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Disciplines (Cholley) > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

What is the 3rd leading cause of death of hospitalized pts in US?

A

Pulmonary embolism

*Also MC nonsurgical maternal death peripartum

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2
Q

What makes up Virchow’s triad?

A
  • Venous stasis
  • Vessel wall inflammation
  • Hypercoagulability
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3
Q

What are RFs for pulmonary embolism?

A

“MOIST CAMELS”

  • Malignancy
  • Obesity
  • Immobilization
  • Surgery
  • Trauma
  • CHF
  • Age > 40
  • Mobility
  • Estrogen excess (birth control)
  • Long bone fx
  • Smoker
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4
Q

What are signs & sx of a pulmonary embolism?

A
  • Dyspnea
  • Pleuritic CP
  • Syncope
  • LE pain/swelling
  • Confusion/anxiety
  • Hypoxia
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5
Q

What is the pulmonary embolism triad?

A
  • Pleuritic CP
  • SOB
  • hemoptysis
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6
Q

What excludes significant pulmonary embolism if normal?

A

V/Q perfusion scan

But further dx testing required in 50-60%

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7
Q

What imaging studies are used for dx of pulmonary embolism? What is considered the test of choice?

A
  • CT w/ contrast (dx test of choice*)

- Echo (evals ventricular dysfunction)

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8
Q

What is a venous compression u/s used for? What does it measure?

A

To evaluate venous system

  • Measures groin distally
  • Evaluates femoral & popliteal veins
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9
Q

Can ABG be used to exclude or dx pulmonary embolism?

A

No!

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10
Q

What does a D-dimer measure?

A

Fibrin degradation products

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11
Q

When is a D-dimer elevated or reduced?

A
  • Elevated w/ CA, inflammation, infection, surgery, trauma, MI, pregnancy
  • Reduced w/ warfarin, sx < 5 days, small clot
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12
Q

What labs can be elevated when a pulmonary embolism is present?

A
  • Pro-BNP

- Troponin

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13
Q

What is the most common finding on EKG for pulmonary embolism?

A

Sinus tach

- S1Q3T3

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14
Q

Anticoagulation tx options for pulmonary embolism include what?

A
  • Heparin
  • Coumadin
  • Lovenox
  • Rivaroxaban
  • If anticoag contraindicated –> Vena caval filter
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15
Q

What are indications of thrombolytic tx?

A
  • Massive PE, hemodynamically unstable
  • Massive DVT
  • Large DVT w/ vascular compromise
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16
Q

What are contraindications for thrombolytic tx?

A
  • Major bleeding within 6 mos
  • Intracranial/spinal surgery or trauma within 2 mos
  • Surgery within 10 days
  • Peri/endocarditis
  • Uncontrolled HTN
  • Pregnancy
  • Aneurysm
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17
Q

What agents are used in thrombolytic tx?

A

Streptokinase, urokinase, altelplase

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18
Q

What is embolectomy reserved for?

A

Massive PE w/ contraindications/unstable to fibrinolysis

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19
Q

What does catheter directed thrombolysis consist of?

A

Alteplase, followed by heparin infusion

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20
Q

What is the pathophysiology triad for asthma?

A
  • Airway inflammation
  • Obstruction to airflow
  • Bronchial hyperesponsiveness
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21
Q

What is the clinical triad for asthma?

A

Dyspnea, wheezing, cough

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22
Q

What is the etiologies of COPD? (5)

A
  1. Tobacco use (MC)
  2. Occupational exposures
  3. Environmental exposures
  4. Alpha 1-antitrypsin deficiency
  5. IVDA
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23
Q

What are the signs & sx of COPD?

A
  • Cough
  • SOB
  • Wheezing
  • Tachypnea
  • Cyanosis
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24
Q

What can you use to assess COPD?

A
  • FEV1
  • Pulse oximetry
  • CXR (not routine)
  • Blood tests (not routine)
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25
Q

What are the goals of tx for COPD?

A
  • Reverse airflow obstruction
  • Provide oxygenation
  • Relieve inflammation
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26
Q

Pulmonary embolism: What is seen on CXR?

A
  • 1/3 are normal
  • Hamptons hump
  • Westermarks sign
  • Fleischner sign
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27
Q

What criteria is used to determine pulmonary embolism risk?

A
  • Wells
  • PERC
  • Geneva
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28
Q

What pharmacological treatments are available for COPD?

A
  • Beta agonists (Albuterol)
  • Epinephrine
  • Ipratropium bromide (give w/ beta agonist)
  • Corticosteroids
  • Magnesium sulfide (reserved for severe exacerbations)
  • Heliox (reserved for severe rxns - peds)
  • Theophylline (no longer recommended)
  • Ketamine (sedation)
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29
Q

What are indications for a BiPAP for COPD?

A
  • Cooperative pt
  • Dyspnea
  • Tachy
  • Hypoxemia
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30
Q

What are contraindications for BiPAP?

A
  • Need for emergent intubation
  • Cardiac/resp arrest
  • Inability to protect airway or clear secretions
  • Decreased LOC
  • Facial trauma or deformity
  • Recent esophageal surgery
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31
Q

What are 4 BiPAP delivery methods?

A
  • Facial mask
  • Nasal mask
  • Helmet
  • Ventilator
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32
Q

What is the difference btwn inspiratory PAP (IPAP) & expiratory PAP (EPAP)?

A

Pressure support

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33
Q

What are RFs for death due to COPD?

A
  • Previous severe exacerbation
  • > 2 hospitalizations in past yr
  • > 3 ED visits in past yr
  • Hospitalization or ED visit in past month
  • Use of > 2 MDIs per month
  • Difficulty perceiving sx severity
  • Low SES
  • Drug use
  • Psychiatric illness
34
Q

What sx indicate progression of COPD?

A
  • Chest tightness
  • Cough
  • Wheezing
  • Prolonged expiration
  • Accessory muscle use
  • AMS
35
Q

What is the 4th leading cause of accidental home death?

A

Foreign body aspiration

- Peak = 1-3 yo

36
Q

What are RFs for foreign body aspiration in adults?

A
  • Altered consciousness
  • Impaired swallowing
  • Stroke related dysphagia
  • Alzheimer’s dementia
  • Parkinson’s
37
Q

How do pts present when FB aspiration occurs?

A

Depends on size & location

  • Cough
  • Stridor (laryngotracheal FB)
  • Wheezing (bronchial FB)
  • SOB
  • Universal choking sign
38
Q

When & in whom should the dx of FB aspiration be considered?

A

In all children w/ unilateral wheezing & persistent sx that do not respond to bronchodilators

39
Q

What imaging studies can you use for dx of FB aspiration?

A
  • CXR (50% normal)
  • CT
  • Laryngoscopy/bronchoscopy
40
Q

What are common locations for FB?

A
  • MC = thoracic inlet
  • Mid esophagus
  • Distal esophagus
41
Q

How do you tx a conscious pt who aspirated a FB?

A

Ask - “Are you choking?”, “May I help you?”

42
Q

What do you do if you aspirate a FB when you are alone?

A
  1. Place fist above navel while grasping fist w/ other hand

2. Lean over chair or counter & drive fist towards yourself w/ upward thrust

43
Q

How do you tx an infant/child who aspirates a FB?

A
  1. Place infant stomach-down across forearm & give 5 blows on back w/ heel of hand.
  2. Place 2 fingers in the middle of the infant’s breastbone & give 5 downward thrusts
44
Q

How do you tx an unconscious pt who aspirated a FB?

A
  • CPR
  • Magill forceps removal

*Do NOT perform blind finger sweep

45
Q

What are s/s of resp. failure?

A
  • Inadequate O2 or ventilation
  • Tachypnea, bradypnea
  • Retractions
  • Nasal flaring
  • Head bobbing
  • AMS
  • See saw breathing
  • Hypoxia
46
Q

What are sx of pneumonia?

A
  • Fever
  • Dyspnea
  • Cough
  • Rigors
47
Q 
What type/color sputum do the following organisms present w/? 
Strep pneumo
Pseudomonas
Klebsiella
Anaerobes
A
  • Strep = rust
  • Pseudomonas = green
  • Klebsiella = red currant
  • Anaerobes = foul-smelling, bad-tasting
48
Q

What sx are suggestive of a legionella infection?

A
  • Brady, hyponatremia
49
Q

What sx is suggestive of mycoplasma pneumo?

A

Bullous myringitis - otitis media

50
Q

What are indicators of health care-associated pneumo? (HCAP)

A
  • In pt hospitalized > 2 days within past 90 days
  • NH resident
  • Pts receiving IV abx
  • Dialysis pts
  • Chronic wound pts
  • Chemo pts
  • Immunocompromised
51
Q

Risk of aspiration pneumo increases w/….

A
  • Poor cough/gag
  • Impaired swallowing
  • GI dysmotility
  • Alcoholism
  • CNS depression
52
Q

What are RFs for strep pneumo?

A
  • Elderly, children < 2
  • Minorities
  • Day care
  • Underlying condition
53
Q

What will you see on CXR for strep pneumo?

A
  • Lobar infiltrate

- 25% have para-pneumonic PE

54
Q

What lab tests should you order for pneumo?

A
  • CBC
  • Chemistry
  • ABG
  • Blood cultures
  • Lactic acid
55
Q

How do you tx pneumo?

A
  • IVF
  • Antipyretics
  • O2
  • Bronchodilator
  • Abx
  • Cough suppressant w/ expectorant
  • Steroids
56
Q

What abx are used to tx HCAP?

A
  • Cefepime or ceftazidime
  • Cipro or levo
  • Vanco
57
Q

What criteria is used to predict mortality for pneumo?

A

CURB 65 (1 pt for each):

  • Confusion
  • Uremia (BUN > 20)
  • RR > 30
  • BP < 90/60
  • > 65 yo
58
Q

What do the CURB 65 scores indicate?

A 
0-1 = inpatient
2 = admission
3-5 = ICU
59
Q

What are characteristics of high altitude illness?

A
  • Hypoxic environment
  • Partial pressure of O2 decreases as pressure changes w/ elevation
  • Elevations > 5000
  • Most pronounced during sleep
60
Q

What is the hypoxic ventilatory response?

A

Carotid body senses decrease in O2 –> stimulation of medulla to increase ventilation rate

61
Q

How does the blood acclimate to altitude?

A

Erythropoietin is increased

62
Q

How does fluid acclimate to altitude?

A
  • Peripheral venoconstriction increases blood volume

- ADH & aldosterone suppressed –> diuresis

63
Q

How does the cardio system acclimate to altitude?

A
  • HR increases to compensate for decreased SV
  • Pulmonary vessels constrict
  • Cerebral BF increases
64
Q

How does the body acclimate to altitude during sleep?

A

Cheyne-stokes breathing

65
Q

What are sx of acute mountain sickness?

A
  • Lightheaded, dizzy
  • HA (Bifrontal. Increases w/ bending over, valsalva)
  • Breathlessness w/ activity
  • Anorexia, nausea
  • Weakness
  • Irritability
66
Q

How does acute mountain sickness present? What is the hallmark finding?

A
  • Postural hypotension
  • Rales
  • Retinal hemorrhages
  • Fluid retention = hallmark
67
Q

What is the pathophys of mountain sickness?

A
  • Due to hypobaric hypoxia

- Cerebral blood increases –> brain enlarges –> edema

68
Q

What is the tx for acute mountain sickness?

A
  • Halt ascent until sx resolve
  • Descend 500-1000m
  • O2
  • Acetazolamide
  • ASA, tylenol, motrin
  • Dexamethasone
69
Q

How do you prevent mountain sickness?

A
  • Ascend gradually
  • Avoid overexertion, alcohol, resp. depressants
  • Eat high carb meals
  • Start acetazolamide 24hrs before ascent
  • Dexamethasone
70
Q

What are sx of high altitude cerebral edema?

A

AMS w/ neuro sx:

  • ataxia
  • stupor
  • coma
  • CN palsy 3 & 6
71
Q

How do you tx high altitude cerebral edema?

A
  • O2
  • Descend/evacuate
  • Dexamethasone
  • Loops
72
Q

What is the most lethal high altitude illness?

A

High altitude pulmonary edema

73
Q

What are sx of high altitude pulmonary edema?

A
  • Dry cough –> productive cough
  • Decreased exercise performance, increased recovery time
  • Rales
  • Dyspnea
  • Coma, death
74
Q

How do you tx high altitude pulmonary edema?

A
  • Immediate descent = TOC
  • O2
  • Nifedipine
75
Q

What is the MC reason for admission in Medicare pts?

A

CHF

76
Q

What causes LV dysfunction?

A
  • Aortic stenosis
  • HTN
  • AF
  • CAD
77
Q

What are s/s of CHF?

A
  • hypoxemia
  • htn
  • tachy
  • dyspnea
  • wt gain
  • rales
78
Q

What labs should you order for CHF?

A
  • CBC
  • Chemistry
  • Cardiac enzymes
  • Pro-BNP
79
Q

What imaging studies are used for CHF?

A
  • EKG (STEMI, LV hypertrophy)
  • CXR
  • US
  • Echo (tamponade, VSD)
80
Q

What is seen on CXR for CHF?

A
  • dilated upper lobe vessels
  • cardiomegaly
  • edema
  • enlarged pulm artery
  • pleural effusions
  • kerley lines
81
Q

How do you tx CHF?

A
  • O2 & ventilation
  • Nitroglycerin
  • Morphine
  • Diuretics
  • Dobutamine (can be given in addition to NTG)
82
Q

What tx should you avoid in CHF?

A
  • CCBs
  • NSAIDs
  • Anti-arrhythmics

Disciplines (Cholley) (9 decks)

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