IV)
  • Corticosteroids (methylpred 125 IV)
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