Respiratory Distress Flashcards
Quiz 1
What is respiratory distress
combo of pts subjective sensation of dyspnea w/ physical signs indicating difficulty breathing
What is respiratory failure
lungs and respiratory muscles cannot move enough air to adequately oxygenate and eliminate CO2
What s/s are seen in respiratory failure
end organ dysfunction
What are end organ dysfunction s/s
hypoxia and hypercapnia leading to altered mental status
What are 3 factors leading to impending arrest?
pulse oximetry decreased
CO2 Capnography decreased
Arterial or venous blood gas affected
What are the two changes seen in arterial or venous blood gas?
decreased O2 followed by increased CO2
decrease pH
What 4 choices are given in impending arrest?
Do nothing wait for arrest
BiPAP
Rapid Sequence intubation
Surgical airway
What are the 5 Pros to BiPAP?
- reduces work of breathing
- Improves pulmonary compliance
- Recruits alveoli
- Limited sedation needed
- Decreased rates of intubation
What are the 4 Cons to BiPAP?
- Exacerbate air trapping
- Barotrauma can lead to pneumothorax
- Anxiety
- Increase intrathoracic pressure
What two things are used in RSI for controlled intubation?
induction agent (sedative) neuromuscular blocking agent (paralytic)
What drives the decision for RSI or not RSI?
TIME AND AIRWAY DIFFICULTY
If the pt is apneic and unresponsive this is considered?
a crash airway
When should you prep and review other options for RSI?
prior to RSI
What two things are used to access airway difficulty?
Mallampati Score
Lemon Score
What is the scale for Mallampati Score
1= easiest 4= most difficult
What does LEMON stand for?
L- look externally E- evaluate w/ 3 rule M- Mallampati Score O- Obstruction N- neck mobility
What is not a necessary priority?
identifying underlying etiology
What should be done after securing the airway and stabilizing the patient?
identifying the underlying etiology
If there are signs of a impending respiratory arrest what two things are considered?
RSI or BiPAP
What things should be in your safety net for a respiratory patient?
Vital signs w/ pulse oxy O2 supplementation(prior and during) Patent IV access EKG Defib pads Capnography Venous or arterial blood gas
What should be done on a physical exam?
cardiac pulmonary neuro ent and pertinent systems
What 2 test should be done?
EKG and CXR 2 view
What labs should be done?
ABG or VBG
CBC, Coagulaton Studies (INR, PT, PTT), CMP, Cardio enzymes (Troponin, CK, CK-MB)
What s/s is seen in a COPD exacerbation?
decreased O2
Increased CO2 retention
What is the txt for COPD exacerbation?
O2
Neb B-2 agonist/anticholinergic (Albuterol and ipratropium)
PO or IV Corticosteriods
+/- ABx
What is the disposition of COPD?
improvement in ED
Ability to perform ADL @ home
Walk of life
What are s/s of asthma exacerbation?
dyspnea, wheezing, chest tightness, and cough w/ hx of asthma
Acute sever asthma attack that does not improve w/ usual doses of inhaled bronchodilators and steroids?
status asthmaticus
Txt for asthma exacerbation?
O2
B2 agonist/ anticholi (Albuterol and ipratropium)
PO or IV corticosteroids
+/- Abx
Disposition of asthma exacerbation?
improvement in ED
ADL
Walk of life
S/S of adult respiratory distress syndrome?
severe, rapid onset of dyspnea, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure
What are 5 causes of ARDS?
severe sepsis syndrome/bacterial pneumonia trauma multiple transfusions aspiration of gastric contents drug overdose
Txt for ARDS?
Txt etiology
Prepare ventilation once patient fatigues
Fluid restriction and diuretics
s/s of CHF?
recent hx of chest pain, fluid overload (SOB, dyspnea on exertion, paroxysmal nocturnal dyspnea, cough, edema)
Txt for CHF?
O2- +/- BiPAP
Diuretics w/ strict IO
Pacing or abortive thxp for dysrhytmias
What is the disposition for CHF exacerbation?
improvement in ED
ADL
Walk of life
Worsening cardiac function
