Respiratory Emergencies

Question 1

Get at least an “AMPLE” history

Answer 1

Allergies
Medications
Past illnesses
Last meal, last menstrual period
Events preceding episode that brought them in

Question 2

Acute Respiratory Failure as seen on ABGs

Answer 2

PO2 is < 60 mmHg or PCO2 is > 50 mmHg

Question 3

Goal of therapy is to restore adequate oxygenation and/or ventilation

Answer 3

O2 sats ≥ 90%

Get PaO2 ≥ 60 mmHg

Question 4

Consideration for NPPV (non-invasive positive pressure ventilation)

Answer 4

Only for patients who can protect/maintain their airway
Commonly used for COPD exacerbations
Not for those with severe impairment in oxygenation, acute lung injury, ARDS

Question 5

ARDS always results from another severe underlying disease may be direct or indirect:

Answer 5

Direct – Caustic agent going to the lungs, by trauma through the chest wall or by aspiration
Indirect – Causative agent arrives at the lungs via the blood stream (infection, poisoning)
Secondary to sepsis

Question 6

Acute Mountain Sickness Management

Answer 6

Supplemental oxygen
Acetazolamide (250 mg at onset and BID-TID)
Alternative: dexamethasone (8 mg loading dose, 4 mg q6h)
*Give both with HACE

Question 7

Common sources of cyanide

Answer 7

Fruit pits (Peaches, plums, cherries, apricots)
Product of burning wool, nylon, cotton, silk, acrylic, polyurethane, plastics

Question 8

Cyanide poisoning treatment (antidote) Three pronged approach:

Answer 8

Inhaled nitrites (amyl nitrites)
Injected nitrites (sodium nitrite)
Injected Sodium Thiosulfate
**Contraindicated with concomitant carbon monoxide poisoning

Question 9

Carbon Monoxide Treatment

Answer 9

administration of 100% O2 for 4 hours

Hyperbaric Oxygen Therapy`

Question 10

Acute asthma: medical therapy

Answer 10

Albuterol (inhaled beta 2 agonist) with Ipratropium bromide (atrovent) (anticholinergic)
Then IV Methylprednisolone (Solu Medrol)

For life threatening exacerbations that remain severe after 1 h of intense bronchodilator therapy: Magnesium sulfate
Epi for anaphylaxis DO NOT GIVE with Terbutaline

Question 11

Wet and dry drowning

Answer 11

Wet: Aspiration of fluid or foreign material
Dry: Laryngospasm or airway obstruction

Question 12

Positive End Expiratory Pressure (PEEP) Dangers

Answer 12

High intrathoracic pressures can cause decreased venous return and decreased cardiac output
May produce pulmonary barotrauma
May worsen air-trapping in obstructive pulmonary disease

Question 13

NPPV Contraindications

Answer 13

Facial trauma
Decreased LOC/ inability to cooperate
Required sedation
Unable to clear secretions
Aspiration risk
Active upper GI bleed
Recent oral, esophageal or gastric surgery

Question 14

Respiratory Rate Calculation

Answer 14

Tidal Volume remains the same

New Rate = Rate x PaCO2
Desired PaCO2