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Emergency Medicine > Pulmonary Emergencies > Flashcards

Pulmonary Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Retropharyngeal Abscess

A

Emergency - extends from base of skill to tracheal bifurcation

Can spread to mediastinum

Children: usually from a lymph node that drains head and neck

Adults: penetrating trauma, mouth/teeth infection, or lymph nodes

Fever, neck pain, limitation of cervical motion, muffled voice, respiratory distress

CT scan of neck is gold-standard

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2
Q

Retropharyngeal Abscess Treatment

A

Immediate I&D

IV hydration

IV Clindamycin or Unasyn

GABHS, staph aureus, anaerobes, H-flu

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3
Q

Retropharyngeal Abscess Complications

A

Extension into mediastinum - pleural or pericardial effusion

Upper airway asphyxia

Sudden rupture - leads to aspiration pneumonia and widespread infection

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4
Q

Angioedema PEARLs

A

Often asymmetric swelling

Affects face, lips, mouth, larynx, extremities, genitalia, and bowel

Can occur in isolation, with urticaria, or as a part of anaphylaxis

Rapid assessment of airway, close monitoring, consider angioedema

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5
Q

Angioedema - Mast Cell Mediated

A

Responds to epi, glucocorticoid, and antihistamines

Allergic reaction

Intubate w/ any sign of respiratory distress

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6
Q

ACEI Induced Bradykinin Mediated Angioedema

A

Intubate immediately w/ sign of respiratory distress

DC ACEI - sx should resolve in 24-72 hours

Sx severe or no improvement in 24 hours - Antihistamines, C1 inhibitor therapy (recombinant C1 inhibitor)

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7
Q

Hereditary Angioedema

A

Intubate w/ respiratory distress

C1 inhibitor concentrate (Ruconest) - 1st line

Bradykinin receptor antagonist - 2nd line

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8
Q

Anaphylaxis

A

Acute, potentially lethal multisystem syndrome from sudden release of mast cells and basophils

Sudden onset urticaria, angioedema, flushing, pruritis, HOTN

Epinephrine is the only drug that will reverse the process

Can also give diphenhydramine, steroids, albuterol, vasopressors (shock)

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9
Q

Stridor - Inspiratory, Expiratory

A

Inspiratory: obstruction at the level of the larynx

Expiratory: obstruction at the level of the trachea

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10
Q

Stupor vs Coma

A

Stupor: lack of critical cognitive function and LOC - pt is almost entirely unresponsive, only responds to base stimuli like pain

Coma: unconsciousness lasting more than 6 hours - patient cannot be awakened, fails to respond to painful stimuli/light/sound, lacks normal sleep-wake cycle; no initiation of voluntary actions

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11
Q

Spontaneous Pneumothorax

A

Sudden onset of dyspnea, pleuritic chest pain that often occurs at rest

Decreased chest excursion, breath sounds; hyperresonant to percussion, possible subQ emphysema

Treatment: Supplemental O2, Needle decompression with chest tube placement

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12
Q

Tension Pneumothorax

A

Labored breathing

Tachycardia

HOTN

Tracheal shift

JVD

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13
Q

Acute Pulmonary Edema Presentation

A

Dyspnea

Frothy pink sputum

Pedal edema

Ascites

Rales/Wheezing

HTN

Hypoxemia

Tachycardia

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14
Q

Acute Pulmonary Edema

A

From cardiogenic and noncardiogenic sources

-Sudden increase in left-sided intracardiac filling pressures or increased alveolar-capillary membrane permeability

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15
Q

Acute Cause Cardiogenic Pulmonary Edema

A

Ischemia

Acute severe mitral regurgitation

Acute aortic regurgitation

HTN crisis secondary to bilateral renal artery stenosis

Stress induced cardiomyopathy

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16
Q

Chronic Causes Cardiogenic Pulmonary Edema

A

Decompensated systolic CHF

Decompensated diastolic CHF

Left ventricular outflow tract (LVOT) obstruction

Valvular heart disease

17
Q

Causes Noncardiogenic Pulmonary Edema

A

Acute respiratory distress syndrome (ARDS) - Major cause

Altitude

Neurogenic

Narcotic overdose

Pulmonary embolism

Eclampsia

Transfusion-related injury

Salicylate overdose

18
Q

ARDS Etiology

A

Sepsis

Acute Pulmonary Infection

Trauma

Inhaled toxins

DIC

Freebase cocaine smoking

Post CABG

Inhalation of high concentration O2

19
Q

Cardiogenic and Noncardiogenic Acute Pulmonary Edema Treatment

A

Treat underlying cause, add on O2

Furosemide only in hemodynamically stable

Cardiogenic: Ischemia - nitrates, diuretics - also valvular disease; treat arrhythmias via ACLS protocols and diuretics

Noncardiogenic: ARDS - intubate w/ vent and PEEP; Diuretics may be helpful

20
Q

Aspiration

A

Massive aspiration requires immediate protection of airway from further injury by intubation

Once intubated, can lavage and suction the lower airway

Treat underlying cause:

  • prolonged BVM during CPR
  • Neurologic compromise secondary to stroke/SAH/head injuries
21
Q

Acute Asthma and Peak Flow

A

Allows an objective measurement of the severity of the airflow obstruction

Peak flow <40% predicted = severe airflow obstruction

Measure before and after each nebulizer or MDI treatment

22
Q

Acute Asthma - Medical Therapy

A

Bronchodilator - albuterol (inhaled beta 2 agonist)

-Ipratropium bromide (Atrovent) - anticholinergic

Glucocorticoid - methylprednisolone

Magnesium sulfate - for life-threatening exacerbations that remain severe after 1 hour of intense bronchodilator therapy

Epi - for suspected anaphylaxis or unable to use bronchodilators

Terbutaline - for severe, unresponsive asthma; CANNOT GIVE WITH EPI

23
Q

COPD Exacerbation

A

Most often viral or bacterial infection brings it on

Increase/change of usual symptom character - dyspnea, cough, sputum production

Admission - ADLs limited, fail to respond to initial therapy, high-risk comorbidities, worsening hypoxemia

-CURB-65

24
Q

COPD Exacerbation Treatment

A

Supplemental O2

Solumedrol (methylprednisolone) 60 mg IV

Antibiotics - pseudomonas coverage - Levaquin

Inhaled bronchodilators - Albuterol and atrovent (Duoneb)

25
Q

CURB-65

A

Confusion

BUN >7

Respiratory Rate >30

SBP <90; DBP <60

Age >65

26
Q

Pulmonary Embolism

A

Dyspnea

Tachypnea

Cough with rales

Hemoptysis

Syncope

Lower extremity edema, pain, erythema

Cyanosis

Diaphoresis

HOTN

27
Q

Pulmonary Embolism Radiographic Findings

A

Hampton’s Hump on CXR

CT with pulmonary infarction or saddle embolism

EKG: S-waves in lead 1; Q waves and inverted T waves in lead 3

-S1Q3T3

28
Q

PE Treatment

A

O2

Stabilize HOTN - fluid bolus (500-1000 mL NS), vasopressors

Unfractionated heparin (in unstable) or LMWH (preferred)

Fondaparinux w/ allergy to heparin or Hx heparin-induced thrombocytopenia (HIT)

Start Warfarin

Thrombolytics w/ acute PE and HOTN w/ vasopressors or in hemodynamically unstable pts w/o high bleeding risk

29
Q

Pneumonia Workup

A

Everyone gets PA and lateral CXR, CBC, CMP

Inpatient get blood cultures, sputum culture and gram stain, Pneumococcal and Legionella urine antibody tests

30
Q

Pneumonia Admission Indications

A

SpO2<92%

Febrile >40 C

RR>30

Tachycardia >125

SBP <90

CURB-65

Pneumonia Severity Index (PSI/PORT)

31
Q

Non-ICU Pneumonia Pathogens and Treatment

A

Strep pneumo MC

-RSV/Influenza, Mycoplasm, H-flu, Legionella, Chlamydia

Antibiotics: Respiratory fluoroquinolone (Levofloxacin), Antipneumococcal beta-lactam (Ceftriaxone), Macrolide (Azithromycin)

32
Q

ICU Pneumonia Pathogens and Treatment

A

Strep pneumo

Legionella

Gram-negative bacilli

Staph aureus - consider MRSA

Antibiotics: Ceftriaxone + Azithro OR Cetriaxone + Levofloxacin OR Levofloxacin + Aztreonam

Emergency Medicine (10 decks)

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