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CEN > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

With reference to breath sounds what does wheezing sound like?

A

Musical, whistling noise, high-pitched

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2
Q

With reference to breath sounds what do crackles or rails sound like?

A

Popping noises that are non-musical

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3
Q

With reference to breath sounds what do rhonchi sound like?

A

Snoring sound, low pitch

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4
Q

With reference to breath sounds what does pleural friction rub sound like?

A

Grating sound with respirations

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5
Q

What is the V-Q relationship?

A

The open Alveolus and the open capillary are necessary in order for diffusion of gases to occur. When there is a problem with either of these structures, blood is not oxygenated

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6
Q

Normal arterial blood gases:

A

PH = 7.35 to 7.45
PA02 = 80 to 100
PACO2 = 35 to 45 HCO3 equals 22 to 26
BE = +/- 2

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7
Q

What happens to your pH during acidosis?

A

Your pH decreases

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8
Q

What happens to PCO2 and HCO3 during respiratory acidosis?

A

PCO2 is increased
HCO3 is normal

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9
Q

What happens to PCO2 and HCO3 during metabolic acidosis?

A

PCO2 is normal
HCO3 is decreased

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10
Q

What happens to your pH during alkalosis?

A

PH is increased

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11
Q

What happens to PCO2 and HCO3 during respiratory alkalosis?

A

PCO2 is decreased
HCO3 is normal

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12
Q

What happens to PCO2 and HCO3 during metabolic alkalosis?

A

PCO two is normal
HCO3 is increased

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13
Q

What are some other names for acute respiratory distress syndrome (ARDS)?

A

Hyaline membrane disease
Wet loan
Posttraumatic pulmonary insufficiency
DeNang lung
Shock long
Acute lung injury (ALI)
pulmonary contusion

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14
Q

What is the mortality rate of ARDS?

A

40 to 70%

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15
Q

What are the Etiologies of acute respiratory distress syndrome that are related to direct pulmonary injury?

A

Pneumonia
Embolism
Aspiration
Inhalation
Prolonged exposure to oxygen
High altitude pulmonary edema
Lung contusions

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16
Q

What are the Etiologies of acute respiratory distress syndrome that are related to systemic illnesses?

A

Sepsis
Disseminated intravascular coagulation
Pancreatitis
Uremia
Anaphylaxis
Drug overdose
Eclampsia
Radiation therapy
Shock

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17
Q

What are the etiologies of acute respiratory distress syndrome that are related to trauma?

A

Multisystem trauma
Massive blood transfusions

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18
Q

Possible causes of respiratory alkalosis:

A

Acute asthma
Hepatic failure
Pregnancy
Pneumonia
Lung disease
Pulmonary disease
Anxiety
Aspirin toxicity
Metabolic acidosis
CNS disease
Sepsis

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19
Q

Symptoms of respiratory alkalosis:

A

Deep rapid breathing
Lightheadedness
Dizziness
Agitation
Carpopedal spasm
Twitching
Tetany
Muscle weakness

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20
Q

Treatment for respiratory alkalosis:

A

Correct underline cause
Oxygen for acute episode of hypoxemia
Paper bag
Adjust tidal volume and minute volume (prevent hyperventilation)

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21
Q

Possible causes of respiratory acidosis:

A

Hyperventilation
CNS trauma
Cardiac arrest
Sleep apnea
Ventilator therapy
Airway obstruction
ARDS
Myasthenia gravis
Guillian Barre
Pneumothorax
Pneumonia
pulmonary edema

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22
Q

Symptoms of respiratory acidosis:

A

Restlessness
Confusion
Somnolence
Tremor
Coma
Headache
Papilledema
Tachycardia
Hypoxemia

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23
Q

Treatment for respiratory acidosis:

A

Treat underlying cause

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24
Q

 Possible causes of metabolic alkalosis:

A

Due to acid loss:
Vomiting
NG tube in place
Lavage
Fistula‘s
Massive blood transfusions
Cushing’s disease
Due to bicarbonate retention:
Intake of bicarbonate of soda
IV fluids with bicarbonate/lactate
Alteration in ECF electrolytes
Decreased potassium

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25
Q

Symptoms of Metabolic Alkalosis:

A

Decreased Cerebral Perfusion
Irritability
Picking at clothing
Twitching
Confusion
Decreased Potassium
Dysrhythmias
Decreased blood flow
Carpopedal spasm
Impending tetany

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26
Q

Treatment of Metabolic Alkalosis:

A

Replace losses with potassium and normal saline.
Stop diuretics.
Acetazolamide to increase excretion of bicarbonate.

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27
Q

Causes of Metabolic Acidosis:

A

Increased Acids:
DKA
Lactic Acidosis
Malnutrition
Starvation
Chronic Alcoholism
Bicarbonate Loss:
Diarrhea
Intestinal suction
Renal failure
Hyperaldosteronism
Aspirin intoxication

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28
Q

Symptoms of Metabolic Acidosis:

A

Headache
Malaise
Lethargy
CNS depression
Kussmaul breathing
Nausea
Vomiting
Warm skin
Flushed

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29
Q

Treatment for Metabolic Acidosis:

A

Na bicarbonate
Monitor electrolytes
IV administration
Mechanical ventilation
Antibiotics
Antidiarrheals

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30
Q

Characteristic Findings of ARDS:

A

Hypoxia
Dyspnea
Diffuse Bilateral Infiltrates

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31
Q

Pathophysiology of ARDS:

A

Increased permeability of alveolar/capillary membrane occurs from the release of chemical mediators, alveolar macrophages, and vasoactive substances.
Decreasing surfactant causes decreased lung compliance.
Atelectasis occurs causing severe respiratory distress and failure.

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32
Q

Manifestations of ARDS:

A

Tachypnea
Tachycardia
Hypoxia
Hypotension
Respiratory Distress
Restlessness
Cyanosis
Crackles
Bilateral infiltrates - “fluffy/ground glass appearance”

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33
Q

Treatment of ARDS:

A

-Supportive care is provided with intubation and mechanical ventilation with the addition of PEEP to maintain gas exchange (high frequency jet ventilation may be used).
-Correct things that might cause a shift to the left.
-Fluid balance must be monitored closely with a foley in place.
-Treat temperature.
-Treat infections and use high level of infection control techniques.
-Maintain hemoglobin level of at least 12-15gm/dL and correct factors that might cause a shift to the left.

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34
Q

Describe Asthma:

A

-Reversible obstructive pulmonary disease with intermittent episodes of bronchospasm. Rapid assessment is mandatory.
-Lymphocytes produce IgE in response to an allergen which attaches to the MAST cells (basophils) in bronchial walls which in turn releases chemical mediators.

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35
Q

If Asthma is not controlled what can it turn into?

A

Status Asthmaticus
-does not respond to conventional therapy.
- may lead to respiratory arrest.

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36
Q

Manifestations of Asthma:

A
  • Wheezing on inspiration/expiration.
  • Wheezing may not be present.
  • Prolonged expiratory phase.
  • Respiratory distress.
  • Tachycardia
  • Restlessness
  • Pallor
  • Exhaustion
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37
Q

Signs of impending respiratory failure in an Asthma patient:

A
  • Decreasing oxygen saturation.
  • Decreasing respiratory effort.
  • Decreasing LOC.
  • Increasing retention of Carbon Dioxide.
  • Cyanosis
  • Use of accessory muscles.
  • Absence of wheezing.
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38
Q

Treatment of Asthma:

A
  • Bronchodilators
  • Corticosteroids
  • Magnesium/Heliox
  • Fluids
  • Possible Intubation
  • Monitor due to potential cardiac dysrhythmias.
  • Peak flow monitoring before and after nebulizer treatments. (Normal 250-300. 100 is bad)
  • Monitor ABGs:
    • Hypoxemia will be present -pO2 <80mm Hg.
    • Most patients will be hypocapneic due to hyperventilation.
    • Hypercapnia will develop as condition worsens.
    • Hypercapnia will create respiratory acidosis.
    • Metabolic acidosis will occur from anaerobic metabolism.
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39
Q

What is Acute Bronchitis?

A

Inflammatory process that is usually viral (can have secondary Bacterial).

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40
Q

Manifestations of Acute Bronchitis:

A
  • Dyspnea
  • Wheezing
  • Cough
  • fever
  • Chest/back pain
  • malaise
  • prolonged expiratory phase
  • Rhonchi
  • Neck vein distinction with chronic bronchitis.
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41
Q

Treatment for Acute Bronchitis:

A
  • Aerosol treatments
  • Postural drainage
  • Oral fluids
  • Bronchodilators
  • Corticosteroids
    -Antibiotics if secondary infection
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42
Q

What is Bronchiolitis?

A
  • Lower respiratory tract infection with inflammation of airways in children under the age of 2 years.
  • 90% is caused by RSV.
  • Profuse secretions produce cellular debris and fibrin from a necrotic response which obstructs the bronchioles and bronchi leading to air trapping, high resistance, and atelectasis.
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43
Q

Manifestations of bronchiolitis:

A
  • URI symptoms
  • poor feeding
  • irritability
  • tachycardia
  • decreased O2
  • cyanosis
  • cough
  • vomiting
  • decreased sleep
  • wheezing
  • changes in LOC
  • tachypnea
  • depressed fontanelle
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44
Q

Treatment of Bronchiolitis:

A
  • Observe closely for signs of respiratory failure/need for hospitalization
    • Sats <90%
    • Heart rate >200
    • RR >70 consistently.
    • grunting, head bobbing, retractions, nasal flaring, accessory muscle use.
  • Oxygen
  • Hydration
  • May need intubation.
  • Ribavirin - antiviral for RSV (may have bad side effects).
  • Synagis - monoclonal antibodies (used for special pop. Shot q 30 days).
45
Q

What is Chronic Obstructive Pulmonary Disease (COPD)?

A

Chronic and recurrent airflow obstruction which affects at lease 15 million Americans.
Is the second most common disability in the U.S.
2 types:
- Chronic Obstructive Bronchitis
- Emphysema

46
Q

Describe Chronic Obstructive Bronchitis:

A
  • Inflammation of bronchi which causes increased mucus production and chronic cough.
  • Decreased ciliary function causes increased susceptibility to infections.
  • Chronic Hypercapnia occurs with hypoxia becoming the respiratory stimulus.
47
Q

What hereditary component causes Hereditary COPD?

A

Alpha 1 antitrypsan deficiency causes hereditary COPD (ex: 20 year old with COPD).

48
Q

Describe Emphysema:

A
  • Impeded expiration from:
    • Permanent overdistention of alveoli
    • alveolar wall destruction
    • airway collapse
    • decrease in elastic recoil
  • Increased ventilatory dead space from the formation of air pockets.
  • Decreased functional lung tissue also occurs from the air pockets.
49
Q

Manifestations of Chronic Obstructive Bronchitis:

A
  • Blue Bloater*
  • Productive cough
  • stocky build
  • increased music production
  • Normal respiratory rate
  • Hypoxemia (that becomes stimulus to breath)
  • Increased PaCO2
  • Rhonchi
  • Frequent infections
  • Accessory muscle use
  • peripheral edema
  • Risk for PE/Polycythemia
    -X-ray shows enlarged heart.
50
Q

Manifestations of Emphysema:

A

Pink Puffer
- cough uncommon - not productive
- Thin/barrel chest
- Oxygenated blood - low cardia output
- tachypnea
- PaO2 normal or slightly decreased
- PaCO2 usually low until end stage
- wheezing
- distant heart sounds
- accessory muscle use
- leans forward while sitting
- pursed-lip breathing
- Lung overinflation and diaphragm low

51
Q

Treatment for COPD:

A
  • Suction
  • Oxygen - do not withhold
  • Bronchodilators
  • Steroids
  • Antibiotics
  • Hydration
  • Education
  • Lung volume reduction surgery
52
Q

What is Croup?

A

Laryngotracheobronchitis - subglottic.

53
Q

What are the usual causes of Croup?

A
  • Parainfluenza virus type 1
  • Parainfluenza virus type 3
  • Adenovirus
  • RSV
  • Influenza A
54
Q

What are the characteristics of Croup?

A
  • Barking cough
  • Hoarse voice
  • Low grade fever
  • Inspiratory strider
  • Respiratory distress
  • Steeple sign on x-ray (Hallmark)
55
Q

What is the treatment for Croup?

A
  • POC
  • Oxygen and humidified air
  • Racemic Epinephrine (can rebound in 60-90 minutes) (this decreases mucosal edema and laryngeal spasm)
  • Corticosteroids
  • Hydration
  • Reduce the work of breathing.
56
Q

What is Acute Epiglottitis?

A

A life threatening edema of the epiglottis and epiglottic folds (supraglottic).
Is misdiagnosed as croup 20% of the time.

57
Q

What are the usual offending organisms that cause Croup?

A
  • Group A beta hemolytic strep
  • Strep pneumoniae
  • H Flu
58
Q

What are the characteristic findings of Acute Epiglottitis?

A
  • rapid onset
  • fever of 101 or greater
  • Lethargy
  • sore throat
  • *Tripod Position
  • *Drooling
  • *Exhausted facial expression
  • Lateral neck x-ray - thumbprint sign
    *Do not examine Pharynx
59
Q

What is the treatment for Acute Epiglottitis?

A
  • Decrease stress
  • Humidified oxygen
  • May need intubation
60
Q

Describe Hyperventilation:

A
  • Rapid breathing in which carbon dioxide is rapidly blown off.
  • May be anxiety, but must do differential diagnosis because may be pathophysiological reason for the hyperventilation. Always look at ABGs.
61
Q

Manifestations of Hyperventilation:

A
  • Dyspnea
  • Tingling lips/extremities
  • Chest pain
  • jaw pain
  • Air hunger
  • Diaphoresis
  • Panicky
  • Carpopedal spasm (claw hands)
  • headache
  • Confusion
  • if anxiety driven = CO2 will be decreased and PO2 will be normal
62
Q

Treatment for Hyperventilation:

A
  • Rule out causes.
  • Paper bag to rebreathe CO2.
63
Q

What is a Pleural Effusion?

A

Excess fluid in the pleural space.

64
Q

What are the Etiologies of a Pleural Effusion?

A
  • Increased subpleural capillary pressure.
  • Decreased capillary oncotic pressure.
  • Impairment/obstruction of lymphatic flow.
  • Inflammatory conditions.
  • Most Common:
    • CHF
    • Pneumonia
    • Malignancy
    • Pulmonary Embolus
65
Q

Manifestations of Pleural Effusion:

A
  • Dyspnea
  • Chest pain
  • Tachypnea
  • Dullness to percussion
  • Diminished auscultation
  • can cause mediastinal shift
  • Accessory muscle use
66
Q

Treatment for Pleural Effusion:

A
  • Thoracentesis (diagnostic, therapeutic)
  • If empyema - must be drained an treated.
67
Q

Describe Pneumonia:

A
  • Infectious process from inflammation of the pulmonary parenchyma in response to invasion of tissues.
  • Is the 6th leading cause of death in the U.S.
  • Is the leading cause of death in the elderly.
68
Q

What are the Etiologies for Pneumonia?

A
  • Viral
  • Bacterial
  • Mycoplasma
  • Fungi
  • Rickettsiae
  • Parasites
69
Q

What are some Risk Factors for Pneumonia?

A
  • Bedridden
  • Rib fractures
  • Underlying cardio-pulmonary
  • Smoking
  • Diabetes
  • Steroids
  • Immunosuppressives
70
Q

Manifestations of Pneumonia:

A
  • Dyspnea
  • Chest pain
  • Chills
  • Cyanosis
  • Crackles
  • Tachycardia
  • Cough
  • Fever
  • Change in sensorium
  • Tachypnea
  • Pleura Friction Rub
  • Signs of respiratory distress.
71
Q

What is the treatment for Pneumonia?

A
  • Oxygen
  • Suction
  • IV
  • Antibiotics - be sure to do cultures first.
  • Bronchodilators
  • Antipyretics
  • Monitor for dysrhythmias (hypoxia/acidosis)
  • Intubation
72
Q

What is a Pulmonary Embolus?

A
  • Most common pulmonary complication in hospitalized patients.
  • 3rd leading cause of death in the U.S. - 50,000 deaths per year.
  • 70-90% of all elderly patients who die in hospital are found at autopsy to have Pulmonary Embolus.
  • causes complete or partial obstruction of pulmonary capillary vascular use.
    • Massive = > 50% occlusion of larger artery.
      -Submassive = < 50% occlusion.
73
Q

What is Virchow’s Triad (risk factors) for PE?

A

Hypercoagulability:
- malignancies
- Birth control pills
- Dehydration
- Fever
- Sickle Cell crisis
- pregnant
- Sepsis
Vessel Injury:
- Trauma
- IV drug use
- Aging
- DM
- Atherosclerosis
Venous Stasis:
- Immobilization
- Obesity
- Age
- Burns
- Pregnancy
- CHF
- Recent surgery
- Dysrhythmias (A-fib)
- Cardioversion

74
Q

Manifestations of Pulmonary Embolus:

A
  • Tachypnea
  • Tachycardia
  • Crackles
  • Pleuritic chest pain
  • Restlessness
  • Hypotension
  • Cyanosis
  • Pleural friction rub
  • Hemoptysis
  • Confusion
  • Right sided heart failure
  • Petechiae
75
Q

What are some Laboratory studies related to Pulmonary Embolus?

A
  • Chest X-ray (after 24 hours may see small infiltrates.)
  • Increased Sed Rate
  • Increased WBC
  • ABG’s - decreased PO2
  • Increased D-Dimer
  • EKG
  • Doppler studies
  • V-Q scan
  • Pulmonary Angiography (*definitive diagnosis)
  • CT
  • MRI
76
Q

Treatment for Pulmonary Embolus:

A
  • Oxygen
  • foley
  • Anticoagulants
  • Bronchodilators
  • Analgesics
  • Agents for BP and cardiac output
  • Thrombolytic Therapy (TPA, streptokinase, Urokinase)
  • surgical placement of vena caval umbrella/ greenfield filter/ Bird’s nest filter)
  • Pulmonary Embolectomy
77
Q

What are some important things to know about rib fractures?

A
  • Fractures of first and second ribs requires great force so they may have other injuries.
  • 40% mortality from laceration of subclavian vein or artery.
  • Lower rib fractures may have abdominal injuries.
78
Q

What are the manifestations of a rib fracture?

A

Pain
Audible crepitus
Subcutaneous emphysema
Hypo ventilation
Splinting
X-rays – 70% accurate for fracture

79
Q

What is the treatment for a rib fracture?

A

High Fowlers
Analgesics
Nerve blocks
Cough and deep breathing
Spirometry

80
Q

What are some reasons for possible hospitalization with rib fractures?

A

Fractures of three or more ribs.
First and second rib fractures.
Sternal fracture
History of COPD
Displaced fracture
Jagged edges
Flail chest

81
Q

A right lower rib fracture can cause what?

A

Hepatic injury

82
Q

A left lower rib fracture can cause what?

A

Splenic injury

83
Q

What is flail chest?

A
  • Two or more adjacent Ribs fractured into two or more locations.
  • Free floating segment.
  • Paradoxical movement: section drawn inward on inspiration and outward on exhalation.
  • Alveolar tissue is compressed causing physiologic shunting and Venus mixing with a resultant decrease in PO2.
84
Q

Manifestations of flail chest:

A

Paradoxical chest wall movement
Pallor
Confusion
Hypotension
Decreased or absent breast sounds
Hyper/hypoventilation
Cyanosis
Ecchymosis
Diaphoresis
Palpitation of crepitus or fracture

85
Q

What is the treatment for flail chest?

A
  • Oxygen
  • Stabilize the chest wall (recommended on injured side in semi Fowlers position)
  • Limit intake
  • Intubation/ventilation
  • Analgesics
  • Internal fixation
86
Q

What is a pneumothorax?

A
  • Loss of negative intrapleural pressure which collapses the lung and creates a decreased area of adequate V/Q relationship and hypoxemia.
  • Can be fatal
  • Can be trauma related or spontaneous.
87
Q

What are the manifestations of a pneumothorax?

A
  • Sudden chest pain
  • Dyspnea
  • Distended neck veins
  • Signs of shock
  • Referred pain to shoulder
  • Cyanosis
  • Hypotension
  • Hammon’s crunch (air in mediastinum; “crunch” sound every time heart beats)
88
Q

What is the treatment for a pneumothorax?

A

Chest tube
Oxygen
Treat for shock

89
Q

What is a tension pneumothorax?

A
  • Allows air to enter pleural space on inspiration but cannot exit on expiration.
  • Shifts mediastinum with resulting compression.
90
Q

What are the manifestations of a tension pneumothorax?

A
  • Sudden chest pain
  • Dyspnea
  • Distended neck veins
  • Tracheal deviation (to uninjured side)
  • Referred pain
  • Cyanosis
  • Hypertension
  • Signs of shock
91
Q

What is the treatment for a tension pneumothorax?

A
  • Needle thoracostomy (use flutter valve if delay in chest tube will occur)
    • 14 to 16 gauge in the second intercostal space midclavicular line above rib.
  • Chest tube (fifth intercostal mid axillary line on injured side)
  • Oxygen
  • IV fluids
  • Treat for shock
92
Q

What is a hemothorax?

A

An accumulation of blood in the pleural space.

93
Q

What are the 3 types of hemothorax?

A

Minimal - up to 350 mL
Moderate – 350 mL to 1500 mL
Massive - > 1500 mL

94
Q

What are the manifestations of a hemothorax?

A

Dyspnea
Dullness on injured side
Pain
Decreased breast sounds
Shock
Possible mediastinal shift

95
Q

What is the treatment for a hemothorax?

A

Oxygen
Chest tube
Autotransfusion
Thoracotomy
Analgesics
POC

96
Q

What is an open pneumothorax?

A
  • Life-threatening condition.
  • Penetration into chest wall (2/3 the size of the tracheal opening)
  • Produces a sucking sound
  • Immediate occlusive dressing taped on three sides.
  • Watch for development of tension pneumothorax.
  • Remove dressing if tension pneumothorax occurs.
97
Q

What is a pulmonary contusion?

A
  • Bruising of lung.
  • Blood extravasates into the lung parenchyma causing alveolar and interstitial edema which causes tissue anoxia. These changes increase pulmonary vascular resistance and decrease the pulmonary blood flow.
  • May develop into ARDS.
  • Mortality = 40%.
98
Q

What is the manifestations of pulmonary contusion?

A

Chest pain
Chest wall contusion
Dyspnea
Cough
Hemoptysis
Increasing tachypnea
Tachycardia

99
Q

What is the treatment for pulmonary contusion?

A

Position injured set up
Oxygen
Humidified breathing treatments
Restrict fluids unless signs of shock
Analgesics
Diuretics
Corticosteroids

100
Q

What are some reasons to consider intubation with a pulmonary contusion?

A
  • Severe hypoxia
  • Greater than 28% of lung affected
  • Signs of shock
  • Fracture of eight or more ribs
  • Elderly
  • Underlying pulmonary disease
101
Q

What are the manifestations of an esophageal disruption?

A
  • Cough
  • Chest pain
  • Pseudo mediastinum
  • Dyspnea
  • Dysphasia
  • Hematemesis
  • Choking
  • Epigastric pain
  • Pulmonary contusion
  • Respiratory distress
  • Neck pain
  • Hoarseness
  • Subcutaneous/mediastinal emphysema
102
Q

What is the treatment for an esophageal disruption?

A

Oxygen
IV
Chest tube
Esophagogram/Esphagoscopy
Surgery

103
Q

How can a ruptured bronchus/trachea occur?

A

From compressive shearing forces of blunt trauma

104
Q

What are the manifestations of a ruptured bronchus/trachea?

A
  • Respiratory distress
  • History of violent trauma
  • Intercostal retractions
  • Fracture of first five ribs
  • Cough
  • Hemoptysis
  • Signs of pneumothorax
  • Airway obstruction
  • Noisy breathing
  • Hammon’s crunch
  • Mediastinal/subcutaneous emphysema
  • Persistent air leak after chest tube
105
Q

What is the treatment for a ruptured bronchus/trachea?

A
  • Chest tube
  • Intubation
  • Tracheobronchoscopy
  • Surgery
106
Q

What are some special patient populations with regard to respiratory emergencies?

A

Pediatrics
Geriatrics

107
Q

What is special about pediatrics with regard to respiratory emergencies?

A
  • Infants or obligate nose breathers.
  • Children are dependent on diaphragm for adequate chest expansion.
  • Remember the signs of distress
    1) grunting
    2) head bobbing
    3) nasal flaring
  • Airways are very small - it doesn’t take much to obstruct.
  • Airway resistance is 15 times greater than the adult.
  • Thin chest walls and cartilaginous ribs.
  • Greater body surface area and increased respiratory rate leads to dehydration easily.
108
Q

What is special about geriatrics with regard to respiratory emergencies?

A
  • Decreased:
    1) Vital capacity
    2) Muscle strength
    3) Diffusion capacity
    4) Elastic recoil
  • Increased:
    1) Work of breathing.
    2) V-P inequality.
  • Have increased infections.
  • Dyspnea may be only sign of MI.
  • Aspiration mortality high.
  • 50% mortality with two rib fractures.
  • Decreased cough reflex.
  • Pneumonia leading infectious disease.

CEN (6 decks)

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