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First Aid & Emergency Medicine > Respiratory > Flashcards

Respiratory Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are physical signs of respiratory distress? (7)

A

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.

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2
Q

Central cyanosis present as blue in what body parts?

A

Around the core, lips, tongue

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3
Q

Peripheral cyanosis present as blue in which parts of the body

A

Only the extremities and fingers

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4
Q

What is the likely diagnosis in the case of unilateral dusky blue extremity.

A

Arteriole blockage (thrombosis) in the leg.

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5
Q

What is seen in the case of a flail chest?

A

Part of the chest moves in an asynchronistic way.

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6
Q

How many ribs must be broken to produce a flail chest?

A

2/3rds or more of the ribs.

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7
Q

What population is flail chest most commonly seen in?

A

Elderly, or with trauma.

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8
Q

What is subcutaneous emphysema

A

When there is air that escapes the thoracic cavity and diffuses into the subcutaneous space.

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9
Q

What medication in contraindication in flail chest

A

morphine - because it suppresses respiratory drive

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10
Q

What is respiratory distress

A

Inadequate capacity of respiration to support life

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11
Q

What are the most common causes of respiratory arrest? (7)

A
  • Acute coronary syndrome, cardiac arrest
  • acute heart failure
  • electric shock
  • drowning
  • suffocation
  • inhalation of poisonous gases
  • head injury
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12
Q

What are common life-threatening causes of acute sever dyspnea? (8)

A
  • 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)
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13
Q

What are the 3 signs to know with pericardial tamponade?

A
  • low blood pressure
  • JVD
  • very quiet heart sounds

also anxiety and sense of doom

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14
Q

What are some causes of respiratory compromise in children? (6)

A
  • airway anomalies, ie tracheoesophageal fistula, tracheal stenosis, tracheal ring
  • epiglottitis
  • uvulitis
  • tracheitis
  • peritonsillar abscess
  • retropharyngeal abscess
  • asthma
  • broncholitis
  • croup
  • pneumonia
  • anaphlyaxis
  • foreign body
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15
Q

What is the typical appearance of a peritonsillar abscess?

A
  • Typically unilateral, swollen, shine, taut tonsil (swell up to a ping pong ball)
  • Refer to ER right away
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16
Q

When would you tell your patient with tonsillitis to go to the ER? (2)

A
  • If they have SOB

OR

  • If they have fever over 102
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17
Q

What is croup?

A

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.

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18
Q

What are some cardiovascular causes of respiratory failure? (9)

A
  • congenital heart disease
  • acute decompensated heart failure
  • myocarditis
  • pericarditis
  • arrhythmia
  • MI
  • valve dysfunction
  • shock
  • cardiac tamponade
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19
Q

What is pericarditis?

A

Inflammation of the sac surrounding the heart. Pain comes on when a deep inhalation is taken.

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20
Q

What are the hematologic causes of respiratory failure?

…from decreased O2 carrying capacity (7)

A
  • acute sever anemia from trauma or blood loss
  • marked hemolysis
  • methamoglobinemia
  • carbon monoxide poisoning
  • sickle cell disease
  • thalassemia
  • chronic sever anemia
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21
Q

What are neurological causes of respiratory failure? (5)

A
  • CNS trauma
  • CNS infections
  • Seizures
  • Hypotonic muscular conditions (Guillon Barre, Botulism)
  • loss of airway protective reflexes may lead to aspiration
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22
Q

What are some toxic and metabolic causes of respiratory failure? (5)

A
  • Drug overdose - esp narcotics, benzodiazepines
  • alcohol by itself or in combination with above drugs
  • salicylate poisoning
  • Diabetic ketoacidosis
  • Sepsis
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23
Q

What is in the DDX of absent or diminished breath sounds? (5)

A 
COPD
Pneumonia
CHF
Severe asthma
Pneumothorax
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24
Q

If a patient come into you office who is overweight, has a red flushed face and complains of headaches, which diagnosis are you thinking?

A

Sleep apnea

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25
Q

What lab test would support a working diagnosis of sleep apnea?

A

Increased hemoglobin on CBC

Their body has adjusted to their lack of oxygen received at night.

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26
Q

In pneumonia, in addition to absent or diminished breath sounds, what would you hear during a lung exam/ what special test would you run?

A

Whispered pectoriloqy (eee to ayy) - would hear consolidation.

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27
Q

In severe asthma, in addition to absent or diminished breath sound what might you hear during a lung exam?

A

Inspiratory and expiratory wheezing.

Or maybe chronic cough.

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28
Q

In a pneumothorax, in addition to absent or diminished breath sound what might you find during a lung exam?

A

Asymmetry upon percussion

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29
Q

Inspiratory stridor is classically due to air flow _______ above the level of the _____ _____.

A

Obstruction

Vocal Chords

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30
Q

What are some potential causes of inspiratory stridor? (3)

A
  • foreign body
  • epiglottitis
  • angioedema
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31
Q

Expiratory stridor is due to obstruction ________ the level of the ______ ______.

A

below

vocal chords

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32
Q

Example of cause of expiratory/mixed stridor include (3)

A

Croup
foreign body
bacterial tracheitis

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33
Q

What is another name for crackles?

A

rales

34
Q

What is another name for rales?

A

crackles

35
Q

What are crackles. rales due to?

A

inter-alveolar fluid

36
Q

What are some example of condition where you would hear crackles/rales?

A
  • Acute decompensated heart failure (ADHF)
  • Adult respiratory distress syndrome (ARDS)
  • pneumonia
37
Q

What is acute decompensated heart failure (ADHF) caused by?

A

The condition is caused by severe congestion of multiple organs by fluid that is inadequately circulated by the failing heart.

38
Q

What is acute decompensated heart failure (ADHF)?

A

(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.

39
Q

What are some possible etiologies of JVD with lungs that appear to be clear to auscultation? (3)

A
  • Right heart failure!!!!!!
  • Cardiac Tamponade
  • Pulmonary embolism
40
Q

What are some signs and symptoms of worsening CHF?(9)

A
  • anxiety, restlessness
  • dyspnea
  • rapid labored breathing
  • crackling or wheezing sounds
  • cyanosis
  • blood tinges sputum
  • JVD
  • rapid pulse
  • cool, clammy skin
41
Q

What is important to ask in the case of upper extremity DVT?

A

Has the person had a recent history of a catheter in the upper extremity

42
Q

If a patient with upper extremity DVT has no his of recent upper extremity catheter what disease MUST be ruled out?

A

CANCER

43
Q

What are the two general groups of causes of acute pulmonary edema?

A
  1. Cardiac related: MI, CHF, accelerated hypertension

2. Due to near drowning, aspiration pneumonia, smoke inhalation, inhalation of toxins

44
Q

What is included in the initial outpatient treatment of a patient with worsening CHF?

A
  • high flow O2
  • keep patient’s head and shoulder elevated
  • keep patient as calm as possible
  • transport - call 911
45
Q

What are the four stages of acute asthma?

A

1) Mild asthma
2) Moderate asthma
3) Severe asthma
4) Respiratory failure

46
Q

What are the characteristics of mild asthma (stage 1) - 4

A
  • Adequate air exchange
  • mild dyspnea
  • diffuse wheezes
  • FEV1 is 50-80%normal
47
Q

What are the characteristics of moderate asthma - stage 2 (5)

A
  • respiratory distress at rest
  • hyperpnoea (increased depth of breathing)
  • marked wheezes
  • air exchange is normal to decreased
  • FEV1 is 50% of normal or less
48
Q

What are the characteristics of severe acute asthma? (5)

A
  • 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
49
Q

What is pulses paradoxus

A

A drop os blood pressure >10mm with inspiration.

50
Q

What are the characteristics of respiratory failure? (stage 4 acute asthma?

A
  • severe respiratory distress
  • lethargy
  • confusion
  • prominent pulsus paradoxus
  • SCM retraction
  • FEV1 is 10! or normal or less
51
Q

What is the first line treatment for an acute asthma attack.

A

An inhaled or nebulizer short acting beta agonist (SABA) such as Albuterol.

52
Q

True or false: Long acting beta agonists (LABA’s) and inhaled corticosteroids play a significant role in the treatment of an acute asthmatic attack?

A

False

53
Q

Failure of beta agonists to improve acute exacerbation asthma attack may warrant the use of ___ __________.

A

IM epinephrine.

54
Q

True or False: Antihistamines and steroids won’t stop an acute respiratory event, but they will diminish the severity in future events.

A

True

55
Q

ER referral for acute asthma events is indicates if: (4)

A
  • Vital signs are: RR > 30rpm, P > 120 bpm

- Pulse OX 91 with a drop to

56
Q

What is croup?

A

a respiratory illness characterized by inspiratory stridor, cough, and hoarseness

These symptoms result from inflammation in the larynx and subglottic airway

57
Q

What is the hallmark of croup?

A

A barking cough among infants and children

hoarseness predominates in older children and adults

58
Q

What are the typically signs and symptoms of croup? (4)

A
  • 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.
59
Q

True or false: death in croup is common

A

False

croup is a mild and self-limited illness - death rarely occurs due to significant upper airway swelling and obstruction.

60
Q

What is the number 1 drug of choice in anaphylaxis?

A

EPINEPHRINE

61
Q

What is anaphylaxis?

A

A rapidly occurring (1-15 minutes) systemic reaction characterized by respiratory distress, urticaria, occasional abdominal cramps and vomiting, and vascular collapse.

62
Q

Anaphylaxis is what type of hypersensitivity reaction?

A

Type 1

63
Q

The pathophysiology of anaphylaxis involves ______ muscle ________ and vascular _________ with escape of _______in the tissues

A

Smooth, contraction

dilation

plasma

64
Q

In anaphylaxis, the leakage of fluid into the interstitial tissue leads to ________(increased or decreased) volume in the blood stream, eventually leading to ________.

A

decreased, shock

65
Q

In anaphylaxis, fluid in the lungs leads to ________ _________.

A

pulmonary edema

66
Q

True of false: There are contraindications to using epinephrine in the setting of anaphylaxis.

A

FALSE!

There NO absolute contraindication to epinephrine in the setting of anaphylaxis.

67
Q

What concentration does one administer IM epinephrine in the case of anaphylaxis?

A

1mg/ml: Give .3-.5mg preferably in the mid-anterolateral thigh

can repeat every 5-15 minutes as needed

68
Q

What is the difference between anaphylaxis and anaphylactoid reaction?

A

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

69
Q

When does anaphylactoid reaction occur?

A

With first exposure to certain drugs.

70
Q

How are anaphylactoid reactions treated?

A

Similarly to anaphylaxis - immediate use of epinephrine.

71
Q

What are the three symptoms in patients that are particularly high risk. (the triad)

A
  • nasal polyps
  • allergies to aspirin, food allergies
  • hay fever, asthma
72
Q

A patient with panic attack may present with:

A

Classic, discrete episodes of intense fear that begin abruptly and last for several minutes to an hour.

73
Q

What physical symptoms may a patient with panic attacks present to the ER with?

A

chest pain, shortness of breath

74
Q

What is epiglottitis?

A

Inflammation of the epiglottis and adjacent supra-glottis structures.

75
Q

True or false - without treatment, epiglottitis can progress to life- threatening airway obstruction.

A

True

76
Q

What is the typically cause of epiglottitis?

A

It results from bacteria and/or direct invasion of the epithelial layer by the pathogenic organism.

77
Q

The signs and symptoms of epiglottitis include:

A

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

78
Q

True or false: children with epiglottitis usually appear “toxic”

A

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.

79
Q

What hallmark position may a child be seen sitting in in a case of epiglottitis?

A

Trunk leaning forward, neck hyperextended, and chin thrust forward in effort to maximize the diameter of the obstructed airway (the tripod posture)

80
Q

How does the speech sound in a child with epiglottitis?

A

Muffled, “hot potato” voice

81
Q

Which mask has the greatest % of oxygen? And how much %?

A

A Non-rebreather mask - 90%

The air does not mix with the CO2 that you are breathing out.

82
Q

Which mask is the most accurate mask for measuring how much oxygen is being delivered?

A

Venturi mask - it has an apparatus attached

First Aid & Emergency Medicine (10 decks)

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