Respiratory Adult/Pediatric

Question 1

What is bronchospasm?

Answer 1

Constriction of smooth muscles of the bronchi, causing a narrowing and obstruction of lower airways.

This results in poor ventilation, air trapping and increasing secretions that can lead to mucus plugging.

Question 2

When is IM epinephrine appropriate in Asthmatics?

Answer 2

Impending respiratory failure, or severe bronchospasm.

This can be defined as poor to no air movement, inability to speak, profound tachypnea or bradypnea, or falling GCS.

Question 3

What are four signs of impending respiratory failure?

Answer 3

1. Decreased air entry/respiratory effort
2. fatigue
3. DLOC
4. Respiratory rate over 40, or declining respiratory rate.

Question 4

What benefit does ipratropium provide to the asthmatic?

Answer 4

Ipratropium is an anticholinergic that can also produce bronchodilation through a synergistic effect with salbutamol. In addition to its anticholinergic affects ipratropium will reduce airway secretions.

Question 5

What are 5 common signs/symptoms of an acute asthma attack?

Answer 5

1. Tachypnea w/ prolonged expiratory phase
2. Tachycardia
3. Accessory muscle use during inspiration
4. Diaphoresis, increased mucous production
5. Inability to speak in full sentences

Question 6

In asthma, what is an appropriate I:E ratio to expect?

Answer 6

Patients with bronchospasm typically have an expiratory phase that is 2-3 times longer than their inspiratory phase

Question 7

What are 5 questions to ask the severe asthmatic?

Answer 7

W-worsening condition/increased puffer use?
H-Hospital visits?
I-Intubations/ICU stay?
P- puffers?
S-Steroid?

Question 8

What is the correct dose over period of time for Magnesium in Asthma

Answer 8

2G over 20minutes IV

Question 9

What is the pediatric dose for salbutamol MDI?

Answer 9

<10kg not indicated

-10 to 20kg: 5x100mcg up to 3 times
->20kg:10x100mcg up to 3 times

Question 10

What is the pediatric dose for an IV magnesium infusion?

Answer 10

50mg/kg infused over 15minutes.

Question 11

Should croup be treated with antibiotics?

Answer 11

No, Antibiotics do not play a role in treating this condition. It is viral.

Question 12

What are the 3 D’s associated with epiglotittis?

Answer 12

1. Drooling
2. Dysphagia (Swallowing difficulties)
3. Distressed breathing

Question 13

When differentiating croup/epiglottitis from one another, what are some key differences?

Answer 13

Croup: Onset is gradual, generally associated with prodromal symptoms (viral in nature), barking cough w/ inspiratory stridor.

Epiglottitis: Abrupt onset, associated with drooling, dysphagia, difficulty breathing.

Question 14

What are 5 important differentials for upper airway stridor in pediatrics?

Answer 14

1. Croup
2. epiglottitis
3. FBAO
   4.Inhalation injury
4. Anaphylaxis

Question 15

Describe the onset and degenerative process that occurs with COPD

Answer 15

COPD is gradual in onset, and progressively worsens over long periods of time. It is the result of persistent lung irritation resulting in degeneration of key lung structures and increased dead space (emphysema) and increased mucous production.

Question 16

What are 3 key risk factors that subject patients to COPD?

Answer 16

1. Smoking
2. Chemical Exposure
3. Repeated infections.

Question 17

. Is COPD primarily a disease of oxygenation or ventilation?

Answer 17

Ventilation.

Patients chronically remain hypercapnic.

Critical Hypercapnia can develop in patients with COPD despite high respiratory rates and seemingly effective ventilation. This is because of degenerative changes to alveoli and pulmonary circulation.

Question 18

When does a pulmonary embolism occur?

Answer 18

A PE occurs when the pulmonary artery gets blocked either by clot, fat, or air/thrombus. Resulting in decreased perfusion and inability to exchange and utilize oxygen/remove CO2.

Question 18

When does a pulmonary embolism occur?

Answer 18

A PE occurs when the pulmonary artery gets blocked either by clot, fat, or air/thrombus. Resulting in decreased perfusion and inability to exchange and utilize oxygen/remove CO2.

Question 19

List 7 common signs and symptoms of a PE

Answer 19

-Sudden onset SOB while at rest or exertion
-Pleuritic chest pain
-cough
-orthopnea
-calf or thigh pain/swelling
-Wheezing
-Syncope

Question 20

What defines anaphylaxis?

Answer 20

-2 system IgE mediated reaction.

Question 21

What is the difference between IgE mediate and non-IgE mediated reactions?

Answer 21

-Immunoglobulin E causes mediated release of histamine and other mediators secondary to mast-cell and basophil degranulation
-Non-IgE involes slower onset, minimal system involvment. Minor symptoms.

Question 22

Why is epinephrine given in Anaphylaxis?

Answer 22

-B2 and antihistamine affects.

Question 23

Why is glucagon given in anaphylaxis, where the patient may be on BB medications?

Answer 23

BB block beta adrenergic receptor sites, which is where epi primarily works.

Glucagon acts within a different pathway and causes positive inotropy (Contractility) and chronotropic (Heart rate) effects through the production of cyclic AMP

Question 24

Are corticosteroids beneficial in anaphylaxis?

Answer 24

The role of steroids is unproven. Patients who experiences anaphylaxis often are prescribed a several day course of prednisone.