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Disciplines 3 Shea > Respiratory Emergencies 2 > Flashcards

Respiratory Emergencies 2 Flashcards

1
Q

Tx for High Altitude Cerebral Edema

4 things

A
  • Oxygen
  • Descent/Evacuation
  • Dexamethasone
  • Loop Diuretics
    • Furosemide
    • Bumetanide
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2
Q

What is the most lethal of the high altitude illnesses?

A

High Altitude Pulmonary Edema

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3
Q

Which condition?

  • Dry cough, progresses to productive cough
  • Decreased exercise performance / increased recovery time from exercise
  • Rales - increased after exercise
  • Increasing dyspnea
  • Coma, death
A

High Altitude Pulmonary Edema

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4
Q

High Altitude Pulmonary Edema

  • Is due to high ___ ___ _____ & development of pulmonary HTN
A

pulmonary microvascular pressures

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5
Q

Tx for High Altitude Pulmonary Edema

  • Recognition
  • Immediate descent is tx of choice
  • Oxygen, may take up to ___ hours to resolve HAPE
  • ____ every 8 hours
A
  • 72 hours
  • Nifedipine
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6
Q

What is the most common reason for admission in Medicare pts?

A

CHF

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7
Q

Most common cause of CHF?

A

LV dysfunction

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8
Q

4 cardiac issues associated w/ CHF?

A
  • Aortic stenosis
  • Hypertension
  • A. fib
  • Coronary artery disease
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9
Q

Signs / Sxs of what?

  • Hypoxemia
  • HTN
  • Tachycardia
  • Dyspnea
  • Weight gein
  • Rales
A

CHF

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10
Q

Sxs of left or right CHF?

  • Dyspnea
  • Fatigue
  • Cough
  • PND
  • Orthopnea
A

Left

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11
Q

Sxs of left or right CHF?

  • Peripheral edema
  • JVD
  • RUQ pain
A

Right

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12
Q

Testing for CHF (5)

A
  • CBC (anemia)
  • Chemistries (electrolytes / renal function)
  • Cardiac enzymes
  • Pro-BNP (released by ventricular myocardium in response to stretching) >200 suggests CHF
  • EKG

(PECCC)

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13
Q

Chest x-ray for CHF has high or low sensitivity?

  • Dilated upper lobe vessels
  • Cardiomegaly
  • Interstitial edema
  • Enlarged pulmonary artery
  • Pleural effusions
  • Kerley B lines
A

Low

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14
Q

What has a higher sensitivity / specificity compared to CXR for diagnosing CHF?

A

US of lung will show B lines

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15
Q

CHF

What dx test is used to evaluate LV and valvular functions, tamponade, VSD?

A

Echocardiography

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16
Q

3rd leading cause of death of hospitalized pts in the US

A

PE

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17
Q

Most common cause of non-surgical maternal deathin peripartum period is what?

A

PE

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18
Q

PE occurs when proximal portion of ______ breaks off and travels to lung

Most commonly due to ___ or _____ veins, but can result from any vain (except intracranial veins)

A
  • venous thrombosis
  • pelvic or deep lower extremity
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19
Q

Virchow’s Triad of PE

A
  • Venous stasis
  • Vessel wall inflammation
  • Hypercoagulability
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20
Q

Risk Factors of PEs

(moist camels)

A
  • Malignancy
  • Obesity
  • Immobilization
  • Surgery
  • Trauma
  • CHF
  • Age >40
  • Mobility (lack of)
  • Estrogen excess
  • Long bone fx
  • Smoker
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21
Q

Triad of sxs of PE

A
  • Pleuritic CP
  • SOB
    Hemoptysis
22
Q

Wells Score is used for what?

A

Risk Assessment of PE

23
Q

Besides Wells Score, what are 2 other Risk Assessment tools for PE?

A
  • Simplified Revised Geneva Score
  • PERC Criteria
24
Q

If all answers are “yes” for PERC criteria the risk of PE is _____.

A

Less than 2%

25
Q

Is “Experiences Clinical Gestalt” better or worse at assessing risk of PE compared to the tools?

A

Just as well

26
Q

3 CXR signs for PE

(CXR is normal 1/3 of the time)

A
  • Hampton’s Hump (triangular pleural based infiltrate w/ apex pointed toward hilum)
  • Westermark’s sign (dilate pulmonary vessels proximal to embolus w/ sharply demarcated cutoff)
  • Fleischner sign (distended central pulmonary artery)
27
Q

What is the diagnostic test of choice for PE? Why?

A

CT scan

  • Good at identifying central clots, but can miss small peripheral clots
  • Also identifies other possible causes
  • Iodine infusion required
28
Q

What is seen on electrocardiography if pt has large clot (PE) (likely central) w/ poor prognosis?

A

RV enlargment & RV dysfunction

29
Q

What US is used to evaluate primarily the lower extremities from groin distally?

A

Venous Compression US

30
Q

What test cannot be used to exclude / diagnose PE?

A

ABG

31
Q

ABG

  • PAO2 =?
  • PaO2 =?
A
  • PAO2 = partial pressure of oxygen in alveolus
  • PaO2 = partial pressure of oxygen in artery
32
Q
  • What test for PE measures fibrin degradation products?
  • Is detectable within __ hour(s) of thrombus formation
  • Has high negative predictive value, but poor positive predictive value
A
  • D Dimer
  • 1
33
Q

Value is increased with:

  • Cancer
  • Inflammation
  • Infection
  • Aging >70
  • Recent surgery
  • trauma
  • MI
  • pregnancy
  • arterial thrombosis
  • acute CVA
  • Superficial phlebitis
  • RA
  • Liver disease
A

D dimer

34
Q

Value decreased with:

  • Warfarin
  • Sxs <5 days
  • Small clot burden
A
35
Q

What blood tests can be elevated w/ PE?

A

Pro-BNP

Troponin

36
Q
  • What is the most common EKG finding for PE?
  • Followed by what?
  • What EKG finding represents right heart strain and is seen in only 20% of cases?
A
  • Sinus Tachycardia
  • T wave inversions
  • S1Q3T3
37
Q

Tx for PE?

A
  • Heparin, must monitor PTT
  • Coumadin, must monitor PT/INR
  • Lovenox
  • Rivaroxaban (Factor Xa inhibitor)
  • Vena caval filter if problem or contraindications to anticoagualation
38
Q

3 indications for Thrombolytic Tx of PE?

A
  • Massive PE (hemodynamically unstable)
  • Massive ileofemoral DVT
  • Large DVT w/ significant vascular compromise
39
Q

Contraindications for Thrombolytic Tx of PEs

A
  • Major bleeding within 6 months
  • Intracranial or intraspinal surgery / trauma within 2 months
  • Surgery within 10 days
  • Pericarditis/Endocarditis
  • Uncontrolled HTN
  • Pregnancy
  • Suspected aneurysm

(MISPUPS)

40
Q

3 Thrombolytic Agents

A
  • Streptokinase (highly antigenic)
  • Urokinase
  • Alteplase
41
Q

2 mechanical treatments for PE

A
  • Embolectomy (for massive PEs if pt has contraindications to fibrinolysis/unstable after fibrinolysis)
  • Catheter directed thrombolysis (Alteplase infused over 4 hours)
42
Q
  • Chronic/reversible inflammatory disorder affecting 10% of adults and 30% of children
A

Asthma

43
Q

Pathophysiology triad of asthma

A
  • Airway inflammation
  • Obstruction to airflow
  • Bronchial hyper-responsiveness
44
Q

Clinical triad of asthma

A
  • Dsypnea
  • Wheezing
  • Cough
45
Q

Chronic / Irreversible Disorder

A

COPD

  • Chronic Bronchitis
  • Emphysema
46
Q

Chronic Bronchitis or Emphysema?

  • Presence of chronic productive cough for 3 months in 2 successive years
  • Clinical dx
A

Chronic Bronchitis

47
Q

Chronic Bronchitis or Emphysema?

  • Destruction of bronchioles and alveoli
  • Pathologic dx
A

Emphysema

48
Q

Most common risk factor (90%) for COPD?

A

Tobacco use

(only 15% of tobacco smokers develop COPD)

49
Q

Besides smoking, what are 4 other risk factors for COPD?

A
  • Occupational exposures
  • Environmental exposures (air pollution)
  • Alpha 1 antitrypsin deficiency
  • IVDA
50
Q

What is used to assess COPD and is patient dependent?

  • Measures severity of airway restriction
  • Should be compared to pt’s baseline
  • Can be used to monitor response to therapy
  • Use guidelines if age/height table not available
A

FEV1

51
Q

3 tx goals of COPD

A
  • Reverse airflow obstruction
  • Provide adequate oxygenation
  • Relieve inflammation
52
Q
A

Disciplines 3 Shea (13 decks)

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