Respiratory Flashcards
What are physical signs of respiratory distress? (7)
1) Anxiety and restlessness
2) Flaring of nostrils
3) Use of neck muscles
4) Use of abdominal muscles for breathing
5) cyanosis - lips, fingers
6) asymmetrical chest movement - flail chest?
7) Trachea midline or pulled to one side.
Central cyanosis present as blue in what body parts?
Around the core, lips, tongue
Peripheral cyanosis present as blue in which parts of the body
Only the extremities and fingers
What is the likely diagnosis in the case of unilateral dusky blue extremity.
Arteriole blockage (thrombosis) in the leg.
What is seen in the case of a flail chest?
Part of the chest moves in an asynchronistic way.
How many ribs must be broken to produce a flail chest?
2/3rds or more of the ribs.
What population is flail chest most commonly seen in?
Elderly, or with trauma.
What is subcutaneous emphysema
When there is air that escapes the thoracic cavity and diffuses into the subcutaneous space.
What medication in contraindication in flail chest
morphine - because it suppresses respiratory drive
What is respiratory distress
Inadequate capacity of respiration to support life
What are the most common causes of respiratory arrest? (7)
- Acute coronary syndrome, cardiac arrest
- acute heart failure
- electric shock
- drowning
- suffocation
- inhalation of poisonous gases
- head injury
What are common life-threatening causes of acute sever dyspnea? (8)
- arrhythmias
- pericardial tamponade
- pulmonary embolism
- pneumonia or other pulmonary infections
- asthma of COPD exacerbation
- anaphylaxis and angioedema
- poisoning (ie carbon monoxide)
- trauma (ie pneumothorax, hemothorax)
What are the 3 signs to know with pericardial tamponade?
- low blood pressure
- JVD
- very quiet heart sounds
also anxiety and sense of doom
What are some causes of respiratory compromise in children? (6)
- airway anomalies, ie tracheoesophageal fistula, tracheal stenosis, tracheal ring
- epiglottitis
- uvulitis
- tracheitis
- peritonsillar abscess
- retropharyngeal abscess
- asthma
- broncholitis
- croup
- pneumonia
- anaphlyaxis
- foreign body
What is the typical appearance of a peritonsillar abscess?
- Typically unilateral, swollen, shine, taut tonsil (swell up to a ping pong ball)
- Refer to ER right away
When would you tell your patient with tonsillitis to go to the ER? (2)
- If they have SOB
OR
- If they have fever over 102
What is croup?
Inflammation of the soft tissue around the trachea. The trachea is then constricted from the swollen soft tissues, which creates a barking, seal-like sound.
Worse at night
Occurs more in children because they have smaller anatomy.
What are some cardiovascular causes of respiratory failure? (9)
- congenital heart disease
- acute decompensated heart failure
- myocarditis
- pericarditis
- arrhythmia
- MI
- valve dysfunction
- shock
- cardiac tamponade
What is pericarditis?
Inflammation of the sac surrounding the heart. Pain comes on when a deep inhalation is taken.
What are the hematologic causes of respiratory failure?
…from decreased O2 carrying capacity (7)
- acute sever anemia from trauma or blood loss
- marked hemolysis
- methamoglobinemia
- carbon monoxide poisoning
- sickle cell disease
- thalassemia
- chronic sever anemia
What are neurological causes of respiratory failure? (5)
- CNS trauma
- CNS infections
- Seizures
- Hypotonic muscular conditions (Guillon Barre, Botulism)
- loss of airway protective reflexes may lead to aspiration
What are some toxic and metabolic causes of respiratory failure? (5)
- Drug overdose - esp narcotics, benzodiazepines
- alcohol by itself or in combination with above drugs
- salicylate poisoning
- Diabetic ketoacidosis
- Sepsis
What is in the DDX of absent or diminished breath sounds? (5)
COPD Pneumonia CHF Severe asthma Pneumothorax
If a patient come into you office who is overweight, has a red flushed face and complains of headaches, which diagnosis are you thinking?
Sleep apnea
What lab test would support a working diagnosis of sleep apnea?
Increased hemoglobin on CBC
Their body has adjusted to their lack of oxygen received at night.
In pneumonia, in addition to absent or diminished breath sounds, what would you hear during a lung exam/ what special test would you run?
Whispered pectoriloqy (eee to ayy) - would hear consolidation.
In severe asthma, in addition to absent or diminished breath sound what might you hear during a lung exam?
Inspiratory and expiratory wheezing.
Or maybe chronic cough.
In a pneumothorax, in addition to absent or diminished breath sound what might you find during a lung exam?
Asymmetry upon percussion
Inspiratory stridor is classically due to air flow _______ above the level of the _____ _____.
Obstruction
Vocal Chords
What are some potential causes of inspiratory stridor? (3)
- foreign body
- epiglottitis
- angioedema
Expiratory stridor is due to obstruction ________ the level of the ______ ______.
below
vocal chords
Example of cause of expiratory/mixed stridor include (3)
Croup
foreign body
bacterial tracheitis
What is another name for crackles?
rales
What is another name for rales?
crackles
What are crackles. rales due to?
inter-alveolar fluid
What are some example of condition where you would hear crackles/rales?
- Acute decompensated heart failure (ADHF)
- Adult respiratory distress syndrome (ARDS)
- pneumonia
What is acute decompensated heart failure (ADHF) caused by?
The condition is caused by severe congestion of multiple organs by fluid that is inadequately circulated by the failing heart.
What is acute decompensated heart failure (ADHF)?
(ADHF) is a worsening of the symptoms, typically shortness of breath (dyspnea), edema, and fatigue, in a patient with existing heart disease. ADHF is a common and potentially serious cause of acute respiratory distress.
What are some possible etiologies of JVD with lungs that appear to be clear to auscultation? (3)
- Right heart failure!!!!!!
- Cardiac Tamponade
- Pulmonary embolism
What are some signs and symptoms of worsening CHF?(9)
- anxiety, restlessness
- dyspnea
- rapid labored breathing
- crackling or wheezing sounds
- cyanosis
- blood tinges sputum
- JVD
- rapid pulse
- cool, clammy skin
What is important to ask in the case of upper extremity DVT?
Has the person had a recent history of a catheter in the upper extremity
If a patient with upper extremity DVT has no his of recent upper extremity catheter what disease MUST be ruled out?
CANCER
What are the two general groups of causes of acute pulmonary edema?
- Cardiac related: MI, CHF, accelerated hypertension
2. Due to near drowning, aspiration pneumonia, smoke inhalation, inhalation of toxins
What is included in the initial outpatient treatment of a patient with worsening CHF?
- high flow O2
- keep patient’s head and shoulder elevated
- keep patient as calm as possible
- transport - call 911
What are the four stages of acute asthma?
1) Mild asthma
2) Moderate asthma
3) Severe asthma
4) Respiratory failure
What are the characteristics of mild asthma (stage 1) - 4
- Adequate air exchange
- mild dyspnea
- diffuse wheezes
- FEV1 is 50-80%normal
What are the characteristics of moderate asthma - stage 2 (5)
- respiratory distress at rest
- hyperpnoea (increased depth of breathing)
- marked wheezes
- air exchange is normal to decreased
- FEV1 is 50% of normal or less
What are the characteristics of severe acute asthma? (5)
- marked respiratory distress
- marked wheezes or absent great sounds
- check for pulsus paradoxes - drop of blood pressure >10mm with inspiration
- SCM retraction is commonly noted
- FEV1 is 25 - 11% of normal
What is pulses paradoxus
A drop os blood pressure >10mm with inspiration.
What are the characteristics of respiratory failure? (stage 4 acute asthma?
- severe respiratory distress
- lethargy
- confusion
- prominent pulsus paradoxus
- SCM retraction
- FEV1 is 10! or normal or less
What is the first line treatment for an acute asthma attack.
An inhaled or nebulizer short acting beta agonist (SABA) such as Albuterol.
True or false: Long acting beta agonists (LABA’s) and inhaled corticosteroids play a significant role in the treatment of an acute asthmatic attack?
False
Failure of beta agonists to improve acute exacerbation asthma attack may warrant the use of ___ __________.
IM epinephrine.
True or False: Antihistamines and steroids won’t stop an acute respiratory event, but they will diminish the severity in future events.
True
ER referral for acute asthma events is indicates if: (4)
- Vital signs are: RR > 30rpm, P > 120 bpm
- Pulse OX 91 with a drop to
What is croup?
a respiratory illness characterized by inspiratory stridor, cough, and hoarseness
These symptoms result from inflammation in the larynx and subglottic airway
What is the hallmark of croup?
A barking cough among infants and children
hoarseness predominates in older children and adults
What are the typically signs and symptoms of croup? (4)
- barking or hacking cough - less acute onset (usually has a metallic ring to it)
- gradually increasing URI symptoms
- symptoms are often worse at night
- symptoms may improves with exposure to cool, damp air
- fever is typically absent , but with mild URI symptoms it may be present.
True or false: death in croup is common
False
croup is a mild and self-limited illness - death rarely occurs due to significant upper airway swelling and obstruction.
What is the number 1 drug of choice in anaphylaxis?
EPINEPHRINE
What is anaphylaxis?
A rapidly occurring (1-15 minutes) systemic reaction characterized by respiratory distress, urticaria, occasional abdominal cramps and vomiting, and vascular collapse.
Anaphylaxis is what type of hypersensitivity reaction?
Type 1
The pathophysiology of anaphylaxis involves ______ muscle ________ and vascular _________ with escape of _______in the tissues
Smooth, contraction
dilation
plasma
In anaphylaxis, the leakage of fluid into the interstitial tissue leads to ________(increased or decreased) volume in the blood stream, eventually leading to ________.
decreased, shock
In anaphylaxis, fluid in the lungs leads to ________ _________.
pulmonary edema
True of false: There are contraindications to using epinephrine in the setting of anaphylaxis.
FALSE!
There NO absolute contraindication to epinephrine in the setting of anaphylaxis.
What concentration does one administer IM epinephrine in the case of anaphylaxis?
1mg/ml: Give .3-.5mg preferably in the mid-anterolateral thigh
can repeat every 5-15 minutes as needed
What is the difference between anaphylaxis and anaphylactoid reaction?
Anaphylactoid is NON IgE mediated reaction that resembles anaphylaxis, but it is NOT antibody related.
It is a dose related toxin with idiosyncratic mechanism rather than immunology mediated one
When does anaphylactoid reaction occur?
With first exposure to certain drugs.
How are anaphylactoid reactions treated?
Similarly to anaphylaxis - immediate use of epinephrine.
What are the three symptoms in patients that are particularly high risk. (the triad)
- nasal polyps
- allergies to aspirin, food allergies
- hay fever, asthma
A patient with panic attack may present with:
Classic, discrete episodes of intense fear that begin abruptly and last for several minutes to an hour.
What physical symptoms may a patient with panic attacks present to the ER with?
chest pain, shortness of breath
What is epiglottitis?
Inflammation of the epiglottis and adjacent supra-glottis structures.
True or false - without treatment, epiglottitis can progress to life- threatening airway obstruction.
True
What is the typically cause of epiglottitis?
It results from bacteria and/or direct invasion of the epithelial layer by the pathogenic organism.
The signs and symptoms of epiglottitis include:
Abrupt and rapid onset of the three D’s:
- drooling
- dysphagia
- distress
Sudden onset of high fever
sever soar throat, odynophagia (painful swallowing) is also common
True or false: children with epiglottitis usually appear “toxic”
True, however there is a wide spectrum of severity.
The often experience a choking sensation, are distressed during inspiration, and are anxious, restless, and irritable.
What hallmark position may a child be seen sitting in in a case of epiglottitis?
Trunk leaning forward, neck hyperextended, and chin thrust forward in effort to maximize the diameter of the obstructed airway (the tripod posture)
How does the speech sound in a child with epiglottitis?
Muffled, “hot potato” voice
Which mask has the greatest % of oxygen? And how much %?
A Non-rebreather mask - 90%
The air does not mix with the CO2 that you are breathing out.
Which mask is the most accurate mask for measuring how much oxygen is being delivered?
Venturi mask - it has an apparatus attached
