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Acute PNP > Pulmonary & Orofacial Disorders > Flashcards

Pulmonary & Orofacial Disorders Flashcards

1
Q

What are the goals of care for ED treatment of ENT concerns?

A

Rapid recognition of rare surgical and infectious emergencies; obtaining thorough evaluation

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2
Q

What are intracranial complications of sinusitis?

A

Fever, headache, vomiting, change in mental status

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3
Q

What is the diagnostic test of choice to diagnose retropharyngeal abscess?

A

CT scans

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4
Q

What is the priority for otalgia patients?

A

Symptomatic relief

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5
Q

What should facial nerve palsies prompt an evaluation of?

A

Middle ear

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6
Q

What are young children with cochlear implants at significant risk for?

A

Pneumococcal meningitis secondary to acute otitis media

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7
Q

The most common head and neck infection and children and the second most common diagnosis made in ED

A

Acute otitis media

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8
Q

What are risk factors for AOM?

A

Otitis media with effusion/serous otitis media

daycare attendance
exposure to secondhand smoke
immunodeficiency state

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9
Q

What are the most common organisms causing acute otitis?

A

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

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10
Q

Diagnosis of AOM must have any one of the following three criteria:

A

Moderate to severe bulging of TM
Acute onset otorrhea not due to otitis external
Mild bulging and >48 hours of ear pain or intense erythema of TM

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11
Q

Any child how is irritable or lethargic, low-grade fever, and localized pain in the ear

A

Suspect AOM

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12
Q

What is the strongest predictor of AOM?

A

Presence of bulging TM that obliterates normal landmarks

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13
Q

When visualizing directly in the ear canal, how do you pull the pinna?

A

Posteriorly and superiorly

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14
Q

Do not perform irrigation of canal if…

A

Ventilating tube is in place or perforation of TM is suspected

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15
Q

How long can amniotic fluid be present in the middle ear?

A

Days to weeks after birth

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16
Q

How should otherwise healthy patients with AOM be treated?

A

With observation

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17
Q

Very young children; immune, genetic, or craniofacial anomalies, or recent AOM in previous 30 days

A

Should be treated with antibiotics

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18
Q

If the patient is younger than 6 months old with AOM , should they be treated or not treated with antibiotics?

A

Treated with antibiotics

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19
Q

Which children should be referred to an otolaryngologist for evaluation for possible myringotomy and tube placement?

A
  • Multiple episodes of AOM over a period of months
  • OME lasting more than 6 to 8 weeks
  • Complications of middle ear disease
  • Associated hearing or speech concerns
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20
Q

What is the initial therapy for uncomplicated AOM in patients with type 1 hypersensitivity (anaphylaxis or history of hives) to penicillin?

A

Cephalosporin

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21
Q

What is the initial therapy for uncomplicated AOM in patients with type 1 hypersensitivity (anaphylaxis or history of hives) to penicillin and cephalosporins?

A

Macrolide
OR
Clindamycin

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22
Q

What is not recommended for AOM treatment?

A

Antihistamines
Decongestants
Corticosteroids

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23
Q

Myringoscleoriss

A

Calcium deposits within TM resulting in the appearance of white patches

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24
Q

Tympanoscleorsis

A

White deposits in middle ear

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25
Q

How to treat facial nerve paralysis with AOM?

A

Can be partial or complete
Recovers completely if appropriate systemic antibiotic and corticosteroid therapy is given
Myringotomy with or without tube placement should be carried out as soon as possible

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26
Q

What can bacterial invasion of the inner ear cause?

A

Severe sensorineural hearing loss and severe vertigo associated with nausea and vomiting

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27
Q

What season does pertussis normally occur?

A

Late summer and early fall

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28
Q

What bacteria casues pertussis?

A

Bordetella pertussis

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29
Q

Pertussis is endemic every ____ years?

A

3-5 years

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30
Q

What are the three stages of pertussis?

A

Catarrhal, paroxysmal, convalescent

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31
Q

In what stage are people most contagious with pertussis?

A

Catarrhal stage

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32
Q

Describe the catarrhal stage

A

Occasionally short or absent
Symptoms similar to upper respiratory infection (sneezing, mild cough, rhinorrhea, injected conjunctiva, low-grade fever, malaise, anorexia)

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33
Q

Describe the paroxysmal stage

A

Increase in disease severity and frequency of cough with characteristic “whoop” following cough

Copious viscid mucus and post-tussive vomiting

Choking spells can occur in infants instead of whoop

Chest/abdominal pain, rib fractures, and even air leak syndromes can occur in older children

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34
Q

Describe the convalescent phase

A

Symptoms slowly diminish

Cough recurs easily with triggers such as cigarettes, reactive airway exacerbations, or URIs

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35
Q

How does pertussis present in vaccinated children?

A

Persistent paroxysmal cough often with post-tussive emesis that is worst at night and may last as long as 4-6 weeks

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36
Q

What are differential diagnoses for pertussis?

A

Infectious diseases
GI concerns
Neurological disorders

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37
Q

Who qualifies for admission for pertussis?

A

Young infants
Any age with moderate to severe respiratory distress
Dehydration
Evidence of encephalopathy

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38
Q

What precautions should be used for pertussis?

A

Standard and droplet precautions

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39
Q

When should patients suspected with pertussis begin treatment?

A

Upon presentation

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40
Q

Why should erythromycin not be given to neonates?

A

Associated with infantile hypertrophic pyloric stenosis

41
Q

How long should infants be excluded from school with pertussis?

A

Excluded until completion of 5 days of effective therapy or a minimum of 21 days after onset of cough

42
Q

Who is recommended for chemoprophylaxis after exposure to pertussis?

A

All close contacts, even vaccinated, within first 3 weeks of exposure

43
Q

Infection and inflammation of lower respiratory tract in association with detectable radiographic changes of lung parenchyma

A

Pneumonia

44
Q

What is the leading cause of mortality in children younger than 5 years worldwide?

A

Childhood pneumonia

45
Q

Who are at risk for developing pneumonia?

A 
Premature infants
Musculoskeletal abnormalities (severe scoliosis)
Malnourished patients
Chronic lung disease
Those living with caregivers who smoke
46
Q

What is the most common pathogen outside of the neonatal period for pneumonia?

A

S. pneumoniae

47
Q

What are the most common pathogens in community-acquired pneumonia in school-aged children?

A

Mycoplasma pneumoniae and Chlamydia pneumonia

48
Q

What is the common presentation for community-acquired pneumonia?

A

Fever, tachypnea, cough, nasal flaring, retractions, crackles, and focal findings

49
Q

In infants younger than 2 years who present with tachypnea and fever higher than 28C

A

Bacterial pneumonia

50
Q

What are the best radiographs for pneumonia?

A

Posterior/anterior and lateral

51
Q

What is the treatment for older infants with mild cases of pneumonia?

A

Enteral amoxicillin

52
Q

What is the treatment for older children with mild community-acquired pneumonia?

A

Macrolide is first-line

53
Q

What is the treatment for small effusions?

A

Antibiotic therapy alone

54
Q

What is the treatment for large pleural effusion?

A

Refer to pediatric surgery for consideration of VATS procedure or thoracostomy tube placement

55
Q

What causes pulmonary edema?

A

Any disruption in the Starling forces favoring increased filtration or decreased absorption of fluid in pulmonary capillaries

56
Q

What causes cardiogenic pulmonary edema?

A

Most commonly by left-sided heart failure due to any mechanism that leads to depressed left ventricular function damage to myocytes from infectious processes or cardiomyopathies

57
Q

What causes noncardiogenic pulmonary edema?

A

Pulmonary (intrinsic) –infectious process
Neurogenic–any type of CNS insult (surgery, trauma, seizures)
Other causes–medication ingestion (salicylates, narcotics), exaggerated immune responses, administration of some chemotherapeutic agents

58
Q

What are the physical symptoms of pulmonary edema?

A

Shortness of breath, tachypnea, tachycardia, hypoxia, weakness, cough with frothy sputum, diaphoresis, orthopnea, or paroxysmal nocturnal dyspnea

59
Q

What will the exam show for pulmonary edema?

A

Dyspnea, cyanosis, hypoxemia, subcostal retractions, and crackles on auscultation of lungs

60
Q

What will a chest x-ray show for pulmonary edema?

A

Peribronchial cuffing and perihilar haziness and the sometimes enlarged cardiac silhouette

61
Q

What is the primary therapy for pulmonary edema?

A

Supplemental oxygen and diuretics

62
Q

What kind of oxygen levels do patients with pulmonary edema require?

A

Higher levels of PEEP and oxygen to maintain adequate saturation levels

63
Q

Result of edema, de-epithelialization of tracheobronchial region, airway obstruction, and decreased pulmonary compliance

A

Lung injury from smoke inhalation

64
Q

What occurs when nitric oxide is formed in the lungs?

A

Leads to loss of hypoxic vasoconstriction (HPV) which shunts blood from nonventilated alveoli to ventilated alveoli

65
Q

What are some causes of smoke inhalation?

A

Overused electrical outlets, inappropriately used paced heaters, unattended candles, cigarette smoking, and children playing with fire materials

66
Q

What is the common presentation for smoke inhalation?

A

Signs of respiratory distress, hypoxemia, upper airway edema, and wheezing/rhonchi

67
Q

What are diagnostic studies for smoke inhalation?

A

Pulse oximetry, CXR, carbon monoxide and cyanide levels, and direct bronchoscopy

68
Q

What are the signs and symptoms of mild intoxication of carbon monoxide poisoning?

A

Headache and mild respiratory distress

69
Q

What are the signs and symptoms of moderate (>40%) of carbon monoxide poisoning?

A

Irritability, nausea, fatigue, decreased vision, and altered mental status

70
Q

Characterized by obvious use of compensatory mechanisms in attempt to maintain adequate gas exchange

A

Respiratory distress

71
Q

Signs of respiratory distress

A

tachypnea, increased work of breathing (retractions, accessory muscle, grunting, nasal flaring)

72
Q

Progression of signs and symptoms of respiratory distress or respiratory depression accompanied by arterial blood gas values with PaO2 less than 60 and/or PaCO2 more than 50

A

Respiratory failure

73
Q

Result of lung disease, cardiac dysfunction, neurologic abnormalities, or multiple organ dysfunction

A

Failure to adequate oxygenation

74
Q

What are examples of inadequate oxygenation triggers?

A

Pneumonia, inhalation injury, chest trauma, submersion injury, hydrocarbon aspiration, pulmonary hemorrhage, chronic lung disease, BPD, chemotherapy-induced pulmonary fibrosis, asthma

75
Q

Total amount of air in lungs after maximal inspiration

A

Total lung capacity (TLC)

76
Q

Maximum amount of air that a patient can exhale after maximal inhalation

A

Vital capacity (VC)

77
Q

Volume of air left in lungs after maximal exhalation

A

Residual volume (RV)

78
Q

Sum of VC and RV equal ____

A

total lung capacity

79
Q

Representing the resting volume of air in the lungs after a spontaneous breath

A

Functional residual capacity

80
Q

Ability of lungs to stretch and change in volume relative to change in pressure

A

Lung compliance

81
Q

What does low compliance mean?

A

“Stiff” lung meaning circumstance extra work needed to transport normal volume of air

82
Q

Sedation or neuromuscular blockade can cause ____?

A

Used to increase total respiratory compliance by limiting contribution of chest wall rigidity or muscle tone on lung expansion for a given inspiratory pressure

83
Q

What does mean airway pressure (MAP) measure?

A

Average pressure that distends the alveolus and chest wall that correlates with alveolar size and recruitment as well as intrapleural pressure

84
Q

Ventilation that delivers a set tidal volume to patient during preset inspiratory time

A

Volume-regulated

85
Q

What are advantages of volume-regulated ventilation?

A

Reduced risk of volutrauma due to preset tidal volume and better control over minute ventilation and carbon dioxide clearance

86
Q

What are disadvantages of volume-regulated ventilation?

A

Need to delivery high peak pressures to achieve goal tidal volume or minute ventilation; risk of not meeting patient demands for oxygenation

87
Q

Ventilation that delivers pressure-limited breath during predetermined inspiratory time in conjunction with preset ventilation rate

A

Pressu-regulated

88
Q

What are advantages of pressure-regulated ventilation?

A

Better ventilation for stiff lungs, overall lower peak pressure needed for same tidal volume, and even distribution of gas flow

89
Q

What are disadvantages of pressure-regulated ventilation?

A

Varying tidal volume delivery and lack of guaranteed minute ventilation

90
Q

Supports spontaneous respirations with set pressure that is delivered during inspiratory phase

A

Pressure support

91
Q

Amount of pressure that is delivered to pediatric patient during exhalation and in between respiration

A

PEEP

92
Q

When can pressure support ventilation be used?

A

To promote respiratory muscle training and compensate for high resistance of endotracheal tube during spontaneous respiration

93
Q

When can volume support ventilation be useful?

A

To promote respiratory muscle retraining and compensation for high resistance of endotracheal tube during spontaneous respiration

94
Q

Technique of delivering positive pressure via noninvasive interface such as a full face mask, nasal mask, nasal pillows, or helmet

A

Noninvasive ventilation

95
Q

What are contraindications for noninvasive ventilation?

A

Impaired airway protective reflexes; reduced respiratory drive; respiratory failure

96
Q

What is the risk of chronic noninvasive ventilation?

A

Midface hypoplasia

97
Q

Provides one set level of positive pressure through respiratory cycle

A

Continuous positive airway pressure (CPAP)

98
Q

Provides two levels of pressure during respiratory cycle (inspiratory positive pressure airway pressure and expiratory positive airway pressure)

A

Bilevel positive airway pressure (BiPAP)

Acute PNP (8 decks)

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