Respiratory Flashcards
How long should you wait before performing a first trach change?
At least one week
What other bacteria can cause epiglottitis?
Staphylococcus aureus, strep pneumoniae, group a strep
What causes ARDS?
Injury to the alveolar capillary membrane
Three medication use an ER management of status asthmaticus?
Inhaled beta Agnes, corticosteroids, anticholinergics such as atrovent or ipratropium bromide
Define a pulmonary embolism.
Materials traveling in the bloodstream become lodged in the pulmonary arterial bed
Anxiety, high vent rate, tachypnea cause what acid base imbalance?
Respiratory alkalosis
What type of non-invasive ventilation provides two levels of pressure one during inspiration and one lower pressure in between respiratory cycles?
Bi-level positive airway pressure or bi-PAP
Tripod position, drooling, hot potato voice, anxiousness are all signs of what respiratory disease?
Epiglottitis
List three airway considerations in children?
Smallmouth, large tongue, floppy epiglottis, infants are obligate nose breathers
What is the managed management strategy when using invasive ventilation is status asthmatic is?
Allow for permissive hypercapnia
What invasive ventilator mode has a set volume delivered with each breath and a set pressure? Set rate and volume with pressure delivered to achieve those volumes
Volume control pressure support
When is most common cause of pneumonia in older neonates?
Staphylococcus or streptococcus
If the capnography measurement suddenly flattens what is the likely cost?
ET tube disconnection
What does VACTERL stand for?
Vertebral defects, anal atresia, cardiac defects, TEF, renal anomalies, limb anomalies
What is pulses paradoxes
Fall in blood pressure during inspiration of 10 MMHG
What is the actor finding of a patient with a croup?
Steeple sign
What CO2 measurement is worrisome in status asthmaticus?
A normal arising carbon dioxide as the patient compensates well for the exacerbation creating a hypocarbia
Retention of CO2 causes…
Respiratory acidosis
Where’s the most common adverse reaction of magnesium sulfate administration in status asthmaticus?
Hypotension
What are the three most common modes for invasive ventilation?
Pressure support, pressure control pressure support, volume control pressure support
What do you do with stay sutures on a fresh trach if the trach needs to be acutely removed?
Pull them up
What are four ways to increase oxygenation?
Increase FIO2, increase the peep, increase i-time which increases mean air way pressure
What antibiotic do you avoid when treating pertussis and infants less than one month of age and why?
Erythromycin can cause hypertrophic pyloric stenosis in infants under one month of age
What problem presents us sore throat fever dysphasia Christmas hot potato voice neck swelling?
Retropharyngeal abscess
What respiratory illness requires chemoprophylaxis for all household contacts?
Pertussis
What does a broncos spasm from asthma or COPD look like on capnography?
A shark fin due to the long exhale
What is the most common cause of pneumonia in neonates?
Group b strep, club Cielo
What is the benefit of giving Helios in a patient in status asthmaticus?
Turns turbulent flow into laminar flow
Wonder three risks to invasive ventilation?
Difficult airway, tracheal or vocal cord injury, subglottic stenosis, muscle weakness or atrophy, pneumothorax or pneumo mediastinum from air leaks
What physical exam is unique to a peritoneal abscess?
Swollen tonsils with uvula deviation
What happens to a patient’s respiratory rate when they are in DKA and why?
They become tachypneic because they are acidotic and trying to blow off CO2
What antibiotic class is used to treat pertussis?
Macrolides
What type of non-invasive ventilation provides one set pressure being delivered to the patient throughout the respiratory cycle?
Continuous positive airway pressure or CPAP
What mode of invasive ventilation has a set pressure with each breath and the amount of volume depends on compliance of lungs? They have a set rate, that will deliver set pressure, or if taking their own breaths they get pressure support
Pressure control pressure support
When treating a RDS using mechanical ventilation what are some management strategies to help decrease ventilator-associated lung injury?
Permissive hypercapnia, low title volume, avoid PIP greater than 30
What are common pathogens responsible for a retrofaring gel abscess?
Streptococcus pyogens, staphylococcus aureus, hemophilus
What are four ways to eliminate more carbon dioxide?
Increase the ventilator rate, in pressure control mode adjust the size of the ventilator breath being delivered so that they have to blow off bigger breaths, in volume control mode increase the title volume, change the I time so that it is shorter so there’s more time for exhalation
What sedating medication is used when intubation is required in status asthmaticus?
Ketamine due to its bronchodilatory effects
What is the most common cause of pneumonia in children age 2 to 5 years?
Viruses followed by streptococcus and hemophilus influenzae
How does a young infant present with pertussis?
Apnea
Is bronchiolitis an upper or lower respiratory disease?
Lower respiratory tract
Differentiate between a parepnemonic fusion and an empyema?
In a parapneumonic effusion the plural is inflamed but the fluid is sterile typically will resolve
Infection bacteria into the plural fluid if antibiotics fail may require a chest tube video assisted thoracentesis
What bacteria most often causes epiglottitis?
Hemophilus influenzae
When evaluating and managing hypercarbia in a patient with asthma what do you do to enhance the removal of CO2?
Decrease the ventilator rate due to the air trapping decreasing the rate will allow for longer expiratory phase?
What is the most common age for a Perry tonsillar abscess?
Older children in adolescence
If suspected bacterial and ammonia would antibiotic is used in school age?
Macrolide
What bacteria causes pertussis?
Bordetella pertussis
Of the three stages of pertussis (catarrhal, paroxysmal, convalescence) what stage is the most health severe?
Peroxisome
What are three reasons for surgical drainage to be required?
Airway compromise, abscess greater than 2 cm come a failure to improve on IV antibiotics within 24 to 36 hours
What are two findings on a chest x-ray of a patient with bronchiolitis?
Flat diaphragms, bronchial wall thickening
What condition interferes with passive exhalation causing a prolonged exhalation phase?
Asthma, bronchiolitis
What can be causes of acute decompensation in a patient who is ventilated?
Mucus plug, displaced tube, aspiration, pneumothorax, deterioration in overall status
Who receives post exposure antimicrobial prophylaxis for?
Within 21 days of exposure who are high risk of severe illness or have close contact with the person at high risk for severe disease such as infants, woman who are pregnant, immunocompromised persons
What will an ABG show on a patient with pulmonary embolism?
Respiratory alkalosis, arterial hypoxia
What is a normal pH?
7.35 to 7.45
When treating a RDS using mechanical ventilation what are some management strategies to help decrease ventilator-associated lung injury?
Permissive hypercapnia, low title volume, avoid PIP greater than 30
What is a normal CO2?
35 to 45
What is a normal bicarb?
22 to 26
Why does a child with status asthmaticus have flattened diaphragms on an x-ray?
Air trapping
What is the most common in about to use if bacterial pneumonia is suspected in an infant older than 3 months of age and young children?
High dose amoxicillin or a beta-lactam
What will an ABG show of a patient with acute respiratory distress syndrome?
PaO2/FiO2 ratio of less than 200
What mode of ventilation has no rate and two levels of pressure one on inspiration and one at the end of expiration and in between breaths? They breathe on the their own but are given pressure as needed when they breathe
Pressure support
What injection can be given as prophylaxis for bronchiolitis?
Palivizumab
What pathogens are typically responsible for a peritonsillar abscess?
Streptococcus pyogenes, staphylococcus aureus, hemophilus
What age is most common for a retropharyngeal abscess?
1 to 5 years
If your peak pressures are increasing over time what is a likely cause of the change in pressure?
Decreased lung compliance
What is a clinical manifestation of a pulmonary embolism?
Pluretic chest pain, dyspnea, sense of doom
Excess ingestion of antacids, excess administration of sodium bicarb, citrate in blood transfusions do what to cause metabolic alkalosis?
Gain base
What is the other name for a croup?
Laryngeal tracheal bronchitis
Pneumonia is in upper or lower respiratory tract infection?
Lower
What is seen in an x-ray of a person with epiglottitis?
Thumbprint sign
This group a disease of the upper or lower respiratory tract?
Upper
What are examples of the macrolides used to treat pertussis?
You were through my sin, clarithromycin, azithromycin
What is the most common cause of pneumonia in older infants or toddlers?
Viruses
Hyperventilation causes…
Respiratory alkalosis
What are the three stages of ARDS?
Exudative, proliferative, fibrotic
What side of the broncos is most likely to be the side of aspiration?
Right
Vomiting, nasogastric sectioning, low potassium and or chloride, diuretics do what to cause metabolic alkalosis?
Loss of metabolic acids
What phrase helps us remember respiratory verse metabolic alkalosis or acidosis?
R o m e or respiratory opposite metabolic equal referring to the two things that are different
What does an oscillator do?
Oscillates around higher mean airway pressure
What antibiotics are used to treat epiglottitis?
Third generation cephalosporin or a third generation cephalosporin plus vancomycin
What virus looks commonly causes croup?
Para influenza type 1 and type 2
What are the most common antibiotics used if bacterial pneumonia is suspected in neonates?
Ampicillin plus amino glycoside or third generation cephalosporin
What is a normal PAO2?
80 to 100
During CPR where the goal is to maintain a minimum of 10 on your capnography what does a set an increase in the ETCO2 mean?
Return of spontaneous circulation
What kind of genetic disease is cystic fibrosis?
Autosomal recessive genetic disease
Pneumonia, lung parenchyma, opioid sedation cause what kind of acid base imbalance?
Respiratory acidosis
Diabetic ketoacidosis, renal failure, lactic acidosis, drug overdose all do what to create a metabolic acidosis?
Increase acid
What is the do se and medication given to treat croup?
Text methadone 0.6 mg per kilogram
How do you check for proper proper placement after intubation?
Chest rise, breath sounds, presence of carbon dioxide by capnogram or capnography, condensation in ETT, chest x-ray
Christmas common cause of pneumonia in children ages 5 to 13 years old?
Mycoplasma pneumoniae, streptococcus pneumoniae
What genetic conditions are associated with obstructive sleep apnea?
Trisomy 21, achondroplasia, prater Willy
Diarrhea, pancreatic or small bowel fluid loss do what to cause metabolic acidosis?
Loss of base
What do you do with a ventilated patient in the case of acute decompensation?
Disconnect patient from the ventilator and back with 100% oxygen
What are normal tidal volumes?
6-8
