Respiratory Distress

Question 1

combination of patient’s subjective sensation of dyspnea with physical signs indicating difficulty breathing

Answer 1

respiratory distress

Question 2

when the lungs and respiratory muscles cannot move enough air adequately oxygenate and eliminate CO2

Answer 2

respiratory failure

Question 3

what 3 S&S of end organ dysfunction begin to appear in respiratory failure?

Answer 3

hypoxia
hypercapnia
altered mental status

Question 4

what are 4 findings suggestive of impending arrest?

Answer 4

decreased pulse oximetry
decreased CO2 capnography
decreased O2 followed by increased CO2
decreased pH

Question 5

what are 5 pros of bilevel positive airway pressure (BiPAP)? (5)

Answer 5

reduce work of breathing
improve pulm compliance
recruit alveoli
limited sedation required
decreased rates of intubation

Question 6

what are 4 cons of bilevel positive airway pressure? (BiPAP)? (4)

Answer 6

exacerbate air trapping (COPD)
barotrauma = pneumothorax
anxiety
increased pressure = low venous return = high afterload = decreased cardiac output = hypotension

Question 7

in which condition is BiPAP dangerous in?

Answer 7

COPD

Question 8

use of an induction agent (sedative) and neuromuscular blocking agent (paralytic) to allow for a controlled emergency intubation

Answer 8

Rapid Sequence Intubation (RSI)

Question 9

what mallampati score indicates the easiest airway? the most difficult airway?

Answer 9

class 1
class 4

Question 10

what is the LEMON score to assess airway difficulty?

Answer 10

Look externally
Evaluate 3-3-2 rule
Mallampati score
Obstruction
Neck mobility

Question 11

what is the 3-3-2 rule?

Answer 11

3 FB incisor distance
3 FB hyoid-mental distance
2 FB thyroid to mouth distance

Question 12

what is the safety net for a respiratory patient? (4)

Answer 12

vital signs w/ pulse oximetry
O2 supplementation
IV access
EKG

Question 13

what is the rule of thumb for IV fluids in a respiratory patient?

Answer 13

avoid IV fluids until volume status assessed

Question 14

what 2 diagnostics should be ordered for the respiratory patient?

Answer 14

EKG
2-view chest xray

Question 15

what 5 labs should be ordered for the respiratory patient?

Answer 15

ABG/VBG
CBC
CMP
coagulation studies
troponin

Question 16

work of breathing increased due to higher airway resistance and lung hyperinflation (air trapping)

Answer 16

COPD exacerbation

Question 17

how do O2 and CO2 levels change in a COPD exacerbation?

Answer 17

decreased O2
increased CO2

Question 18

what is the treatment for a COPD exacerbation? (3)

Answer 18

supplemental O2
albuterol + ipratropium
corticosteroid (PO/IV)

Question 19

what can be added to the treatment for COPD exacerbation if the patient has increased sputum volume, change in sputum color, fever, is sus for infection, or has a consolidation on CXR?

Answer 19

antibiotics

Question 20

a patient presents with dyspnea, wheezing, chest tightness, and cough. Dx?

Answer 20

asthma exacerbation

Question 21

acute severe asthma attack that does not improve with usual doses of inhaled bronchodilators and steroids?

Answer 21

status asthmaticus

Question 22

what is the treatment for an asthma exacerbation? what can be added if + fever or sus for infection?

Answer 22

supplemental O2
albuterol + ipratropium
corticosteroids (PO/IV)

antibiotics

Question 23

what can be used as a rescue for an asthma exacerbation? (2)

Answer 23

low dose ICS + formoterol

Question 24

severe, rapid onset dyspnea, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure

Answer 24

ARDS

Question 25

ARDS that occurs when the lung cells are injured and edema accumulates in the interstitial and alveolar spaces; majority of patients are placed in ventilators.

Answer 25

exudative ARDS

Question 26

ARDS in which most patients recover and are removed from mechanical ventilation; while many still experience dyspnea, tachypnea, and hypoxemia.

Answer 26

proliferative ARDS

Question 27

ARDS in which some patients may require long-term support on mechanical ventilators or supplemental oxygen due to alveolar-duct and interstitial fibrosis.

Answer 27

fibrotic ARDS

Question 28

what is the management/treatment for ARDS? (4)

Answer 28

treat cause
prep for mechanical ventilation
fluid restriction
diuretics

Question 29

what are 3 causes of a heart failure exacerbation?

Answer 29

decreased ejection fraction d/t MI or dysrhythmias
decreased diuretic
increased intake of fluids/Na

Question 30

a patient presents with SOB, dyspnea on exertion, paroxysmal nocturnal dyspnea, cough, and edema. Dx?

Answer 30

fluid overload

Question 31

what is the treatment for a heart failure exacerbation? (3)

Answer 31

diuretics + strict I&Os
+/- BiPAP
+/- pacing/abortive therapy

Question 32

what is the treatment for a foreign body aspiration?

Answer 32

supplemental O2 (BiPAP vs RSI)

Question 33

what are 2 worst case scenario treatment options for a foreign body aspiration?

Answer 33

intubate
positive pressure to push FB into right mainstem

Question 34

a patient presents with cough, fever, myalgias, headache, and sore throat. Dx? Treatment?

Answer 34

SARS-CoV 2
check UpToDate

Question 35

what is the preferred initial test to diagnose SARS-CoV?

Answer 35

NAAT

Question 36

what should we do if the NAAT for COVID is negative but it is still highly suspicious?

Answer 36

repeat NAAT in 24-48 hours