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Disciplines 3 Shea > Respiratory Emergencies 3 > Flashcards

Respiratory Emergencies 3 Flashcards

1
Q

“Cornerstone of therapy for COPD”

A

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
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2
Q

Is an MDI or Nebulizer better for delivery of Albuterol (beta agonist)?

A

Equal efficacy, but must use spacer/chamber for MDI

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3
Q

Is beta agonist delivered intermittenty or continuously?

A

Continuous is reserved for SEVERE exacerbations

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4
Q

Which delivery method of Albuterol (beta agonist) has increasd side effects?

A

Parenteral (IV usually) =not oral

  • Epinephrine
  • Terbutaline
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5
Q

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?
A

Epinephrine

  • IM
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6
Q

Which COPD med?

  • Blocks cholinergic stimulation of airway smooth muscle
  • Works on large central airways
  • Should be given w/ beta agonist
A

Ipratropium Bromide

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7
Q

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?
A

Corticosteroids

  • Dexamethasone
  • Methylprednisolone
  • Prednisone
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8
Q

Which COPD med?

  • Reserved for severe exacerbations
  • Inhibits smooth muscle action potential leading to bronchodilation
A

Magnesium sulfate

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9
Q

“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
A

Heliox

  • 80% helium
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10
Q

“other” COPD options

  • No longer recommended
A

Theophylline

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11
Q

“other” COPD options

  • Considered “conscious sedation”
A

Ketamine

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12
Q

Which COPD tx?

  • cooperative pt
  • moderate to severe Dyspnea
  • Tachypnea
  • Increased WOB
  • Hypoxemia
A

BiPAP

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13
Q
A
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14
Q

What are the 6 contraindications of BiPAP?

A
  • Need for emergency intubation
  • Cardiac/Resp arrest
  • Inability to protect airway / clear secretions
  • Decreased LOC
  • Facial trauma or deformity
  • Recent esophageal surgery
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15
Q

4 types of BiPAP delivery methods

A
  • Facial mask
  • Nasal mask
  • Helmet
  • Ventilator
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16
Q

BiPAP is a trademarked product of ____ _____

  • What does BPAP stand for?
  • IPAP?
  • EPAP?
  • Difference between IPAP/EPAP?
A

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)
17
Q

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
A

Death

18
Q

Symptom progression of what?

  • Chest tightness
  • Cough
  • Whz
  • Prolonged expiration
  • Accessory muscle use
  • AMS
A

COPD

19
Q

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 > ___.
A
  • 1 and 3 years of age
  • 85 yrs of age
  • accidental home death
  • 1 and 75
20
Q

3 risk factors of FB aspiration in children?

A
  • During development, the child puts everything in their mouths
  • Food particles too large
  • Being fed by older sibling
21
Q

Name a few “lethal objects” for FB aspiration in children (7 total)

A
  • Peanut butter
  • Nuts
  • Balloons
  • Cut up hot dogs
  • Beads
  • grapes
  • marbles
22
Q

5 risk factors for FB aspiration in adults

A
  • Altered LOC
  • Impaired swallowing mechanism
  • Stroke related dysphagia
  • Alzheimer’s dementia
  • Parkinson’s Disease
23
Q

What is a sign/sx of “acute airway obstruction”

A

Cough

24
Q

What sign/sx is associated w/ a laryngotrachel FB?

A

Stridor

25
Q

What sign/sx is associated w/ bronchial FB?

A

Wheezing

26
Q
  • 3 common sxs of FB aspiration
  • What motion will pt make?
A
  • SOB, cough, wheezing
  • Universal Choking Sign
27
Q
  • Aspiration of FB should be considered in all children with what 2 signs??
  • CXR is normal in what % of pts
A
  • Unilateral wheezing
  • Persistent sxs that do not respond to bronchodilators

50%

28
Q

3 dx tests for FB

A
  • CXR
    • often not helpful
    • good for radio-opaque objects
    • unilateal hyperinflation
  • CT
  • Layngoscopy and or bronchoscopy
29
Q

Where is the most common located for FB?

What muscle is this?

A

Thoracic inlet

  • level of clavicles on CXR
  • Site of anatomical change from skeletal to smooth muscle
  • Cricopharyngeus muscle
30
Q

What are the 2 other most common sites of FB besides #1 thoracic inlet?

A
  • Mid esophagus (overlap of aortic arch and carina)
  • Distal esophagus (lower esophageal sphincter)
31
Q

What does this x-ray depict?

A

Hyperexpansion of Right Lung

32
Q

What does this x-ray depict?

A

Hyperexpansion Right Lung

33
Q

What should you ask a CONSCIOUS pt who is choking before helping them?

A
  • Are you choking?
  • May I help you?
34
Q

How do you save yourself if choking and you’re alone?

A

Place fist above navel while grasping fist w/ other hand

Leaning over chair / counter top, drive your fist towards yourself with an upward thrust.

35
Q

Tx for choking infant/child

A
  • 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
36
Q

Tx for choking adult who is UNCONSCIOUS?

A

CPR

DO NOT perform blind finger sweep (may lodge FB further)

37
Q

What tool is used to remove FB?

A

Magill forceps removal

Disciplines 3 Shea (13 decks)

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