Respiratory

Question 1

Kussmaul respirations

Answer 1

seen in DKA
rapid & deep

Question 2

Cheyne stokes respirations

Answer 2

seen in sleep apnea
rhythm pattern with periods of apnea

Question 3

stridor respirations

Answer 3

seen in upper airway obstruction:

croup
epiglottis
anaphylaxis

Question 4

wheezing respirations

Answer 4

seen in lower airway:

asthma
bronchiolitis
crackles from excess fluid
pleural friction rub

Question 5

CPAP

Answer 5

continuous airflow at single set pressure to keep airway open

Question 6

BiPAP

Answer 6

high pressure on inhalation
lower pressure on exhalation

Question 7

what drug assisted analgesic is contradicted with intubation?

Answer 7

succinylcholine which can cause:

• hyperthermia
• hyperkalemia (bad for burns & crush injuries)
• depolarizing neuromuscular blocker (bad for Guillain Barre, MS, & myasthenia gravis

Question 8

name 3 other unfavored analgesics in intubation

Answer 8

• fentanyl (chest wall rigidity)
• propofol (lowers MAP)
• ketamine (increase secretions)

Question 9

patient begins to decompensates, manually ventilate patient and check DOPES

Answer 9

• tube displacement
• obstruction
• pneumothorax
• equipment failure
• stacked breaths

Question 10

pH levels in ABG

Answer 10

7.35 - 7.45

—> below 7.35 is acidotic
<— above 7.445 is alkalotic

Question 11

PaCO2 levels in ABG

Answer 11

45-35
<— above 45 is acidotic
—> below 35 is alkalotic

Question 12

HCO3 levels in ABG
(bicarb brought to lungs and exhaled out by CO2 & excreted through kidneys)

Answer 12

22 -26
—> below 22 is acidotic
<— above 26 is alkalotic

Question 13

pulmonary hyptertension

Answer 13

-caused by right side heart failure

-exertional pulmonary edema, dyspnea & fatigue

• treat with O2, vasodilators, diurectics, an digoxin to increase contracility

Question 14

pulmonary hyptertension

Answer 14

-caused by right side heart failure

-exertional pulmonary edema, dyspnea & fatigue

• treat with O2, vasodilators, diuretics, & digoxin to increase contractility

Question 15

acute bronchitis

Answer 15

-viral inflammation d/t influenza or RSV
-nonproductive dry cough (worse at night)
-cp, sore throat, nasal congestion, low grade fever
-chest xray
-tx with cough meds, steroids, *no ABX

Question 16

epiglottitis
(hot potatoe voice)

Answer 16

-bacterial infection
-triad of drooling, dysphagia, & distress
-abrupt high fever
-thumbprint sign on lateral neck xr
-keep in caregivers arm to calm child (no iv or labs)
-secure airway-if they cry they die

Question 17

croup
(barky seal cough)

Answer 17

-viral infection 6mo-3 years
-gradual onset uri
-low grade fever, inspiratory stridor
*steeple sign on cxr
-tx with racemic nebulized epinephrine & dexamethasone

Question 18

inhalation injuries

Answer 18

-perform escharotomy if circumferential chest butn
-cherry red skin, ST segment depression on ECG due to hypoxia, headache, & confusion

Question 19

inhalation injuries

Answer 19

-perform escharotomy if circumferential chest burn
-cherry red skin, ST segment depression on ECG due to hypoxia, headache, & confusion
- carboxyhemoglobin <10%

Question 20

inhalation injuries

Answer 20

-perform escharotomy if circumferential chest burn
-cherry red skin, ST segment depression on ECG due to hypoxia, headache, & confusion
- carboxyhemoglobin <10%a

Question 21

Non cardiogenic pulmonary edema

(Acute Respiratory Distress Syndrome-ARDS)

Answer 21

• submersion injury
• occurs in rapid ascent while scuba diving, high altitude pulmonary edema, inhalation of toxic gases, heroin overdose

Question 21

Non cardiogenic pulmonary edema

(Acute Respiratory Distress Syndrome-ARDS)

Answer 21

-submersion injury
-occurrs in rapid ascent while scuba diving, high altitude pulmonary edema, inhalation of toxic gases, heroin overdose

Question 22

risks of rib fractures 1-2

Answer 22

aortic dissections

Question 23

risk of rib fractures 4-9

Answer 23

-pulmonary contusion
-blunt chest injury

Question 24

risk of rib fractures 9-12

Answer 24

-injury to spleen, liver, posterior renal

Question 25

pulmonary contusion

Answer 25

-lung injury 24-48hr after event
-respiratory distress, chest wall bruising, restless, crackles
-cxr may not reveal infiltrates until 12 hrs later
-oxygen is priority, semi-fowlers, soft IVF

Question 26

flail chest

Answer 26

• seen most often in high speed mva s/p sternal fx from airbag
  -2 adjacent ribs fractured in 2 places resulting a free floating unstable segment with paradoxical chest wall motion
  -o2, intubation for surgery, soft IVF, check for pneumo/hemo

Question 27

pneumothorax

Answer 27

• decreased breath sounds
• hyperresonance, tachy, tachypneic
  high fowlers, O2, chest tube

Question 28

open pneumo

Answer 28

• sucking chest wound
• emphysema
• cover with 3-sided occlusive dressing at end exhalation & prepare for chest tube

Question 29

tension pneumo

Answer 29

-absent breath sounds, jugular vein distention, hypotension, trachea deviation

-immediate needle decompression 14-16g needle at 2nd ICS over 3rd rib

Question 30

hemothorax

Answer 30

accumulation of blood in pleural space from tear of mammary artery

• think hemo shock (tachy, delay cap refill, clammy, hypo)
• *found by FAST
• tx with 2 large bore IVs, transfuse
  *chest tube between 5-6th ICS, emergency surgery of initial drainage >1500, tidaling is normal

Question 31

rupture diaphragm

Answer 31

abdominal contents herniate into chest and compress lungs

-occurs in lateral impacts
-dyspnea
*gurgling peristaltic sounds in left chest
*Kehr’s sign: progressive scaphoid abdominal pain radiating to left shoulder