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Medical Block > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

Intrinsic risk factors

A

Genetics
Circulatory problems
Sedentary lifestyle

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2
Q

Extrinsic risk factors

A

Smoking
working conditions
environmental

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3
Q

Goal of respiratory emergencies

A

correct hypoxia

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4
Q

angle of louis

A

external landmark of the biforcation (carina) of the bronchus

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5
Q

Alvioli

A
  • Functional unit of respiratory system
  • 300 million in both lungs
  • 1 cell thick and connected to blood supply
  • air passes through diffusion
  • Damage to alveoli decreases surface area which will decrease area of resp.
  • Coated with surfactant to prevent collapsing
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6
Q

Layers around the lung

A

Visceral pleura- lays on the lung

Parietal pleura- lines the pleural space

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7
Q

Atmospheric pressure

A

14.7psi

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8
Q

Inspiratory reserve

A

3000ml

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9
Q

Expiratory reserve

A

1200ml

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10
Q

Residual volume

A

1200ml

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11
Q

Peak flow

A

maximum rate of air flow during a force expiration

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12
Q

COPD primary chemoreceptors

A

Peripheral chemoreceptors

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13
Q

Peripheral chemoreceptors

A
  • Located in the carotid/aortic bodies
  • Back up system, when patient has chronic high C02 levels - hypoxic drive
  • Respond to low levels of 02
  • Increased 02 levels decrease rate, depth etc.
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14
Q

BOHR EFFECT

A

An effect by which an increase of carbon dioxide in the blood and a decrease in pH results in a reduction of the affinity of hemoglobin for oxygen.

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15
Q

Apnea

A

not breathing

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16
Q

Orthopnea

A

Fluid filling the lungs when laying down

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17
Q

Dyspnea

A

Difficulty breathing

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18
Q

Tachypnea

A

rapid breathing

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19
Q

Cheyne Stokes

A

rapid breathing with periods of apnea

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20
Q

Hyperventilation

A

more rapid than normal

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21
Q

Kussmaul

A

(diabetic ketoacidosis)

Deep, rapid breathing

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22
Q

PND (Paroxismal nocternal dyspnea)

A

more difficulty breathing at night

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23
Q

Rales

A

bubbles in water

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24
Q

Rhonchi

A

hair folicles rubbed together

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25
Q

Diminished

A

abcde

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26
Q

Silent

A

Movement but no sound (very bad)

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27
Q

ARDS

A

Complications from trauma, toxins, aspiration, infections, O.D’s

Result in a increase in capillary permeability, stiff lungs and decrease pulmonary capacity

Seen in post injury or illness

Is managed with PEEP and corticosteroids

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28
Q

Blue bloaters (smokers)

A

-Altered ventilation - perfusion relationships in lungs
-Hypoventilation/Hypoxemia (↓ lung capacity, ↑ residual volume with air-trapping)
-Polycythemia (more RBC’s)
Increased CO2retention
Rt. side CHF
Overweight
PRODUCTIVE COUGH*
Short & stocky body build
Rhonchi sounds in lungs

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29
Q

EMPHYSEMA pathophysiology

A

Loss of elasticity within alveoli
Resulting in enlargement of alveoli sacs
Leads to destruction of alveoli and failure of supporting structures to maintain alveolar integrity
Reduction of elasticity leads to the trapping of air in alveoli

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30
Q

Emphysema leads to?

A

Pulmonary hypertension
Right sided CHF

Cor pulmonale—hypertrophy of Rt. Ventricle

Polycythemia(more RBC’s)

31
Q

Emphysema s/s

A

Pink puffers caused by
Decreased Pa02 which produces more RBC’s
High hematocrit levels
Barrel chest: excessive chest muscle use to breath, increase in the anterior/posterior chest diameter
Thin and emaciated looking due to increase caloric need to breath
Pursed lip breathing
Prolonged & rapid respiratory rate

32
Q

Acute s/s of emphysema

A
  • Acute onset brought on by number of reasons, causes exacerbation of disease
  • Tripod breathing
  • Accessory muscle use
  • Dry or productive cough
  • Wheezes or rhonchi
  • Prolonged expiratory phase
  • Associated sx/sx tachycardia, diaphoresis, cyanosis, irritability, confusion, drowsiness, cardiac problems
  • Low SAO2
  • Central site vs peripheral site
33
Q

Asthma

A

Life long asthma

Increased incidence of death after age 45

34
Q

Causes of Asthma

Extrinsic (more common in children, improves with age)

A 
“Non-allergic”
Inhaled allergen
Cold temperature
Vigorous exercise
Emotional stress
35
Q

Causes of Asthma

Intrinsic (more commonly as adult)

A 
Infection
ASA, ibuprofen
Beta blockers (inhibits beta so alpha stimulation takes place)
Exposure to smoke, fumes
Psychological stress
36
Q

s/s of Asthma

A

Smooth muscle contraction
Increased secretion of mucus
Inflammatory changes in the bronchiole walls
Alveolar hypoventilation and marked ventilation-perfusion mismatch leading to hypoxia and C02 retention.
Increased air resistance leads to air trapping due to hyperventilation of alveoli.

37
Q

s/s of asthma

A 
Dyspnea—measure in words
Cough
Bronchospasm
   -Wheezes
   -Quiet chest
        *So tight there are no lung sounds
        *Ominous sign because of lack of air movement.
Accessory muscle use
   -Subclavicular in-drawing 
Pulsus paradoxus
Tachycardia
Low pulse ox
Hypoxia and fatigue 
Associated s/s
   -diaphoresis, tachycardia, unable talk
Abnormal capnography - shark fin shape
Peak airway flow rate
Special questions
   -Hx of intubation/hospitalizations
Usual treatment
   -Frequency of inhaler use, other meds and infection
38
Q

Status Asthmaticus

A

Severe prolonged asthma attack
Key point: Cannot be broken with normal routine medication use
Same as other asthma attacks except more rapid onset and patient in life threatening situation.
Rapid transport with Rx enroute.

39
Q

s/s hyperventilation

A

Carpal/pedal spasms - due to relative hypocalcemia

40
Q

Cystic Fibrosis

A

Inherited disorder of exocrine glands
Cause abnormal secretions of thick mucous which plugs bronchi and GI tract
Fatal disease with life expectancy of avg. 22-28 years
Associated chronic bronchitis, sinusitis, emphysema and respiratory failure
Rx per Sx & Sx

41
Q

PE Patho

A
  • Blockage of pulmonary artery by thrombus, embolus or other foreign matter
  • Results in partial or complete collapse of lung
  • Can limit left heart return resulting in decrease cardiac output and obstructive shock
  • Most common cause is thrombus
42
Q

PE causes

A

Venostasis-bed rest, traveling, age, burns, obesity, varicose veins
Venous injury - Fx or surgery
Increased blood coagulation
Pregnancy - post partum
Disease - COPD, CHF, AFib, MI, Infection
Multiple trauma
BCP - estrogen in pills increase clotting factors

43
Q

PE s/s

A 
Dyspnea, low SA02
Tachypnea
Obvious labored breathing
Chest pain
Cough
Hemopytsis
Diaphoresis
Hypotension
Tachycardia, JVD
44
Q

Myasthenia gravis

A

Gradual muscular weakness

  • eyes
  • throat
  • mouth
45
Q

Gullian Barre

A

Progressive weakness of lower extremities which moves up body into chest leading to inability to breath. Is self limiting

46
Q

ALS

A

*Progressive muscular weakness
Eventually affects respiratory muscles and pt quits breathing
Terminal Disease

47
Q

Spontaneous Pneumothorax

A

Partial to complete collapse of the lung as a result of a ruptured bleb on the pleural lining of the lung

  • Sudden onset of SOB
  • Decrease or absent lung sounds
  • Cough
  • Sharp chest pain which may be referred to shoulder
48
Q

Spontaneous Pneumothorax

A

COPD history
Young, tall, white male adults
Congenital bleb ( on lung
May be precipitated by sneeze or forceful cough

49
Q

Atelectasis

A

Partial collapse of lung due to incomplete expansion, obstruction of airway or lung tissue

50
Q

S/S of Atelectasis

A 
Absent or diminished breath sounds
SOB
Mucous plugs
Excessive secretions
Foreign body obstruction
Splinting respirations with poor lung expansion
51
Q

Laryngospasm

A

Spasm of the muscle in larynx resulting in partial or total airway obstruction

52
Q

S/S of Laryngospasm

A 
Stridor or air hunger
Accessory muscle use
Cyanosis
Decreased LOC
Apnea
53
Q

causes of Laryngospasm

A

Upper airway inflammation (smoke inhalation)
Foreign body
Trauma
Near drowning

54
Q

Pleurisy

A

Inflammation of the pleura
May or may not have effusion (fluid in pleural space)
Pain due to pleural linings (pleura) rubbing
May hear friction rub with respirations

55
Q

s/s of Pleurisy

A 
Sharp pain in chest or back, referred to shoulder
Fever
Dyspnea
Tachycardia
Diaphoresis
Pain increases on inhalation
56
Q

Pneumonia

A

Most commonly unrecognized respiratory emergency in field
Acute inflammation of respiratory bronchioles
Spread by droplet
Viral or bacterial

57
Q

Pneumonia s/s

A

Chest pain
Flu-like symptoms
Rales? or other lung sounds
May have wheezes

58
Q

Legionnaires Disease

A

Acute bacterial infection
Causes pneumonia
Patients die from complications of renal failure and respiratory failure

59
Q

Tuberculosis

A

Airborne disease transported by droplets
TB bacilli enter body and multiply, they usually affect the lungs but infect any part
Most commonly seen in homeless, migrants, immunilogically suppressed or jailed
*MASK THESE PATIENTS!

60
Q

Vocal Cord Dysfunction Syndrome

A

swell or dilate for no reason

61
Q

Infrared light pulse ox

A

SaO2

62
Q

Red light Pulse Ox

A

SpO2

63
Q

normal SAT

A

95-99

64
Q

Mild hypoxia

A

91-94

65
Q

Moderate hypoxia

A

86-91

66
Q

Severe hypoxia

A

85%

67
Q

Bronchodilators

A

Terbutaline (Brethine)
Metaproterenol (Alupent)
Albuterol (Proventil, Ventolin)
Isotherine (Bronkosol)

68
Q

Corticosteroids (anti-inflammatory)

A

Solu-medrol
Vanceril
Azmacort
Aerobid

69
Q

Oral or injected respiratory meds

A

Theophylline (theodur,slo-bid,theo-air)
Popular before inhalers
Prevents certain cells lining bronchi (mast cells) from releasing chemicals, such as histamines

70
Q

Inspection

A 
Assess for injury
Check Anterior & Posterior diameter
Accessory muscle use
Rate, rhythm and equality of breathing
Skins, JVD, edema
71
Q

Palpation

A

Stress the skeletal structures
Check for SQ emphysema
Crepitus

72
Q

Auscultation

A 
Patient position	
Sitting upright
Slightly forward
Shoulders rounded 
Check equipment
Tap dial to check
One for heart tones, one for lung sounds
73
Q

Muffled heart tones

A
  • Soft and distant sounding

* Due to excessive fluid or blood in pericardial sac

Medical Block (20 decks)

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