Respiratory Emergencies Flashcards
What are signs of respiratory distress
Anxiety and restlessness Flaring of nostrils Use of neck muscles Use of abdominal muscles for breathing Cyanosis – lips, fingers Asymmetrical chest movement – flail chest? Trachea midline or pulled to one side
What medications cannot be used if respiratory distress from trauma is suspected
No narcotics! they decrease respiratory drive. Use a local anesthetic block instead
What are common causes respiratory arrest
Acute coronary syndrome, cardiac arrest Acute heart failure Electric shock Drowning Suffocation Inhalation of poisonous gases Head injuries
What are common severe causes of dyspnea
Arrhythmias –ventrical esp Pericardial tamponade Pulmonary embolism Pneumonia or other pulmonary infections Asthma or COPD exacerbation Anaphylaxis and angioedema Poisoning (i.e. carbon monoxide) Trauma (i.e. pneumothorax, hemothorax)
What are common causes of respiratory compromise in children
Airway anomalies i.e. tracheoesophageal fistula, tracheal stenosis, tracheal ring Epiglottitis Uvulitis Tracheitis Peritonsillar abscess Retropharyngeal abscess
What is a sign of peritonsillar abscess
uvula deviation, asymmetric tonsils, tautness of tonsil or loss of rugae, significant pain on swallowing
What are common causes of respiratory distress in children
Asthma Bronchiolitis Croup Pneumonia Pneumonitis Anaphylaxis Foreign body (upper airway, lower airway, esophagus)
what is a first line outpatient treatment for acute, non-lifethreatening asthma
Brew a strong cup of coffee for the methylxanthine to induce bronchodilation
What is Dresser’s syndrome
Pericarditis that occurs 2-3 weeks after an acute MI
What organ systems may be causal in respiratory issues
lungs, hematologic, cardiac, HEENT, neurologic, drugs, endocrine (diabetic ketoacidosis)
What drugs are commonly causal in respiratory failure
narcotics, benzos, alcohol (esp combined with narcotics or benzos, salicylate poisoning
What are some random causes of respiratory failure
Pneumomediastinum Lung tumor Pleural effusion Anxiety/hyperventilation Intra-abdominal process Ascites Pregnancy Morbid obesity
What causes diminished breath sounds
COPD, pneumonia, CHF, severe asthma, pneumothorax
What test is used to distinguish between CHF and pneumonia
BNP will go up in CHF and remain normal in pneumonia
What causes inspiratory stridor
classically due to air flow obstruction occurring above the level of the vocal cords (foreign body, epiglottitis, angioedema)
What are some common causes of Rales (crackles)
pneumonia
Acute decompensated heart failure (ADHF)
Adult respiratory distress syndrome (ARDS)
JVD with lungs that seem to be clear could be due to
Right heart failure
Cardiac tamponade
Pulmonary embolism
If someone presents with upper limb DVT or edema, you should ask
Whether they recently had an indwelling catheter, do they have cancer
What is the appropriate course of action if a patient presents to your office in acute decompensation of heart failure
High flow O2
Keep patients head and shoulders elevated
Keep patient as calm as possible
Transport - call 911
What is Pulsus paradoxus
pulse drops by at least ten
What is stage four asthma attack
respiratory failure: Severe respiratory distress, lethargy, confusion, prominent pulsus paradoxus, SCM retraction. FEV1 is generally 10% of normal or less
What is the drug of choice for status asthmaticus
epi injection. steroids and antihistamines do not interrupt on ongoing asthma attack
What are ssx of croup
inspiratory stridor, cough, and hoarseness, with a barking cough being predominant in children and hoarseness in older individuals
What is the cause of anaphylaxis
IgE mediated
What is the drug of choice in anaphylaxis
IM epinephrine regardless of other contraindications
What is an anaphylactoid reaction
a non IGE mediated reaction resembles anaphylaxis but not antibody related.
When do anaphylactoid reactions tend to happen
Anaphylactoid reaction often occurs with first exposure to certain drugs.
What is Sampter’s triad
asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and NSAIDs. (These patients may also react poorly to exposure to tartrazine and yellow dye #5)
Why does breathing into a paper bag help with panic attacks
The individual is breathing in increased CO2 which tamps down hyperventilation
What is the appropriate course of action if you suspect acute epiglottitis
This is a medical emergency and so immediate referral to ER or calling 911 is appropriate
What are signs of acute epiglottitis
The 3 D’s: dysphagia, drooling, and distress. Hot potato voice, tripod position, fever, anxiety, feeling of choking
Which oxygen mask allows for the most accurate delivery of oxygen
Venturi Mask
