Respiratory Distress Flashcards
5 Mechanisms of Hypoxemia
- Hypoventilation
- R-L Shunting
- VQ Mismatch
- Diffusion Impairment
- Low inspired oxygen
This is exclusively caused by alveolar hypoventilation and is defined as a Paco2 >45 mm Hg (>6 kPa)
HYPERCAPNIA
Alveolar hypoventilation can result from (3)
- Decrease in RR
- Decrease in TV
- Increase in dead space
Signs and Symptoms of ACUTE hypercapnia
increase intracranial pressure: headache, confusion, lethargy
severe: coma and seizure
extreme: cardiovascular collapse
Management
Increase Minute Ventilation through increasing RR and/or TV
Accumulation of these 2 substances in ACE blockade causes cough
bradykinin, substance P
used in ed to treat intractable coughing paroxysms
4 mL of 1% or 2% preservative-free lidocaine (40 or 80 milligrams) by nebulization
For intractable coughing paroxysms in the ED, some patients respond to 4 mL of 1% or 2% preservative-free lidocaine (40 or 80 milligrams) by nebulization. This will cause transient suppression of the gag reflex due to posterior pharyngeal anesthesia.
Classification of Hiccups
Benign and Self limiting - <48h
Persistent >48h
intractable >1month
Drug treatment for persistent hiccups
- Chlorpromazine 25-50mh TIV q2-4h prn
- Metoclopramide 10mg TIV
WOF: EPS and hypotension
if not effective: Nifedipine, Valproic, baclofen, gabapentin
drugs that can cause pseudocyanosis
- Chlorpromazone
- Minocycline
- Amiodarone
- Nicorandil
Silver, gold
Light Criteria
Light criteria for pleural exudate: 1 or more of the following present:
* Pleural fluid/serum protein ratio >0.5
or
* Pleural fluid/serum LDH ratio >0.6
or
* Pleural fluid LDH greater than two thirds of the upper limit for serum LDH
Airway management in massive hemoptysis
larger diameter ET to allow for bronchoscopy
preferentially intubate the unaffected lung
