respiratory emergencies Flashcards by Rawan El gamal

what are the signs of life threatening respiratory distress ?

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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what is kussmaul breathing ?

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

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what is carpopedal spasm evidence of ?

hyperventilation induced by hypocapnia
induces spasm in the hand and feet

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

oxygen therapy
regular bronchodilators
systemic corticosteroids ( prednisolone)

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what usually predisposes the happening of a pulmonary embolism ?

virchows triad:
stasis
vessel wall injury
hypercoagulability
all causing thrombosis

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what are the clinical feature of pulmonary embolism ?

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

small PE may be asymptomatic

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

pulmonary oligemia

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what is the management of blood clot embolus ?

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

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what is characteristically found in pneumothorax ?

mediastinal shift

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what position is pneumothorax best seen in ?

erect view

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what is the management of pneumothorax ?

increase FiO2 hypoxaemic
aspirate air on affected side
chest drain insertion

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what are the features of acute chest infection ?

fever 
cough 
purulent sputum production 
pleuritic pain 
bronchial breathing

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what kind of antimicrobials are required for cavitations ?

anaerobic bacteria ( metronidazole)

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What is the definition of acute respiratory distress syndrome?

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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what is the management of ARDS ?

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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when is stridor observed ?

if there is upper airway obstruction

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what is cherry-red skin a sign of ?

carbon monoxide poisoning

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how do we spot microatalectasis ?

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

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what is cheyne-stoke breathing ?

oscillating between hyperventilation and apnea

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how is disability assessed ?

glucose
ACVPU
pupils

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what are the non thrombotic causes of pulmonary embolism ?

fat globules or fetal cells in pulmonary artery blood

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what are the ABG findings in PE ?

decreased PaO2 ( v/q mismatch )
decreased PaCo2

later :
High PaCO2
Metabolic acidosis

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what are the ECG changes in PE ?

p pulmonale and sinus tachycardia

what are the chest x ray findings in pulmonary embolism ?

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

what is the simplified pulmonary embolism severity index ?

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%

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

good negative test

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

perform CTPA

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

bedside TTE

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

Iff there is RV dysfunction then perform CTPA

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

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 )

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

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

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

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

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

administatiion of anticcoagulant

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

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

what are the different options for reperfusion therapy ?

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

what are the absolute contraindications for the use of fibrinolysis ?

history of stroke CNS neoplasm major trauma bleeding tendency active bleeding

how should the initial anticoagulant be used ?

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

when are vena cava filters indicated ?

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

what is ARDS ?

non-cardiogenic pulmonary oedema and diffuse lung inflammation

what does the berlin criteria state iin regards to ARDS ?

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

in what stage of ARDS do patients tend to recover ?

in the proliferative phase

what is the most common cause of ARDS ?

sepsis pancreatitis

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

organism is usually H. Influenzae treat with Ceftriaxone/chloramphenicol

what to do if intubation is difficult ?

video laryngoscopy fiberoptic intubation

what to do if intubation is unsuccessful ?

retrograde intubation cricothyrotomy tracheostomy

what are the complications of inhalation injury ?

respiratory failure ARDS

wheen should early bronchoscopy be performed in inhalation injury ?

* Soot * Debris * Vomit

what is the management for smoke inhalation ?

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

what is the management for steam inhalation ?

* Consider early/prophylactic intubation *Consider early bronchoscopy and lavage with cool 0.9%saline

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

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

what type of atelectasis happens in ARDS ?

adhesive

what is Luftsichel sign ?

air crescent in Left upper lobe collapse

what are the signs of right sided heart strain ?

raised JVP parasternal heave loud p2

What are the causes of massive postoperative lung collapse?

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

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

massive post operative lung collapse