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Emergency Medicine > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

How is hypercapnia defined?

A

PaCO2 > 45 mmHg

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2
Q

What 2 conditions is BPAP the most effective for? (2 answers)

A
  • CHF

- COPD

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3
Q

A patient presents with sudden onset shortness of breath. On PE you notice absent breath sounds and percussions are hyper-resonant. What is the diagnosis?

A

Pneumothorax

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4
Q

What is the difference between primary vs. secondary spontaneous pneumothorax?

A
  • primary: young healthy adult

- secondary: old patient with comorbidities

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5
Q

What is the biggest risk factor for pneumothorax?

A

smoking!

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6
Q

Who should you consult for pneumothorax?

A

thoracic surgery

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7
Q

A patient presents in respiratory distress with distended neck veins. On PE you notice absent breath sounds. The CXR demonstrates a mediastinal shift. What is the most likely diagnoses?

A

tension pneumothorax

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8
Q

What are the 3 CXR signs of tension pneumothorax?

A
  • ipsilateral increased intercostal spaces
  • contralateral shift of the mediastinum
  • depression of the hemidiaphragm
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9
Q

What classifies a small pneumothorax? What is the management for this patient?

A
  • small pneumo = < 3 cm

- give supplemental O2 and repeat CXR in 4-6 hours

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10
Q

What are the 3 indications for a tube thoracostomy for the management of pneumothorax?

A
  • clinically stable and large (>3cm)
  • clinically unstable
  • secondary spontaneous
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11
Q

What is the treatment for a recurrent pneumothorax?

A
  • pleurodesis
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12
Q

At what location is a tube thoracostomy done?

A
  • 4/5th intercostal space mid to anterior axillary line
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13
Q

What is the immediate treatment for a tension pneumothorax?

A
  • needle decompression with 14g needle
  • either location:
  • 2/3 intercostal space, midclavicular line, above rib
  • 5 intercostal space, midaxillary line, above rib
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14
Q

What are 2 can’t miss diagnoses when a patient has hemoptysis?

A
  • PE

- cancer

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15
Q

What is Virchow’s triad and what does correlate with?

A
  • Hypercoaguability, stasis, endothelial injury

- risk factors for PE

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16
Q

A patient presents with shortness of breath and syncope. Lung sounds are normal. What is the can’t miss diagnosis here?

A
  • pulmonary embolism
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17
Q

What is the most common EKG finding in acute pulmonary embolism?

A
  • sinus tachycardia
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18
Q

What does S1Q3T3 mean?

A

Deep S wave in Lead I
Deep Q wave in Lead 3
Inverted T wave in Lead 3

associated with PE

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19
Q

What is the ED work up PE?

A
  • PERC
  • D-dimer
  • (If positive) Chest CTA
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20
Q

Why would you get troponin and NT-proBNP in a patient with PE?

A

to check if there is any right heart strain

predictor of worse outcome

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21
Q

In a patient with a small PE, who is doing well in no pain and is hemodynamically stable what is the recommended treatment?

A
  • treat as outpatient with direct oral anticoagulants (DOACs)
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22
Q

In what situation would a patient with a PE only be treated with lovenox?

A
  • if they are pregnant

* need to be on it until the end of pregnancy*

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23
Q

In what situation would a patient with a PE only be treated with heparin?

A
  • if patient has renal dysfunction and can’t take lovenox
  • OR if the chances of the patient going to surgery is high

*heparin is fast acting and short duration so appropriate if patient is getting a procedure

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24
Q

In what situation would you treat a patient with PE with thrombolysis (tPA)?

A
  • if patient is hemodynamically unstable d/t massive PE (Saddle)
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25
Q

If a patient has a PE and a very high bleeding risk what is the recommended treatment?

A

surgical embolectomy

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26
Q

What is the second line treatment for PE if a patient has a contraindication for DOACs?

A
  • Coumadin with Lovenox bridge
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27
Q

45-year-old female with a history of asthma presents to the emergency department complaining of shortness of breath, chest tightness, cough and wheezing. Her symptoms started yesterday after being exposed to her neighbor’s cat, which she allergic to. No fevers, chills, palpitations, hemoptysis, leg swelling. What is the likely diagnoses?

A

asthma exacerbation

28
Q

How can you distinguish between mild vs. mod-severe asthma exacerbation?

A
  • mild = hear wheezing
  • mod/sev = absence of wheezing

keep in mind not all wheezes is asthma

29
Q

A peak flow of < _____ L/min or < _____ % of baseline represents a severe asthma attack

A
  • < 200 L/min

- <50% of baseline

30
Q

What is the first line treatment protocol for asthma exacerbation? (3 parts)

A
  • “Stack” Duo-Neb (2.5 mg albuterol/0.5mg ipratropium every 20min x 3)
  • supplemental oxygen (if needed)
  • glucocorticoids PO (40mg x 5 days)
31
Q

What radiographic features are common in COPD exacerbation?

A
  • flattening of the hemidiaphragms and hyperinflated lungs d/t air trapping
32
Q

Why would you get a D-dimer in patients with COPD exacerbation?

A

Having COPD is a risk factor for developing PE

33
Q

What is the most basic way to determine if the patient has a mild, mod, or severe COPD exacerbation?

A
  • count how many cardinal symptoms they have (1 = mild, 2 = mod, 3 = severe)
34
Q

What is the goal O2sat in COPD exacerbation?

A

88-92%

high flow untritrated O2 does not improve outcomes

35
Q

What is the medical treatment protocol for COPD exacerbation?

A
  • supplemental O2 if needed (goal 88-92%)
  • Duo-nebs (2.5mg/3mL albuterol and 0.5mg ipratropium every 20mx3)
  • PO glucocorticoid therapy (40mg/60mg)

IV magnesium is not beneficial in COPD exacerbation

36
Q

What antibiotic would you consider giving in a mod/severe case of COPD exacerbations?

A

Z-packs

37
Q

What are the 3 cardinal symptoms of a COPD exacerbation?

A
  • increased cough
  • increased sputum production or purulence
  • increased shortness of breath
38
Q

What is the cause of 70% of COPD exacerbations?

A

respiratory infections

39
Q

A patient presents with rapid onset headache, fever, sore throat, and a non-productive cough. CXR are negative. What is most likely the diagnosis?

A

influenza

in COVID19 CXR wouldn’t be negative (in most cases)

40
Q

How does administration of tamiflu change based on if a patient is a young healthy patient vs. an old patient with comorbidities?

A
  • young healthy patient = treat within 24-48 hour time window or don’t use
  • old patient with comorbidities = treat irrespective of time
41
Q

What is the main side effect with tamiflu?

A

GI (nausea, vomiting, diarrhea)

42
Q

In patients with influenza with associated severe cough what medication can be prescribed for cessation of the cough?

A

Robitussin AC

AC = added codeine

43
Q

What is the dosing for tamiflu?

A

75mg BID for 5 days

44
Q

What is the mainstay of treatment for COVID19?

A

supportive

45
Q

What is the indication for steroids for treatment for COVID19?

A

if patient is hypoxic and being admitted

46
Q

What is the benefit of Remdesivir for treatment for COVID19?

A

decreased duration of hospital stay

47
Q

What is the most common pathogen causing pneumonia?

A

strep pneumo

*three most common: strep pneumo, H-flu, M-cat

48
Q

What 2 pathogens can you find with an urine antigen in a patient who presents with pneumonia?

A
  • legionella

- strep pneumo

49
Q

Which of the following is no longer recommended as part of a work-up for pneumonia?

a. CBC, chemistry
b. lactate
c. urine antigen
d. Chest XR
e. cultures

A

e. cultures

50
Q

What is the treatment for inpatient CAP?

A

IV Ceftriaxone and azithromycin

51
Q

What is the treatment for outpatient CAP if a patient is healthy vs. with comorbidities?

A
  • healthy: doxycycline, amoxicillin, or both
  • comorbidities: augmentin and doxycycline

5-7 day course

52
Q

What is the clinical sign for septic shock?

A
  • high lactate with hypotension
53
Q

What is the treatment for septic shock secondary to pneumonia?

A
  • vanco + cefepime
  • OR vanco + zosyn
  • vancomycin is weight based and is re-dosed renally*
  • cefepime is 2g*
54
Q

What is the classic sign of legionella?

A
  • GI symptoms and hyponatremia along with respiratory symptoms
  • same treatment as CAP*
55
Q

What pathogen do you have to worry about with post influenza pneumonia?

A

staph

MRSA in patient’s with comorbidities such as dialysis

56
Q

What are the 2 side effects of doxycycline?

A
  • pill induced esophagitis

- photosensitivity

57
Q

A 70-year-old male with a history of congestive heart failure, IDDM, HTN, HL presenting with shortness of breath x 1 week. He has a non-productive cough. He has also noticed swelling in both legs over the last week, weight gain, and using extra pillows to sleep at night. What diagnosis is this?

A
  • acute decompensated heart failure (aka CHF exacerbation)
58
Q

What extra heart sound do you hear in acute decompensated HF?

A

S3 gallop

59
Q

What are the 4 common triggers of acute decompensated HF?

A
  • Dietary indiscretion
  • Med noncompliance
  • Respiratory infection
  • Arrythmia / MI
60
Q

What is the best lab test for acute decompensated HF?

A

NT- ProBNP

61
Q

What are the 4 radiographic findings consistent with acute decompensated HF?

A
  • pulmonary edema
  • kerley lines
  • cardiomegaly
  • pleural effusions
62
Q

What are the side effects of diuresis? (3)

A
  • hypovolemia
  • hypokalemia
  • hyponatremia
63
Q

What is the treatment for acute decompensated HF if the patient is lasix naive?

A

start with a low dose of PO lasix 20mg IV

64
Q

What is the treatment for acute decompensated HF if the patient is already on lasix?

A
  • give their home dose but IV

* IV twice as potent

65
Q

What is the treatment for severe/flash acute decompensated HF? (3 things)

A
  • BiPAP
  • lasix 80mg IV
  • nitroglycerin
66
Q

For any patient who presents with acute decompensated HF what should you check first before considering fluids?

A

get echo to measure EF

Emergency Medicine (4 decks)

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