Part 12: Cardiac Arrest in Special Situations Flashcards
What may increased wheezing indicate clinically?
A positive response to bronchodilator therapy
What are the 3 key abnormalities in the pathophysiology of asthma?
Bronchoconstriction
Airway inflammation
Mucous plugging
What may the absence of wheezing indicate?
Critical airway obstruction
Why may the SaO2 fall initially during bronchodilator therapy with B2-agonist?
Beta2 agonists produce both bronchodilation and vasodilation and initially may increase intrapulmonary shunting.
What are the other possible causes of wheezing? (name 8)
Pulmonary oedema Chronic obstructive pulmonary disease (COPD) Pneumonia Anaphylaxis Foreign bodies PE Bronchiectasis Subglottic mass
Which out of the three key abnormalities in asthma are amendable to drug treatment?
Only bronchoconstriction and
inflammation
Which drug is used to treat the inflammation in asthma?
Corticosteroids
What complications can arise during positive pressure ventilation of a patient with severe bronchoconstriction?
Breath stacking (auto-PEEP)
Hyperinflation
Tension pneumothorax
Hypotension
What respiratory rate and tidal volume should be used during normal or mechanical ventilation of a patient with severe bronchoconstriction?
Smaller respiratory rate
Smaller TV (6-8ml/kg)
Shorter inspiratory time (eg. adult inspiratory flow rate 80 to 100ml)
Longer expiratory time (eg, inspiratory to expiratory ratio 1:4 or 1:5)
How can one quickly reduce high-end expiratory pressure when using mechanical ventilation of a patient with severe bronchoconstriction?
By separating the patient from the ventilator circuit; this will allow PEEP to dissipate during passive exhalation
What measure can a paramedic take to dissipitate auto PEEP during cardiac arrest of a patient with severe bronchoconstriction?
During arrest a brief disconnection from the bag mask or ventilator may be considered, and
compression of the chest wall to relieve air-trapping can be effective
What possible diagnosis should be considered for all asthmatic patients with cardiac arrest, especially in whom ventilation is difficult?
Tension pneumothorax
What does the term classic anaphylaxis refer to?
Refers to hypersensitivity reactions mediated by the immunoglobins IgE and IgG
What are the most common causes of anaphylaxis? (Name 4)
Pharmacological agents
Latex
Foods
Stinging insects
What is the most common physical finding in anaphylaxis?
Urticaria
What is the common early sign of respiratory involvement due to anaphylaxis?
Rhinitis
What physical findings can suggest more severe respiratory compromise due to upper airway edema and lower airway edema?
Stridor
Wheezing
What is the recommended target pressure for volume resuscitation in anaphylaxis according to AHA 2010?
90mmHg
What other drugs may be considered according to AHA 2010 besides adrenaline in patients with anaphylaxis?
Antihistamines
Beta-adrenergic agents
IV corticosteroids
What interventions are the standard of care for treating the critically ill pregnant patient according to AHA 2010?
Place the pt in the full left-lateral position
Give 100% oxygen
IV access above the diaphragm
Assess for hypotension
Consider reversible causes of critical illness an
treat condition that may contribute to clinical deterioration as early as possible
What BP is considered as maternal hypotension, that requires therapy?
SBP < 100mmHg
or < 80% of baseline
Why is full left-lateral position recommended in AHA 2010 for pregnant patient?
Pregnant uterus can compress the inferior vena cava,
impending venous return and thereby
reducing SV and CO
What degree of tilt should be applied during management of critically ill pregnant patient?
27 to 30 degrees using a firm wedge to support the pelvis and thorax
Why can pregnant patients develop hypoxemia rapidly?
Because of decreased functional residual capacity and
increased oxygen demand
