Respiratory Emergencies 3 Flashcards
“Cornerstone of therapy for COPD”
Beta Agonist (albuterol)
- B1 stimulation increases rate/force of contractility, increases small intestine motility
-
B2 stimulation produces bronchodilation, vasodilation, uterine relaxation, tremor
- (Works primarily on small airways)
- Relaxes bronchial smooth muscle
Is an MDI or Nebulizer better for delivery of Albuterol (beta agonist)?
Equal efficacy, but must use spacer/chamber for MDI
Is beta agonist delivered intermittenty or continuously?
Continuous is reserved for SEVERE exacerbations
Which delivery method of Albuterol (beta agonist) has increasd side effects?
Parenteral (IV usually) =not oral
- Epinephrine
- Terbutaline
Which med for COPD?
- acts as bronchodilator
- NOT beta selective
- Administration: nebulized or SQ or IM
- Most studies show no benefit over albuterol
- Which route of administration has better/more dependabe absorption?
Epinephrine
- IM
Which COPD med?
- Blocks cholinergic stimulation of airway smooth muscle
- Works on large central airways
- Should be given w/ beta agonist
Ipratropium Bromide
Which COPD med?
- Also a cornerstone of therapy
- reduce inflammation
- Upregulates B receptors
- No preferred route
- High dose NOT recommended
- What are 3 names of this med?
Corticosteroids
- Dexamethasone
- Methylprednisolone
- Prednisone
Which COPD med?
- Reserved for severe exacerbations
- Inhibits smooth muscle action potential leading to bronchodilation
Magnesium sulfate
“other” COPD options
- 80% ___ mixed w/ 20% oxygen
- Reserved for severe pediatric reactions
- Cannot be used in those needing increased oxygenation..
- Not routinely recommended/used
Heliox
- 80% helium
“other” COPD options
- No longer recommended
Theophylline
“other” COPD options
- Considered “conscious sedation”
Ketamine
Which COPD tx?
- cooperative pt
- moderate to severe Dyspnea
- Tachypnea
- Increased WOB
- Hypoxemia
BiPAP
What are the 6 contraindications of BiPAP?
- Need for emergency intubation
- Cardiac/Resp arrest
- Inability to protect airway / clear secretions
- Decreased LOC
- Facial trauma or deformity
- Recent esophageal surgery
4 types of BiPAP delivery methods
- Facial mask
- Nasal mask
- Helmet
- Ventilator
BiPAP is a trademarked product of ____ _____
- What does BPAP stand for?
- IPAP?
- EPAP?
- Difference between IPAP/EPAP?
Respironic Corporation
- Bilevel Positive Airway Pressure
- Inspiratory Positive Airway Pressure
- Expiratory Positive Airway Pressure
- Difference is “pressure support” (equivalent to PEEP : Positive End Expiratory Pressure)
Risk factors for what?
- Previous severe exacerbation (intubation / ICU)
- >2 hospitalizations in past year
- >3 ED visits in past year
- ED visit or hospitalization in the past month
- More than 2 MDI uses / month
- Difficulty perceiving severity of sxs
- Low socioeconomic status
- Illicit drug use
- Psych illness
Death
Symptom progression of what?
- Chest tightness
- Cough
- Whz
- Prolonged expiration
- Accessory muscle use
- AMS
COPD
Foreign Body Aspiration
- Potentially life threatening event
- Peak age of occurrence is between ___ and ___
- Second peak seen at age ____ yrs
- 4th leading cause of __ ___ ___.
- Most commonly occurs in those < __ and > ___.
- 1 and 3 years of age
- 85 yrs of age
- accidental home death
- 1 and 75
3 risk factors of FB aspiration in children?
- During development, the child puts everything in their mouths
- Food particles too large
- Being fed by older sibling
Name a few “lethal objects” for FB aspiration in children (7 total)
- Peanut butter
- Nuts
- Balloons
- Cut up hot dogs
- Beads
- grapes
- marbles
5 risk factors for FB aspiration in adults
- Altered LOC
- Impaired swallowing mechanism
- Stroke related dysphagia
- Alzheimer’s dementia
- Parkinson’s Disease
What is a sign/sx of “acute airway obstruction”
Cough
What sign/sx is associated w/ a laryngotrachel FB?
Stridor
What sign/sx is associated w/ bronchial FB?
Wheezing
- 3 common sxs of FB aspiration
- What motion will pt make?
- SOB, cough, wheezing
- Universal Choking Sign
- Aspiration of FB should be considered in all children with what 2 signs??
- CXR is normal in what % of pts
- Unilateral wheezing
- Persistent sxs that do not respond to bronchodilators
50%
3 dx tests for FB
-
CXR
- often not helpful
- good for radio-opaque objects
- unilateal hyperinflation
- CT
- Layngoscopy and or bronchoscopy
Where is the most common located for FB?
What muscle is this?
Thoracic inlet
- level of clavicles on CXR
- Site of anatomical change from skeletal to smooth muscle
- Cricopharyngeus muscle
What are the 2 other most common sites of FB besides #1 thoracic inlet?
- Mid esophagus (overlap of aortic arch and carina)
- Distal esophagus (lower esophageal sphincter)
What does this x-ray depict?
Hyperexpansion of Right Lung
What does this x-ray depict?
Hyperexpansion Right Lung
What should you ask a CONSCIOUS pt who is choking before helping them?
- Are you choking?
- May I help you?
How do you save yourself if choking and you’re alone?
Place fist above navel while grasping fist w/ other hand
Leaning over chair / counter top, drive your fist towards yourself with an upward thrust.
Tx for choking infant/child
- Place infant stomach-down across your forearm and give 5 quick forceful blows on infants back w/ heel of your hand
- W/ infant face up, place 2 fingers in middle of infant’s breast bone, give 5 quick downward thrusts
Tx for choking adult who is UNCONSCIOUS?
CPR
DO NOT perform blind finger sweep (may lodge FB further)
What tool is used to remove FB?
Magill forceps removal
