Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medical Emergencies > Pulmonary Emergencies > Flashcards

Pulmonary Emergencies Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

upper airway conditions

A
  • susceptible to conditions that can obstruct the airway and impair ventilation
  • most commonly caused by infections
  • also allergic reactions and foreign bodies
  • airway obstruction may present with no obvious signs of illness
  • some airway diseases can become life threatening
  • Airway obstructions may have dysphagia with drooling, abnormal sounds with breathing or speaking (especially stridor on inspiration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

upper respiratory tract

A
  • nasopharynx
  • oropharynx
  • laryngopharynx
  • nasal cavity
  • larynx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

aspiration

A
  • inhalation of anything other than breathable gases
  • water, blood, vomitus, food
  • patient who receive tube feedings are susceptible
  • many geriatric patients have impaired swallowing ability due to stroke, CNS issues
  • aspiration of stomach acid may cause pneumonitis in addition to pneumonia
  • fluid typically coming from the stomach (acidic) -> pneumonia develops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pathophysiology of aspiration

A
  • aspiration of stomach contents into lungs with trauma or OD and has high mortality rate
  • aspiration of foreign bodies may be seen in intoxicated or traumatized adults
  • older adults may have reduced gag reflex from aging or stroke
  • chronic aspiration of food in older adults: common cause of pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

aspiration treatment

A
    1. aggressively reduce risk of aspiration when ventilating (and gastric distention) by using nasogastric tube whenever possible (sucks out stomach contents so there is nothing to aspirate)
    1. aggressively monitor pts ability to protect their own airway and use advanced airway when needed
    1. aggressively treat aspiration with suction and airway control if previous steps fail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

aspiration

A
  • nasal gastric tube - removes all stomach contents so aspiration risk is low
  • pneumonia is your biggest concern
  • put them on their side, sit them up -> position appropriate
  • use suction to minimize risk of aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

foreign body obstruction

A
  • tongue is the most common cause of airway obstruction in (semi) conscious patients
  • can result in death of pt with trauma, insulin shock, seizure, or intoxicated
  • increase incidence of FB aspiration in infants/toddlers
  • coins and toys most common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

signs and symptoms of foreign body obstruction

A
  • size of object determines partial or total obstruction
  • sudden onset of coughing, dyspnea, and signs of choking are hallmarks
  • air trapping from partial obstruction of lower airway may lead to pneumothorax
  • sudden onset of wheezing (one lung) in child
  • Aspirated foreign objects may remain trapped for weeks or months. Chronic blockage may cause bronchial collapse or obstructive pneumonia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

foreign body obstruction treatment

A
  • determined by ability to breathe or cough
  • supplemental oxygen may ease symptoms
  • immediate intervention for pt’s w/stridor, ↓O2 saturation, cyanosis, impending respiratory failure
  • calm the patient and family members
  • conscious patients with partial obstruction: abdominal thrusts may stimulate cough
  • if pt loses consciousness -> chest compressions
  • prepare meds for RSI (rapid sequence intubation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

epiglotitis

A
  • lift threatening infection -> swelling of epiglottis can obstruct trachea
  • adult men are 3x more likely than women
  • most common in children 2-4 years of age
  • mortality rate 7% in adults, 1% in children
  • pathophysiology- more common before H. influenzae type b (Hib) vaccine
  • now more likely caused by streptococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

signs and symptoms of epiglottitis

A
  • begins w/sore throat, progresses to pain on swallowing and muffled voice
  • moderate or severe respiratory distress (pt may be in tripod position)
  • fever, heavy drooling, stridor, pain on palpating larynx, tachycardia, low O2 saturation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

rapid sequence induction

A
  • RSI
  • prior to starting RSI, ready endotracheal tube, have forceps handy, prepare suction
  • NM-blocking drugs: affect Ach synthesis or block Ach receptors.
    1. pre-fill patient’s lungs w/high concentration O2
  • NRB or BVM attached to 100% oxygen, High flow nasal cannula
    1. administer neuromuscular-blocking drugs to induce unconsciousness & paralysis
  • may see object with laryngoscopy allowing you to grasp the obejct.
    1. insert endotracheal tube if all clear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

epiglottitis differential diagnosis

A
  • bacterial tracheitis, retropharyngeal abscess, Ludwig’s angina, peritonsillar abscess
  • dx. can be confirmed by plain film radiographs (x-rays) of neck & fiber-optic laryngoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

epiglottitis treatment

A
  • administering oxygen
  • nebulizers
  • ER tx. aimed at oxygenation & ventilation, do not put anything in pt’s mouth, intubate in field only if absolutely necessary, antibiotics & corticosteroids, nebulized epinephrine
  • Endotracheal intubation is best achieved surgically w/ENT nearby.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ludwigs angina

A
  • Potentially life-threatening connective tissue infection (cellulitis) of submandibular space, often after tooth abscess
  • Pathophysiology:
  • swelling, redness, & warmth between hyoid bone and mandible
  • bacterial infection: Streptococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

signs and symptoms of ludwigs angina

A
  • severe gingivitis & cellulitis
    • submandibular swelling
    • drooling
    • airway obstruction
    • displacement of tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

differential diagnosis lugwigs angina

A
  • retropharyngeal/pre-vertebral abscess
  • bacterial tracheitis
  • epiglottitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ludwigs angina treatment

A
  • maintain airway (may require prophylactic intubation in ER)
  • humidified oxygen in the field
  • antibiotics -> is it viral or bacterial (viral is not antibiotics)
  • ENT surgeon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

emergency surgical airway procedures

A
  • cricothyrotomy**- AKA thyrocricotomy, cricothyroidotomy, inferior laryngectomy
  • less than 0.6% of intubations require this
  • numbers decreasing with increased use of RSI
  • last resort procedure for life-threatening cases
  • if endotracheal/nasotracheal intubation is impossible or contraindicated
  • only temporary
  • severe facial trauma, foreign body, anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

lower airway conditions

A
  • more diffuse obstruction to air flow with in lungs
  • 20% of adults in US suffer from emphysema, chronic bronchitis, or asthma
  • lung conditions usually classified as obstructive or restrictive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

obstructive lung disease

A
  • hard to exhale all the air in the lungs

- air comes out slower than normal and high amount of air stays in lungs after full exhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

emphysema

A
  • muscus and puss in the alveoli

- not allowing good gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

restrictive lung disease

A
  • lungs restricted from fully expanding
  • usually conditions affecting stiffness in lungs or chest wall, weal muscles, damaged nerves
  • interstitial lung disease, sarcoidosis (autoimmune), obesity, scoliosis, ALS, MD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Interstitial lung disease example

A

-idiopathic pulmonary fibrosis. Main symptom of both is shortness of breath with exertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

COPD

A
  • emphysema and chronic bronchitis

- obstructive and restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

asthma

A
  • 20-30% of hospital admissions
  • high relapse rate
  • affects more than 25 million people in the US
  • higher prevalence in children
  • 90% of asthmatics had first symptoms by age 6
  • tachycardia
  • wheezing
  • obstructive
  • can grow out of it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

pathophysiology: asthma

A
  • chronic inflammation and constriction of bronchi results in wheezing
  • airway becomes overly sensitive to allergens, viruses, environmental irritants
  • inflammation is prime cause of symptoms: dyspnea, wheezing, coughing
  • bronchoconstriction**
  • Body responds to persistent bronchospasm with edema & mucous secretion, results in bronchial plugging and atelectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

signs and symptoms of asthma

A
  • wheezing
  • dyspnea
  • chest tightness, discomfort, pain
  • cough
  • signs of recent URI
  • signs of exposure to allergens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

asthma

A
  • patient initially hyperventilates -> results in decrease CO2 levels (respiratory alkalosis)
  • continued airway narrowing, exhalation more difficult -> increase in CO2
  • progressive increase in tachypnea, tachycardia, wheezing and may see retractions
  • accessory muscle recruitment
  • decrease O2 saturation
30
Q

inhalers

A
  • bronchodilation
  • steroids coat the throat
  • albuterol
  • opens the airway
31
Q

asthma summary: severe asthma exacerbation

A
  • O2 saturation < 90%
  • tachypnea
  • frequent or recent hospital visit
  • history of intubation
  • peak flows < 60% predicted values
  • accessory muscle use/retractions
  • duration > 2 days
  • history frequent corticosteroids
32
Q

asthma: differential diagnosis

A
  • many conditions present with wheezing
  • asthma usually diagnosed by history of episodes
  • bacterial pneumonia, viral respiratory infections, COPD, CHF, foreign object, can all present with wheezing
  • asthma vs. COPD asthma airway narrowing is reversible
33
Q

asthma: treatment

A
  • inhaled beta-2 agonists: albuterol, levalbuterol (Xopenex) used in early wheezing
  • terbutaline or epinephrine: IV or injection added for more severe attacks
  • IV corticosteroids reduce inflammation in bronchi, but may take hours to work (long acting)
  • even with aggressive pharmacologic therapy, some pt’s may still progress to severe respiratory distress or failure
  • Beta 2 agonists: smooth muscle relaxation, bronchodilation,
34
Q

asthma pharmacologic therapy doses

A
    1. inhaled beta-2 agonists:
  • albuterol- 2.5-5 mg every 20 mins for 3 doses or continuously, followed by 2.5-10 mg every 1-4 hours as needed
    1. parenteral beta-2 agonists:
  • terbutaline: 0.25 mg
  • 1:1,000 epinephrine: 0.3 mg
35
Q

asthma pharmacological delivery

A
  • nebulizer
  • inhaler
  • spacer
36
Q

COPD

A
  • Chronic airflow obstruction caused by chronic bronchitis or alveolar destruction from emphysema
  • 4th leading cause of death in U.S.
  • 14 million people have COPD: 12.5 million have chronic bronchitis, rest have emphysema
  • Rate climbs with age and higher in smokers
  • Cigarette smoking is leading cause
  • 15% of all smokers will develop clinically significant COPD.
37
Q

characteristics of COPD

A
  • characterized by wheezing and airway edema like asthma, but different mechanism
  • usually not born with
  • rate at which COPD evolves is primarily linked to smoking history: how much and how long
  • minor genetic risk
38
Q

pathophysiology: COPD

A
  • chronic inflammation from exposure to inhaled particles damages airway
  • body’s repair process results in scarring and narrowing
  • alveoli become enlarged with thickened has exchange membrane of associated capillaries
  • has exchange impaired
  • mucus-secreting glands and cells multiply, increasing mucus production
  • cilia destroyed
  • barrel chest results from airway restriction and air trapping
  • chronic cough and shortness of breath
  • chronic hypoxia results in chemoreceptors unable to react to fluctuations in blood O2 level
  • lung function declines, sputum production increases
  • air trapping from lungs’ inability to move air out of airways
  • lungs become hyper-inflated w/ limited gas exchange: results in hypoxia and hypercarbia
  • chronic hypercarbia effects chemoreceptor sensitivity, hypoxic drive takes over
  • body maintains a slightly alkalotic to compensate
  • pH affected and patient prone to infections and intolerant of exercise.
39
Q

signs and symptoms of COPD

A
  • acute exacerbations
  • dyspnea
  • cough
  • intolerance of exertion
  • wheezing
  • productive cough
  • chest pain
  • diaphoresis (sweat)
  • orthopnea
  • increase RR
  • decrease O2 saturation
  • accessory muscle use
  • peripheral edema
  • hyperinflated lungs
  • hyperresonance on percussion
  • coarse rhonchi
40
Q

COPD: differential diagnosis

A

-asthma, bronchitis, pneumonia, pulmonary fibrosis, pneumothorax, cardiac conditions causing dyspnea (MI, angina, CHF, pulmonary embolus)

41
Q

treatment of COPD exacerbation

A
  • mainly maintaining oxygenation & ventilation
  • nasal cannula or venturi mask to maintain O2 sat minimum 94%
  • if still hypoxic: nonrebeathing mask w/high flow O2, aggressive airway/ventilation mgmt.
  • CPAP may be indicated prior to intubation in alert, acutely hypercapnic patient
  • severe cases: endotracheal intubation w/RSI or nasotracheal
  • once airway is secured, administer beta-2 agonists early and often
  • adding anticholinergic agents can provide an additional 20-40% bronchodilation
  • systemic corticosteroids (injectible) in moderate or severe cases
  • if acute respiratory failure: NPPV required or endotracheal intubation w/invasive ventilation thru a ventilator
  • 3 nebulized doses 20 minutes apart or consecutively in severe cases. NPPV: non invasive positive pressure ventilation.
42
Q

pneumonia

A
  • lung infection that causes fluid build up in alveoli
  • resulting inflammation can cause fever, dyspnea, chills, chest pain, productive cough
  • Three broad causes of pneumonia:
    1. community acquired
    1. hospital acquired- : nosocomial- begins 48 hours or more after hospitalization.
    1. Ventilator associated: viral, bacterial, fungal, chemical (stomach contents) -> more susceptible
43
Q

pneumonia stats

A
  • > 3 million cases diagnosed annually in US
  • if untreated mortality rate of 30%
  • increased susceptibility with advanced age
  • comorbid conditions- HIV, CHF, diabetes, leukemia, asthma, COPD, bronchitis
  • scarring from infection may result in compromised gas exchange
44
Q

signs and symptoms of pneumonia

A
  • classic symptoms are cough, fever, and sputum production
  • acute onset with rapid progression is usually bacterial, rather than viral
  • may also include: chills, malaise, nausea, vomiting, diarrhea, myalgia, chest pain, dyspnea, tachypnea, tachycardia, hypoxia, abnormal breath sounds: rales, rhonci
45
Q

differential diagnosis pneumonia

A
  • confirming diagnosis can be made with chest x-ray, clinical presentation and accurate HPI
  • asthma, bronchitis, COPD episode, foreign objects, epiglottitis, CHF, MI
46
Q

pneumonia treatment

A
  • supplemental oxygen in clinically significant cases (by nasal cannula to maintain sat above 94%)
  • more intensive oxygenation: CPAP
  • early antibiotic intervention
47
Q

respiratory syncytial virus

A
  • RSV- major cause of illness in young children
  • infection in lungs and airways
  • more serious illness in premature babies and children with suppressed immune systems
  • can lead to other more serious illnesses that affect heart and lungs
  • RSV infection can cause bronchiolitis and pneumonia
48
Q

respiratory syncytial virus pathophysiology

A
  • highly contagious
  • spread through droplets from cough
  • spread rapidly in schools/child care centers
  • virus can survive on surfaces (hands, clothes)
49
Q

signs and symptoms of respiratory syncytial virus

A
  • dehydration

- can cause severe upper respiratory infections and asthma symptoms in adults

50
Q

respiratory syncytial virus treatment

A

-treat airway and breathing problems with supplemental oxygen (humidified is better)

51
Q

pleural effusion

A
  • collection of fluid outside lung on one or both sides of chest
  • lung gets compressed, causes dyspnea
  • may occur in response to any irritation, infection, CHF, or cancer
  • should be considered as a contributing dx in any patients with lungs cancer and shortness of breath
52
Q

pleural effusion pathophysiology

A
  • caused by fluid collecting between visceral and parietal pleura
  • sac of fluid similar to a blister
  • with each breath, tissues rub against each other causing inflammation and more fluid to accumulate in the space
  • some can contain several liters of fluid and can decrease lung capacity and cause dyspnea
53
Q

signs and symptoms of pleural effusion

A
  • dyspnea
  • also chest pain, cough, orthopnea, dyspnea on exertion
  • decreased breath sounds over region where fluid have moved lung away from chest wall
  • patient usually feels better sitting upright
  • fluid must be removed to completely resolve
54
Q

pleural effusion treatment

A
  • if CPAP doesnt work
  • fluid can be extracted by needle thoracentesis for dx and symptomatic relief
  • in rare cases tube thoracostomy
55
Q

pulmonary embolism

A
  • sudden blockage of lung artery with a blood clot

- DVT (deep vein thrombosis) is most common cause- blood clot travels to lungs from leg

56
Q

pulmonary embolism pathophysiology

A
  • pulmonary circulation may be compromised by clot, fat embolism from broken bone, or air entering circulation from a laceration in neck or improver IV
  • usually lodges in major branch of pulmonary artery
57
Q

signs and symptoms of pulmonary embolism

A
  • most challenging diagnosis to make in ED because of vague, general symptoms
  • risk post surgery or trauma or with catheters
  • chest pain, dyspnea, tachycardia, syncope, hemoptysis (coughing blood), new onset wheezing, new cardiac arrhythmia, thoracic pain
  • may evolve quickly and lead to cardiac arrest
58
Q

pulmonary embolism treatment

A
  • bedridden patients are often prescribed anticoagulants to reduce risk of clot formation
  • patients who have numerous clots can be treated with tPa (tissue plasminogen activator)
  • few patients survive cardiac arrest caused by large emobolus
59
Q

velecula ***

A
60
Q

why do we intubate

A
  • need a definitive airway
  • procedure for a patient that cant maintain their own airway
  • basic airway adjuncts and patient positions are unsuccessful
  • patient not adequately ventilating on their own
61
Q

when do you intubate

A
  • when respiratory compromise suspected
  • when all intrinsic mechanisms have failed to alleviate respiratory difficulty
  • before they transition to respiratory failure
62
Q

how do you confirm the intubation was successful?

A
  • chest rise
  • condensation in the endotracheal tube
  • direct visualization
  • absent epigastric sounds
  • waveform capnography
  • bilateral lung sounds
63
Q

assessing causes of acute deterioration of intubated patient

A
  • if acute deterioration occurs, take patient off ventilator and use bag mask while assessing
  • DOPE
  • D- displaced tube
  • O- obstructed tube- plugged with secretion or patient biting on it
  • P- pneumothorax- can occur during positive pressure ventilation
  • E- equipment failure- ventilator run out of oxygen
64
Q

intubation: final thoughts

A
    1. should be last option for asthmatic patients (difficult to ventilate, prone to pneumothorax)
    1. be proactive- intubate/ventilate before cardiac arrest occurs (conscious patients in respiratory arrest may need sedation/RSI)
    1. lack of gag reflex in stroke or intoxicated patients makes them prone to vomiting (consider intubation to protect airway)
    1. if med administered to diabetic or OD patient, use bag mask first and monitor for changes
65
Q

RSI medication

A
  • rapid sequence intubation medication
  • these medications stop breathing so you can intubate
  • sedate
  • paralyze
  • more sedation
  • pain management
66
Q

summary

A
  • upper/lower respiratory system- what structures physiologically differentiate them?
  • COPD- how is it managed from a ventilation standpoints and what population is most prone
  • asthma- signs and symptoms, treatment
  • intubation:
  • what does the process entail
  • what equipment is used to help facilitate this process
  • how do you determine whether your intubation is successful
  • DOPE and how it relates to intubation
  • how do RSI medications works
67
Q

laringiscope

A

attaches to the miller and macintosh blades

68
Q

macintosh and miller blades

A
  • miller blades are used for pediatrics -> miller blades are straight
  • epiglottis of a child is much bigger (thats why it can become obstructed easier)
  • miller blades go under the epiglottis
  • macintosh blades are used for adult patients -> curved
  • macintosh blades goes into the velicular space
69
Q

stylet

A

-allows tracheal tube to be bent to any shape

70
Q

intubation

A

-

Medical Emergencies (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions