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ICC1 > respiratory emergencies > Flashcards

respiratory emergencies Flashcards

1
Q

what are the signs of life threatening respiratory distress ?

A

alterations in mental status
absent breath sounds
pallor and diaphooresis
retracctrion and use of accessory muscles
audible stridor
severe cyanosis
1-2 word dyspnea

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2
Q

what is kussmaul breathing ?

A

type of hyperventilation in response to acidosis
inspiratory filling of the neck veins

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3
Q

what is carpopedal spasm evidence of ?

A

hyperventilation induced by hypocapnia
induces spasm in the hand and feet

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4
Q

what is the management of acute exacerbation of chronic airway limitation ?

A

oxygen therapy
regular bronchodilators
systemic corticosteroids ( prednisolone)

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5
Q

what usually predisposes the happening of a pulmonary embolism ?

A

virchows triad:
stasis
vessel wall injury
hypercoagulability
all causing thrombosis

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6
Q

what are the clinical feature of pulmonary embolism ?

A

classic triad of :
sudden onset of shortness of breath
pleuritic chest pain
haemoptysis

small PE may be asymptomatic

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7
Q

what may be present in a chest x ray suggestive of pulmonary embolism ?

A

pulmonary oligemia

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8
Q

what is the management of blood clot embolus ?

A

start anticoagulant with low molecular weight heparin adjusted for weight
consider thrombolysis

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9
Q

what is characteristically found in pneumothorax ?

A

mediastinal shift

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10
Q

what position is pneumothorax best seen in ?

A

erect view

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11
Q

what is the management of pneumothorax ?

A

increase FiO2 hypoxaemic
aspirate air on affected side
chest drain insertion

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12
Q

what are the features of acute chest infection ?

A 
fever 
cough 
purulent sputum production 
pleuritic pain 
bronchial breathing
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13
Q

what kind of antimicrobials are required for cavitations ?

A

anaerobic bacteria ( metronidazole)

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14
Q

What is the definition of acute respiratory distress syndrome?

A

non-cardiogenic RF
onset within 1 week of worsening respiratory symptoms
PaO2/FiO2 < 200 mmHg, regardless of level of PEEP
bilateral infiltrates on chest X-ray
pulmonary artery wedge pressure < 18 mmhg

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15
Q

what is the management of ARDS ?

A

remove the causative agent
maintain mean arterial pressure above 60 mmhg
sedate with an opiate-benzodiazepine
muscle relaxation
high dose corticosteroids

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16
Q

when is stridor observed ?

A

if there is upper airway obstruction

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17
Q

what is cherry-red skin a sign of ?

A

carbon monoxide poisoning

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18
Q

how do we spot microatalectasis ?

A

chest x ray may be normal but A-aDO2 will be high

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19
Q

what is cheyne-stoke breathing ?

A

oscillating between hyperventilation and apnea

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20
Q

how is disability assessed ?

A

glucose
ACVPU
pupils

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21
Q

what are the non thrombotic causes of pulmonary embolism ?

A

fat globules or fetal cells in pulmonary artery blood

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22
Q

what are the ABG findings in PE ?

A

decreased PaO2 ( v/q mismatch )
decreased PaCo2

later :
High PaCO2
Metabolic acidosis

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23
Q

what are the ECG changes in PE ?

A

p pulmonale and sinus tachycardia

24
Q

what are the chest x ray findings in pulmonary embolism ?

A

1- hampton’s hump - wedge shaped opacity
2- westermark sign - oligemia of lung field
3- fleishner sign - enlarged pulmonary artery
4- Palla’s sign - enlarged right descending pulmonary artery

25
Q

what is the simplified pulmonary embolism severity index ?

A

age >80
history of cancer
history of cardiopulmonary disease
pulse above 110
systolic BP less than 100
SaO2 < 90

0 points then the 30 day mortality risk is 1%
if 1 or more then the 30 day mortality risk is 10.9%

26
Q

what is the value of the d dimer test in PE ?

A

good negative test

27
Q

iff there is a high clinical probability of PE what is the next best step in management in a hemodynamically stable patient ?

A

perform CTPA

28
Q

what is the first line investigation to perform in a hemodynamically unstable patient who is suspected to have a pulmonary embolism ?

A

bedside TTE

29
Q

what is the next step after performing bedside TTE in a hemodynamically unstable patient ?

A

Iff there is RV dysfunction then perform CTPA

30
Q

what is the next step in management afte anticoagulant addministration in a haemodynamically stable patient ?

A

asses the severity of the patient using the following two point :
1- clinical severity and presence of comorbidities
2- RV dysfunction which is assessed by TTE
if any of these factors are present perform a troponin test
if troponin is positive then the patient is intermediate high risk ( consider reperfusion and monitor )
if it is negative then the patient is intermediate low risk ( hospitalize )

31
Q

what is the management if a patient present with acute PE and is haemodynamically unstable ?

A

automatically high risk patient and must perform reperfusion and give cardio and pulmonary support

32
Q

what measure should be taken when providing support for a hemodynamically unstable patient suffering from acute PE ?

A

after administration of anticoagulant
1- give oxygen therapy and ventilation
2- vasopressin and appropriate fluids for RV dysfunction
3- once anticoagulant is given start CPR for no less than 60-90 minutes

33
Q

if the patient is confirmedd to have acute PE what is thee first step in managemnt ?

A

administatiion of anticcoagulant

33
Q

what should the Fio2 and SpO2 levels in acute PE management be maintained at ?

A

On FIO2 0.6–1.0 to maintain SaO2 93–98%.

34
Q

what are the different options for reperfusion therapy ?

A

systemic thrombolysis (fibrinolysis )
Percutaneous catheter-directed treatment
Surgical embolectomy

35
Q

what are the absolute contraindications for the use of fibrinolysis ?

A

history of stroke
CNS neoplasm
major trauma
bleeding tendency
active bleeding

36
Q

how should the initial anticoagulant be used ?

A

parenteral anticoagulant along with VKA for 5 days or more until the INR is 2-3 for 3 days
VKA such as warfarin

37
Q

when are vena cava filters indicated ?

A

recurrent PE despite adequate anticoagulation
primary prophylaxis for high risk patients
in VTE and patients where AC are contraindicated

38
Q

what is ARDS ?

A

non-cardiogenic pulmonary oedema and diffuse lung inflammation

39
Q

what does the berlin criteria state iin regards to ARDS ?

A

1- onset within 1 week of insult or new worsening respiratory symptoms
2- bilateral opacities ( that arent lung collapse, nodules or effusion )
3- respiratory failure not due to cardiac reasons fluid overload ( resp wedge pressure must be less than 18 )
4- PaO2/FIO2 ≤300 mmHg, PEEP ≥5 cm H2O

40
Q

in what stage of ARDS do patients tend to recover ?

A

in the proliferative phase

41
Q

what is the most common cause of ARDS ?

A

sepsis
pancreatitis

42
Q

what is the organism for acute epiglottitis and what is the treatment ?

A

organism is usually H. Influenzae treat with Ceftriaxone/chloramphenicol

43
Q

what to do if intubation is difficult ?

A

video laryngoscopy
fiberoptic intubation

44
Q

what to do if intubation is unsuccessful ?

A

retrograde intubation
cricothyrotomy
tracheostomy

45
Q

what are the complications of inhalation injury ?

A

respiratory failure
ARDS

46
Q

wheen should early bronchoscopy be performed in inhalation injury ?

A
  • Soot
  • Debris
  • Vomit
47
Q

what is the management for smoke inhalation ?

A
  • Urgent laryngoscopy
  • Endotracheal intubation
  • Bronchoscopy with bronchial toilet using warmed
    0.9%saline
  • Benzylpenicillin
    *Specific treatment for poisons within
    smoke(CO/cyanide)
48
Q

what is the management for steam inhalation ?

A
  • Consider early/prophylactic intubation
    *Consider early bronchoscopy and lavage with cool 0.9%saline
49
Q

what is the management in cases of aspiration of gastric contents ?

A

1- early bronchoscopy and physiotherapy
2- cefuroxime plus metronidazole or clindamycin for 5 days

50
Q

what type of atelectasis happens in ARDS ?

A

adhesive

51
Q

what is Luftsichel sign ?

A

air crescent in Left upper lobe collapse

52
Q

what are the signs of right sided heart strain ?

A

raised JVP
parasternal heave
loud p2

53
Q

What are the causes of massive postoperative lung collapse?

A

1- aspiration of vomitus due to full stomach
2- post op inadequate chest expansion

54
Q

acute chest pain, severe dyspnea and cyanosis, acute RVF—all of this post-op, what is the most likely diagnosis?

A

massive post operative lung collapse

ICC1 (50 decks)

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