Pulmonology Flashcards
Where is Larynx located?
Upper airway
Where is the laryngopharynx located?
Upper airway
Paroxysmal nocturnal dyspnea
Left sided heart failure
Blood tinged sputum
Left sided heart failure
Expiratory wheeze
Asthma
Increase in CO2 retention
Pulmonary emphysema
Purse lip breathing
Pulmonary Emphysema
Bronchi collapse
Pulmonary Emphysema
Prolonged expiratory time
Pulmonary emphysema
The lower airway consists of?
Alveoli, Lungs, pulmonary and bronchial vessels
Digital clubbing
Pulmonary Emphysema
Air movement in and out of lungs
Ventilation
What structures are necessary for adequate ventilation?
Chest wall, Pleura, Diaphragm
Pink puffer
Pulmonary Emphysema
Blue bloater
Chronic bronchitis
Recurrent cough and sputum production
Chronic bronchitis
Visceral pleura is located on?
Lung surface
Hypercapnia
Chronic bronchitis
Acidosis
Chronic bronchitis
Active process of breathing
Inhalation
Distended jugular veins
Right sided heart failure
Ascites
Right sided heart failure
Dependent edema
Right sided heart failure
Passive process of breathing
Exhalation
What regulates ventilation?
Medulla, stretch receptors, changes in PCO2, COPD patients
What are the parts of the upper airway?
Nasal cavity, nasopharynx, oropharynx, laryngopharynx, larynx
What are the requirements for pulmonary perfusion?
Adequate blood volume, Intact pulmonary capillaries, Efficient pumping action of heart
Flail chest
2 more more adjacent ribs broken in 2 or more places
What are some reasons for disruption in diffusion?
Hypoxia and damaged alveoli
Tall white males
Spontaneous pneumothorax
What is commonly seen with patients with orthopnea?
Patients are unable to sleep supine
White/yellow mucus
Chronic Bronchitis
Unproductive cough
Emphysema
Pink frothy sputum
Pulmonary edema
Brown/rusty sputum
Pneumonia
Fever
Pneumonia
Hemoptysis
Pulmonary edema secondary to CHF
1-2 word dyspnea
Pulmonary emphysema
What are the 4 parts of a physical exam with airway emergencies?
Inspection, Palpation, Percussion, Auscultation
Barrel chested
Emphysema
Tracheal deviation moves in what direction from collapsed lung?
Towards collapsed lung
Tracheal deviation in a tension pneumothorax moves in what direction?
Away
Dull percussion is heard in?
Hemothorax or pneumothorax
Hollow percussion sounds are heard with?
Simple pneumothorax
Ominous breath sound
Stridor
Heard on inhalation
Stridor
Partial upper airway obstruction
Stridor
MUSICAL respirations
Wheezing
Heard on exhalation
Wheezing
Coarse/rattling breath sound
Rhonchi
Breath sound indicative of fluid in airways
Rales/Crackles
Plural friction rub is seen with?
Inflammation of plura
Swelling and redness of extremities are indicative of?
Venous clot
Finger clubbing indicates?
Chronic hypoxia
Heart rate in respiratory emergency is?
Tachycardic
Systolic BP decrease on inhalation is known as?
Pulsus paradoxus
Increased inter-thoracic pressure can result in?
Pulsus paradoxus
PEFR
Peak Expiratory Flow Rate
A graphic display of CO2 concentration
Capnography
ARDS
Adult respiratory distress syndrome
ARDS is mainly caused by?
Sepsis
What is the first drug given for pulmonary edema?
Nitroglycerine
CPAP is utilized for?
Pulmonary Edema
Treatment for pulmonary edema
CPAP and nitroglycerine
CPAP cannot be given if?
BP is less than 90.
CPAP creates an increase in intrathoracic patient which drops BP
Trigger causes a release of histamine, causing bronchoconstriction and bronchial edema
Asthma
Treatment goals for asthma
THREE “Ates”
Oxygenate
Hydrate
Dilate
PROTOCOL INTERVENTION: ASTHMA
Albuterol (2.5mg x3) Atrovent (0.5mg X2) Mix Terbutaline (0.25mg SQ) CPAP Solumedrol (60-250mg IVP)
- **Mag Sulfate (2GMs IV over 10 minutes) IF BRONCHODILATORS ARENT WORKING
- *****EPI 1:1 (0.3mg IM) DEPENDING UPON AGE OF PATIENT
Magnesium sulfate
Given if not responding to bronchodilators
Greatly diminished breath sounds and not broken by bronchodilators
Status Asthmatics
Fix for status asthmatics?
TUBE!!!
Sharkfin capnography waveform indicates?
Bronchoconstriction
What is normal SpO2 readings for emphysema patients?
88-92%
Weakened and collapsed air sacs with excess mucus
Emphysema
Loss of alveoli elasticity
Emphysema
Ineffective cough
Emphysema
Thin
Emphysema
Increased red blood cells
Polycythemia
Polycythemia
Emphysema
Right heart failure caused by COPD
Cor Pulmonale
1 cause of acute right heart failure
Pulmonary emboli
PROTOCOL INTERVENTION: COPD
Albuterol (2.5mg) and Atrovent (0.5mg) mix nebulized
Terbutaline (0.25mg SQ) CAN BE GIVEN FIRST IF TIDAL VOLUME DECREASED
CPAP
FAT
Chronic bronchitis
Blue Bloater
Chronic bronchitis
Productive cough
Bronchitis
Odorless/colorless
Carbon Monoxide
Binds to hemoglobin 200% faster than oxygen
Carbon monoxide
First sign of carbon monoxide poisoning
Headache
Late signs of carbon monoxide poisoning
Cherry-red appearance
How will SpO2 read with carbon monoxide poisoning?
False high readings - carbon monoxide has bonded to hemoglobin
Hyperbaric chamber treatment
Carbon Monoxide
High flow oxygen administration will decrease the saturation of the carbon monoxide by?
Half amount in 1 hour
Chest pain worsens on inspiration
Pulmonary Embolism
Low SpO2 and low CO2
Pulmonary Embolism
Saddled PE
Lodged at bifurcation of pulmonary artery
Result from recent surgery, long bone fractures, postpartum, AFIB, birth control
PE
Carpal/Pedal spasms
Hyperventilation
Rales/rhonchi
Pulmonary Edema
Pressure is higher in capillaries than alveoli
Pulmonary Edema
PROTOCOL INTERVENTION: PULMONARY EDEMA
BP above 90 systolic
Nitroglycerine (0.4mg IV X3)
CPAP
Lasix (0.5mg/kg if on lasix; 1mg/kg if not on lasix)
Morphine (2-10mg IVP) MAX OUT ON NITRO BEFORE GIVING
lasix is given for pulmonary edema due to?
vasodilation
Morphine is given for pulmonary edema due to?
Vasodilation
Pedal edema
Right sided heart failure
JVD
Right sided heart failure
Increase in peripheral venous pressure
Right sided heart failure
Pulmonary edema is high permeability when
Including ARDS
CPAP is not given if BP is less than?
90mmHg
Vasodilators
Decrease preload
PROTOCOL INTERVENTION: PULMONARY EDEMA
NTG 0.4mg SL repeated every 5 minutes up to 3 NTG doses total
CPAP
Viral pneumonia
Not treated with antibiotics
High risk for aspiration pneumonia
Altered mental status
Three components of becks triad
Narrowing pulse pressure (difference btw systolic and diastolic)
Muffled heart tones
JVD
Sudden onset of one-sided chest pain with difficulty breathing
Pulmonary embolism
Oxyhemoglobin
Amount of oxygen bound to hemaglobin
Deoxyhemoglobin
Decrease in oxygen levels bound to hemoglobin
CYANOSIS
Carboxyhemoglobin
Amount of carbon monoxide bound to hemoglobin