Respiratory Emergencies

Question 1

What are signs of respiratory distress

Answer 1

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

Question 2

What medications cannot be used if respiratory distress from trauma is suspected

Answer 2

No narcotics! they decrease respiratory drive. Use a local anesthetic block instead

Question 3

What are common causes respiratory arrest

Answer 3

Acute coronary syndrome, cardiac arrest
Acute heart failure
Electric shock
Drowning
Suffocation
Inhalation of poisonous gases
Head injuries

Question 4

What are common severe causes of dyspnea

Answer 4

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)

Question 5

What are common causes of respiratory compromise in children

Answer 5

Airway anomalies i.e. tracheoesophageal fistula, tracheal stenosis, tracheal ring 
Epiglottitis
Uvulitis
Tracheitis
Peritonsillar abscess
Retropharyngeal abscess

Question 6

What is a sign of peritonsillar abscess

Answer 6

uvula deviation, asymmetric tonsils, tautness of tonsil or loss of rugae, significant pain on swallowing

Question 7

What are common causes of respiratory distress in children

Answer 7

Asthma
Bronchiolitis
Croup
Pneumonia
Pneumonitis
Anaphylaxis
Foreign body (upper airway, lower airway, esophagus)

Question 8

what is a first line outpatient treatment for acute, non-lifethreatening asthma

Answer 8

Brew a strong cup of coffee for the methylxanthine to induce bronchodilation

Question 9

What is Dresser’s syndrome

Answer 9

Pericarditis that occurs 2-3 weeks after an acute MI

Question 10

What organ systems may be causal in respiratory issues

Answer 10

lungs, hematologic, cardiac, HEENT, neurologic, drugs, endocrine (diabetic ketoacidosis)

Question 11

What drugs are commonly causal in respiratory failure

Answer 11

narcotics, benzos, alcohol (esp combined with narcotics or benzos, salicylate poisoning

Question 12

What are some random causes of respiratory failure

Answer 12

Pneumomediastinum
Lung tumor
Pleural effusion
Anxiety/hyperventilation 
Intra-abdominal process
Ascites
Pregnancy
Morbid obesity

Question 13

What causes diminished breath sounds

Answer 13

COPD, pneumonia, CHF, severe asthma, pneumothorax

Question 14

What test is used to distinguish between CHF and pneumonia

Answer 14

BNP will go up in CHF and remain normal in pneumonia

Question 15

What causes inspiratory stridor

Answer 15

classically due to air flow obstruction occurring above the level of the vocal cords (foreign body, epiglottitis, angioedema)

Question 16

What are some common causes of Rales (crackles)

Answer 16

pneumonia
Acute decompensated heart failure (ADHF)
Adult respiratory distress syndrome (ARDS)

Question 17

JVD with lungs that seem to be clear could be due to

Answer 17

Right heart failure
Cardiac tamponade
Pulmonary embolism

Question 18

If someone presents with upper limb DVT or edema, you should ask

Answer 18

Whether they recently had an indwelling catheter, do they have cancer

Question 19

What is the appropriate course of action if a patient presents to your office in acute decompensation of heart failure

Answer 19

High flow O2
Keep patients head and shoulders elevated
Keep patient as calm as possible
Transport - call 911

Question 20

What is Pulsus paradoxus

Answer 20

pulse drops by at least ten

Question 21

What is stage four asthma attack

Answer 21

respiratory failure: Severe respiratory distress, lethargy, confusion, prominent pulsus paradoxus, SCM retraction. FEV1 is generally 10% of normal or less

Question 22

What is the drug of choice for status asthmaticus

Answer 22

epi injection. steroids and antihistamines do not interrupt on ongoing asthma attack

Question 23

What are ssx of croup

Answer 23

inspiratory stridor, cough, and hoarseness, with a barking cough being predominant in children and hoarseness in older individuals

Question 24

What is the cause of anaphylaxis

Answer 24

IgE mediated

Question 25

What is the drug of choice in anaphylaxis

Answer 25

IM epinephrine regardless of other contraindications

Question 26

What is an anaphylactoid reaction

Answer 26

a non IGE mediated reaction resembles anaphylaxis but not antibody related.

Question 27

When do anaphylactoid reactions tend to happen

Answer 27

Anaphylactoid reaction often occurs with first exposure to certain drugs.

Question 28

What is Sampter’s triad

Answer 28

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)

Question 29

Why does breathing into a paper bag help with panic attacks

Answer 29

The individual is breathing in increased CO2 which tamps down hyperventilation

Question 30

What is the appropriate course of action if you suspect acute epiglottitis

Answer 30

This is a medical emergency and so immediate referral to ER or calling 911 is appropriate

Question 31

What are signs of acute epiglottitis

Answer 31

The 3 D’s: dysphagia, drooling, and distress. Hot potato voice, tripod position, fever, anxiety, feeling of choking

Question 32

Which oxygen mask allows for the most accurate delivery of oxygen

Answer 32

Venturi Mask