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Disciplines Exam 4 > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

Dyspnea Definition

A

Subjective feeling of difficult, labored, or uncomfortable breathing

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2
Q

Tachypnea Definition

A

Rapid breathing

Normal varies by age

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3
Q

Bradypnea Definition

A

Slow breathing

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4
Q

Orthopnea Definition

A

Dyspnea in recumbent position

MC in CHF

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5
Q

Paroxysmal nocturnal dyspnea definition

A

Dyspnea that awakens pt from sleep

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6
Q

Hypoxia Definition

A

Insufficient delivery of O2 to tissues.

SaO2 < 94% on Room Air

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7
Q

Hypoxemia (Blood Gas)

A

Abnormally low arterial O2 tension

PaO2 < 60mmHg

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8
Q

Causes of Hypoxemia

A

Hypoventilation-increased PaCo2

Right-2-Left shunt: hallmark = failure to increase O2 levels with supplemental O2

V:Q mismatch

Diffusion

Low inspired O2 (high altitudes)

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9
Q

Stridor

A

Upper Airway
Inspiratory
Foreign body, croup, epiglottis
Anaphylaxis

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10
Q

Wheezing

A

Lower Airway
Expiratory
Asthma, COPD, foreign body, cariogenic pulmonary edema

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11
Q

Rales

A

Lower airway
Sounds like velcro pulled apart
CHF

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12
Q

Ronchi/crackles

A

Lower airway

PNA

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13
Q

Symptoms of Hypoxia

A

Early:
Restlessness
Anxiety
Tachycardia/pnea

Late:
Bradycardia
Extreme Restlessness
Dyspnea

Peds:
Feeding difficulty
Inspiratory stridor
Nares Flare
Expiratory Grunt
Sternal retracting
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14
Q

Respiratory distress or failure

A

Inadequate O2 and/or vent
Signs: Tachypnea/bradypnea, retractions, nasal false, head bobbing (up for inhale, down for exhale), pre-arrest, AMS, See-saw breathing (abd muscles) hypoxia

Grunting = late

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15
Q

PNA

A

Infection of alveoli

Triad: FEVER, DYSPNEA, COUGH

Sputum:
Rust = Step PNA (MC)
Green = Pseudo, Haemophilus
Red currant: Klebsiella
Foul-smelling or bad-test: anaerobes

Signs/symp:
brady/hypoNa: legionella
Bulls myringitis: myco PNA

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16
Q

CAP vs HAP vs VAP

A

CAP: pt no hospitalized/resident of LTC x 14 days prior

HAP (nosocomial): > 48hr post-admit

VAP: PNA > 48 hr post-intubate

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17
Q

Healthcare-associated

A 
pt hospitalized > 2d last 90d
NH resident
IV ABX
HD
Chronic Wounds
Chemo
Immunocomprosmised
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18
Q

Aspiration PNA

A

Inhalation of oropharyngeal secretion

Risk increased:
poor cough (muscle weakness)
poor gag reflex
Impaired swallow
GI dysmotility
ETOH
CNS depression
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19
Q

Streptococcus PNA

A

MCC PNA
symptoms: sudden fever, rigors, productive cough, dyspnea

Risks: elderly, <2y.o
minorities
Day care
Underlying medical conditions

Lobar infiltrate

para-PNA pleural effusion (around infiltrate)

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20
Q

Lobar Infiltrates on CXR

A

Heart edge = RML

Upper, no touch: RUL

Lower, Heart border intact: RLL

If on L and hits heart: LUL (lingular)

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21
Q

Staph Aureus PNA

A

Common following viral

CXR shows extensive infiltrates (Cavitations)

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22
Q

Klebsiella PNA population

A

Common in ETOH, NH its

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23
Q

PNA diagnostic testing

A 
CXR, CT (CT tech better)
CBC
Chems
ABG
Blood cultures (req'd if you admit)
Lactic Acid (measures if tissues getting enough NTR/O2; also treatment measure)
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24
Q

PNA Therapy

A 
IVF (NS/LR)
Antipyretics (HR incr 10 /1degree over normal)
O2
Bronchodilator
Abx
Cough Suppressant w/ expectorant
Steroids
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25
Q

HCAP Abx

A 
Cefepime
Ceftazidime
Piperacillin-Tazobactam
Ciprofloxacin
Levofloaxin
Vancomycin
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26
Q

CURB 65

A 
Mortality Predictor
Confusion
Uremia (BUN>20)
Resp Rate > 30 br/min
BP < 90mmHg sys/60mmHg dia
Age > 65

0-1 OP
2 admit
3-5 ICU

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27
Q

High Altitude Illness

A

Partial Pressure of O2 decr as barometric pressure changes
elevates >5000ft (MC 8-14K)
Most pronounced during sleep
Most critical: sleeping altitude and rate of ascent

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28
Q

Altitude Acclimation (ventilation response)

A
  1. Carotid body senses decr in art O2
  2. Stimulates medulla to incr. vent rate (resp alka)
  3. Response lessened by rest depressants, chronic hypoxia
  4. Acetazolamide causes bicarb diuresis
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29
Q

Altitude Acclimation (blood)

A

Erythropoietin increased in plasma
Increases RBC mass
Starts as early as 2 hours after ascent

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30
Q

Altitude Acclimation (fluid)

A

Peripheral venoconstriction increases central blood volume

ADH and aldosterone suppressed causes diuresis

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31
Q

Altitude Acclimatization (CVD)

A

HR incr. to compensate for decr stroke volume
Max exercise HR decr
Pull vessels constrict
Cerebral blood flow increases

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32
Q

Altitude Acclimatization (sleep)

A

Cheyne-Stokes breathing common > 9000 ft

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33
Q

Acute Mountain Sicknesss

A

Si/sx: lightheaded, dizzy, H/a (bifrontal, incr bending over/valsalva), breathlessness w/ activity, anorexia, Nausea, weakness, irritability
Findings: postural Hypotension, rales up to 20% retinal hemorrhages, FLUID RETENTION (decr urination)

34
Q

Acute mountain Sickness Patho

A

Hypoaric hypoxia

  1. Cerebral blood increases
  2. Brain enlarges
  3. Vasogenic Edema develops
35
Q

Acute Mountain Sickness Treatment

A 
Halt further ascent until symptoms resolve
500-1000m descent rapidly effective
O2 0.5-1L/min
Acetazolamide (has sulfa)
ASA, tylenol, motrin
Dexamethasone
36
Q

Acute Mountain Sickness Prevention

A

Gradual Ascent
Avoid overexertion, ETOH, Respiratory depressant
Eat High CHO meal
Start Acetazolamide 24 hr before ascent (stop 2 days at altitude, resume if symptoms reoccur)
Dexamethasone

37
Q

High Altitude Cerebral Edema

A

AMS w/ neuro symptoms
-ataxia, stupor, coma, CN 3,6 palsy

Trx: O2, descent/evacuate, dexamethasone, loop diuretics

38
Q

High Altitude Pulmonary Edema (Si/sx)

A

Most lethal of high altitude illnesses

Si/sx: dry cough prog into productive, decr exercise performance incr recovery time, rales (incr post-ex), incr dyspnea, Coma, death

39
Q

High Altitude Pulm Edema trx and background

A

Due to high pulm microvascular pressures development of pulm HTN

Trx: recognition, TOC: IMMEDIATE DESCENT, O2 (72 hr), Nifedipine

40
Q

CHF (MC’s)

A

MC reason for admit in Medicare pts

MCC: LV dysfxn (Aortic Stenosis, HTN, A fib, CAD)

41
Q

CHF (Si/sx)

A

hypoxemia, HTN, tachycardia, dyspnea, wt gain, rales

42
Q

Right vs Lef sided

A

Left: dyspnea, fatigue, cough, PND, orthopnea

Right (Swelling)): Peripheral Edema, JVD, RUQ pain

43
Q

CHF Testing

A 
CBC (anemia)
Chems (lytes, renal fxn)
Cardiac Enzymes
Pro-BNP (released by ventricular myocardium 2/2 stretching; >200)
EKG: LV hypertrophy, dysrhythmias, STEMI
CXR: low sensitive, dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulm artery, pleural effusions, kerley lines
U/s: lung: B lines (comet tails)
Echo: LV/valve fxn, tamponade, VSD
44
Q

CHF Trx

A

Adequate O2/vent (non-invasive vs invasive)
Nitro (decr preload, bp)
Morphine sulfate (decr preload, anxioloysis)
Diuretic (furosemide = MC; 90 min, causes ventilation, diuresis)
Dobutamine (+ inotropic effect w/ mild chornotropic; in addition to Nitro)
CCB: may cause pulm edema, card shock
NSAIDS: inhibit effect of diuretics
Anti-arrhythmic’s: pro-arrhythmic effects

45
Q

Pulm Embolism (PE) background

A

3rd lead COD hospital
MCC nonsurgical maternal death peripartum
Occurs when prox venous thrombosis breaks off and travels to lung
-MC pelvic or deep LE veins (any except intracranial)
Virchow’s triad

46
Q

What is virchow’s triad

A

Venous stasis
Vessel wall inflammation
Hypercoagulability

47
Q

PE Risk Factors

A 
Malignancy
Obesity
Immobilization
Surgery
Trauma
CHF
Age > 40
Mobility (lack)
Estrogen excess
Long bone fx
Smoke
48
Q

PE Si/sx

A

Dyspnea, pleuritic chest pain (50%), syncope, LE pain/swell, confusion, anxiety, hyperemia

measure tibial tuberosity, <2cm difference between calves

TRIAD: PLEURISY, SOB, HEMOPTYSIS

49
Q

PE Risk (wells)

A 
Wells score
3=suspected
3=alt dx less likely
1.5= tachycardia
1.5 = immobile, sx (4 wks)
1=hemoptysis
1=malignant
0-1 = low
2-6 = mod
>6 = high
50
Q

PE Risk (geneva)

A 
Age >65
Active malignant
u/l LLE pain
prev DVT/PE
Hemoptysis
Recent sx/frx
tender LE veins or u/l LE edema
HR 75-94 (x2>94)

Low = 2
High >2

51
Q

PE risk (PERC)

A 
PE r/o
<50
PO >94%
HR < 100
o prior venous thromboembolism
no recent sx/trauma 4 weeks
no hemopotyis
no estrogen use
no u/l swelling

if all yes, risk < 2%

52
Q

PE testing

A

CXR: normal 1/3
-hamptoms hump, westermarks, felischner sign

V/Q scan
CT scan (Test of CHOICE)
-central clots, may miss small peripheral; req iodine

Echo: limited, R ventricular dyxfxn
Venous compression u/s

Blood: ABG - widened A-a gradient (alveolus vs artery)
D Dimer: fibrin degradation
Pro-BPN
Troponin
EKG: Sinus tacky (t-wave), S1Q3T3
53
Q

PE trx

A

Heparin, coumadin, lovenox, rivaroxaban, vena caval filter (contra to anticoag)

54
Q

Thrombolytic trx (indicate/contra)

A

Ind: massive PE, hemo unstable, massive ileofemoral DVT, large DVT w/ vascular compromise

Contra: major bleed last 6 mos, IC/spinal sx or trauma (2 mos), sx last 10d, peri/endocarditis, uncontrolled HTN (200/110), pregnancy, suspected aneurysm

55
Q

Thrombolytic trx (agents)

A

Streptokinase
Urokinase
Alteplase

56
Q

Thrombolytic trx (mech)

A

Embolectomy (massive PE w/ contra to fibrinolysis or unstable after)

Catheter directed thrombolyisis (alteplase + heparin)

57
Q

Asthma background

A

Chronic reversible inflammatory d/o

58
Q

Asthma Patho triad

A

Airway inflammation
obstruction to airflow
bronchial hyper responsiveness

59
Q

Asthma Clinical Triad

A

Dyspnea
Wheeze
Cough

60
Q

COPD

A

Chronic Irreversible d/o

Bronchitis: chronic productive cough x 3 dos in 2 yrs (clinical dx)

Emphysema: destruction of bronchioles and alveoli, pathologic d/x

61
Q

COPD Etiology

A 
Tobacco use (MC)
Occupational exposures
Environment exposures (pollution)
Alpha 1-antitrypsin deficit
IVDA
62
Q

COPD si/sx

A 
cough (worse in AM)
SOB
wheeze
tachypnea
cyanosis
63
Q

COPD Assessment

A

FEV1 (pt dependent)
can also be used to monitor therapy response

Pulse ox
CXR (abnormal only 1/3)

64
Q

COPD trx

A

Goals: reverse obstruction, provide adequate O2, relieve inflammation

65
Q

Beta Agonist

A

Cornerstone of COPD therapy
B1: incr rate/force cardiac, SI motility
B2: bronchodilation, vasodilator, uterine relax, tremor (small airways mostly)

Ex: albuterol

Delivery: MDI/Nebulizer (Spacer w/ MDI); intermittent vs continuous, Inhaled vs IV/SQ (longer into lungs!)

66
Q

Epinepherine

A

Bronchodilator (not B selective)
Nebulizer, SQ, IM
No benefit over albuterol

Only give IV in code

67
Q

Ipratropium Bromide

A

blocks cholinergic stimulation of airway smooth muscle
primarily on large central airways
give w/ beta agonists

68
Q

Corticosteroids

A

another cornerstone of therapy
decr inflammation and up regulate B receptors
high dose not recommended
-one

69
Q

Mg SUlfate

A

Severe exacerbations

inhibits SM action potential leading to bronchodilation

70
Q

Other COPD meds

A

Heliox (80% helium w/ O2) for severe, not for those needing increased O2

Theophylline (no longer)

Ketamine (conscious sedation); doesn’t affect VS but opens airway

71
Q

BiPAP indicate/contra

A

indicated: cooperative, dyspnea, tachypnea, increased work to breath, hypoxemia

Contra: emergent intubate, cardiac/resp arrest, inability to protect airway/clear secretions, decreased LOC, facial trauma/deformity, recent esophageal surgery

72
Q

Bipap deliver

A

Facial, nasal, helmet, vent

73
Q

What is BiPap

A

Bilevel + Airway Pressure
IPAP = inspiratory; EPAP = expiatory

IPAP - EPAP = pressure support (PEEP)

74
Q

Risk factors for death in COPD

A 
Prev severe exacerbation (intubate/ICU)
>2 hospital
>3 ED
hosp/ED last month
>2 MDIs/month
Diff perecieng symptom severity
low SES
illicit drug use
Psych illness
75
Q

COPD symptom progression

A 
Chest tightness
cough
wheeze
prolonged expire
accessory muscle use
alteration in mental status
76
Q

Foreign Body Aspriation

A

Potentially life-threatening event
peak age: 1-3; >85
4th COD accidentally @ home

RF: childhood development, too large food, fed by older siblings, small parts

Lethal objects: PB, nuts, marbles, grapes, balloons, beads, hotdog

77
Q

FB aspirate adult risks

A 
Risk: altered LOC
impaired swallow
Stroke dysphagia
Alzheimer dementia
Parkinson's
78
Q

FB presentation

A 
Depends on size and location of FB
Cough (acute)
stridor = laryngotracheal
wheeze = bronchial
SOB, cough, wheeze

universal choking sign

79
Q

what if no hx?

A

high index suspicion
dx considered in all kids w/ u/l (esp R) wheeze + persistent symptoms that don’t respond to bronchodilators
CXR may be normal in 50%

80
Q

FB Dx

A

CXR (radio-opaque), U/L hyper inflate
CT
Laryngoscopy/bronchoscopy

81
Q

Common Locatiosn for FB

A

MC: thoracic inlet (~clavicles); skeletal to smooth muscle
Cricopharyngeus muscle
Mid esophagus (aortic arch/carina)
Distal esophagus (lower essophageal sphincter)

82
Q

FB trx

A

conscious: heimlich; ask if you are choking and if i can help

Alone: self-hemilich

infant/child: between scapula on knee, CPR

Unconscious: CPR, no blind finger sweep

Disciplines Exam 4 (4 decks)

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