Pulmonary Emergencies Flashcards
Sound that indicates airway obstruction is incomplete
stridor
Where can the infection of a retropharyngeal abscess spread to?
mediastinum causing pleural or pericardial effusion
extends from the base of the skull to the tracheal bifurcation
retropharyngeal space
Xray finding that is consistent with retropharyngeal abscess
expansion of the prevertebral soft tissues
What is the imaging modality of choice for a suspected retropharyngeal abscess (ie gold standard)?
CT scan of neck
What is the managemnet of a patient with a retropharyngeal abscess?
IV abx (clinda or unasyn) started in ER and IV hydration. ENT consult for I&D.
Subdermal or submucosal swelling that is diffuse and nonpitting affecting the face, lips, mouth, throat, larynx, extremities, genitalia and possibly the bowel (colicky abdominal pain) . Can occur in isolation, with urticaria or as a component of anaphylaxis
angioedema
What is the treatment of allergic (mast cell mediated) angioedema after assessing the airway?
epi 0.3 mg IM, methylprednisolone IV or oral prednisone, and diphenhydramine 25-50 mg IV
what is the difference in the between angioedema that is mast cell or bradykinin mediated?
mast cell responds to epi, glucocorticoids, antihistamines whereas bradykinin mediated is due to ACEI or hereditary angioedema
What is the treatment of ACEI (bradykinin) induced angioedema after assessing the airway?
discontinue ACEI and reassess in 24-72 hrs if sx haven’t resolved
What is the treatment of hereditary (bradykinin mediated) angioedema after assessing the airway?
C1 inhibitor concentrate, Bradykinin receptor antagonist or kailikrein inhibitor
Acute, potentially lethal, multisystem syndrome from the sudden release of mast cells and basophils into the circulation
anaphylaxis
What symptoms are commonly observed in patients experiencing anaphylaxis?
pruritic urticaria, angioedema, flushing and hypotension
What is the treatment of anaphylaxis that reverse the process?
epi every 5-15 minutes for up to 3 doses.
What are other pharmacological treatment options in addition to epi that may help treat anaphylaxis?
albuterol nebulizer, H1 (ranitidine)/H2 blocker (benadryl), glucocorticoid (solumedrol)
Noise during assessment of head and neck trauma that indicates pooling of liquids in the oral cavity or hypopharynx
gurgling
What causes wheezing?
Narrowing of lower airways
Why do patients in a stupor or coma have an inability to protect their airway?
lack of gag reflex
lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain.
stupor
Accumulation of air in the pleural space. Can be spontaneous or trauma induced. Sudden onset of dyspnea and pleuritic chest pain that occurs at rest
pneumothorax
Describe the patient who is at greatest risk of a pneumothorax
tall, thin males between 20-40 yrs (Marfans)
Associated with mediastinal shift to the contralateral side and impaired ventilation leading to cardiac compromise
tension pneumo
Patient who has h/o of heavy smoking presents with sudden stabbing pain in right pectoral and right lateral axillary regions and SOB. PE reveals hyperresonance to percussion. What is the appropriate management?
needle aspiration/decompresion followed by chest tube placement (unstable) or primary treatment with chest tube (stable)
What locations can be used to accomplish decompression of a pneumothorax?
2nd or 3rd ICS at the midclavicular line or at the 5th ICS at the anterior axillary line
From sudden increase in left sided intracardiac filling pressures or increased alveolar capillary membrane permeability
acute pulmonary edema
Major cause of noncardiogenic pulmonary edema
ARDS
Initial management of acute pulmonary edema both cardiogenic or noncardiogenic
O2, lasix 40-80mg IV if stable, then tx cause
requires immediate protection of the airway from further injury by intubation. Once intubated can then lavage and suction the lower airway
massive aspiration
Reduction in airway diameter caused by smooth muscle contraction, vascular congestion, bronchial wall edema, and thick secretions.
asthma
Quantification of severe hypoxemia
SpO2 ≤ 95% despite high flow O2 by nonrebreather
Helps give an objective measurement as to the severity of airflow obstruction. Less than 40% of predicted is severe. Should be measured before and after each nebulizer or MDI tx
peak flow
Bronchodilators used for medical therapy of asthma. Given every 20 minutes via neb or puffs
beta 2 agonist (albuterol) or antichoinergic (atrovent)
For life threatening asthma exacerbations that remain severe after 1 h of intense bronchodilator therapy. 2 g IV over 20 min
magnesium sulfate
For severe asthma unresponsive to standard therapies. 0.25mg SQ q 20 min X 3 doses. Administration contraindicated with epi
terbutaline
Most often precipitated by a viral or bacterial infection. Increase or change in character of usual symptoms of dyspnea, cough or sputum production.
COPD exacerbation
What is the initial management of an acute COPD exacerbation?
O2, solumedrol, levaquin (includes pseudo coverage), bronchodilators
EKG findings consistent with a PE
S waves in lead 1, Q waves in lead III, and inverted T waves in lead III (S1Q3T3)
Pharmacological treatment of hypotension in patient with a PE
Fluid bolus of 500 to 1000 ml NS and Vasopressors
use in unstable patients for treatment of acute PE in case you need to stop anticoagulation and trial thrombolytics
Unfractionated Heparin (UFH)
Risk factors for PE described by Virchow’s triad
hypercoaguable state, venous stasis, endothelial injury
Patient presents with pleuritic chest pain, cough, hemoptysis, diaphoresis. PE reveals tachycardia, tachypnea, crackles, and accentuation of the 2nd heart sound. What is the imaging of choice to work-up this patient?
CT scan
Give an example of abx options for treating non-ICU pneumonia. Include a respiratory fluoroquinalone and antipneumococcal beta-lactam + a macrolide
levoflaxacin or ceftriaxone plus azthromycin
What is the abx option for a patient with pneumonia in the ICU who is allergic to PCN?
Respiratory fluoroquinolone PLUS aztreonam
How does the differentiation between inspiratory and expiratory stridor help distinguish level of airway obstruction?
inspiratory- level of larynx
expiratory- level of trachea
