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Disciplines (Emergency) > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Hypoxia

A

SaO2 <94% on room air

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2
Q

Hypoxemia

A

Low arterial oxygen <60mmHg

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3
Q

What condition’s hallmark is failure to increase oxygen levels with supplemental oxygen?

A

Right to left shunt

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4
Q

Stridor

A
  • Upper airway
  • inspiratory

Causes: Foreign body, croup, epiglottitis, anaphylaxis

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5
Q

Wheezing

A
  • Lower airway
  • Expiratory
  • “musical quality”

Causes: Asthma, COPD

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6
Q

Rales

A
  • Lower airway
  • “velcro being pulled apart”

Ex. Congestive Heart Failure

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7
Q

Rhonchi

A

-Lower Airway
-Pneumonia
“loud, low, coarse. snore-like”

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8
Q

Signs of respiratory distress in children

A
  • subcostal retractions
  • nasal flaring
  • head bobbing
  • Seesaw breathing
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9
Q

Pneumonia with green-colored sputum

A

Pseudomonas, Heamophilus

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10
Q

Pneumonia with red currant jelly sputum common in alcoholics and nursing home patients?

A

Klebsiella

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11
Q

Pneumonia with bradycardia, hyponatremia

A

Legionella

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12
Q

Pneumonia with bullous myringitis (blister on the ear drum)

A

Mycoplasma pneumoniae

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13
Q

Hospital-acquired PNA - when does it occur?

A

PNA symptoms after 48 hours of being admitted (otherwise it is CAP)

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14
Q

Symptoms of streptococcus pneumoniae PNA

A
  • Sudden onset fever
  • Rigors**
  • Productive cough
  • Dyspnea
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15
Q

What antibiotics woud you treat with for HCAP?

A 
-Cefepime 
or
-Ceftazidime
or
-Piperacillin-tazobactam
or 
-Levofloxacin
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16
Q

What does CURB65 stand for?

A

Confusion
Uremia (BUN >20)
Respiratory rate (>30 breaths/min)
Blood pressure <90mmHg or 60mmHg diastolic

65- over 65 years old?

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17
Q

What is CURB65 used for?

A

mortality predictor in PNA. Helps us decide who needs to be admitted

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18
Q

CURB 65 point ranges?

A

0-1: outpatient
2: admit
3-5: ICU

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19
Q

When is high altitude illness most pronounced?

A

During sleep (Cheyne-Stokes breathing)

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20
Q

At what elevations can High altitude illness be seen?

A

> 5000 feet (ex. Denver)

(most commonly at 8,000-14,000)

ex. Mt. Hood is 11,000ft

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21
Q

High altitude causing increased respiratory rate leading to alkalosis. What is the treatment?

A

Acetazolamide (Diamox)

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22
Q

What is the hallmark finding in Acute Mountain Sickness?

A

Fluid retention

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23
Q

Acute Mountain Sickness: treatment

A
  1. Halt ascent, descend as quickly as possible
  2. Oxygen
  3. Acetazolamide
  4. Aspirin 650mg
  5. Dexamethasone 4mg every 6 hours
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24
Q

What cranial nerve palsys are associated with High Altitude Cerebral Edema?

A

Cranial nerve 3,6

CN 3 palsy - “down and out”

25
Q

What is the treatment for High Altitude Cerebral Edema?

A
  • Oxygen
  • Dexamethasone
  • Loop diuretic
26
Q

What is the most lethal form of high altitude illness?

A

high altitude pulmonary edema

27
Q

What are the 3 treatments to give to a patient experiencing High altitude Pulmonary Edema?

A
  1. Immediate descent**
  2. Oxygen
  3. Nifedipine
28
Q

What is the most common reason for admission in medicare patients?

A

CHF

29
Q

Which lab when over 200 is suggestive of CHF?

A

Pro-BNP

30
Q

Congestive Heart Failure: EKG findings

A
  1. LV hypertrophy
  2. Dysrhythmias
  3. STEMI
31
Q

What CXR finding would help confirm suspicion of CHF?

A

If the heart size is >50% of the chest diameter

32
Q

In a patient with CHF, ultrasound of the lungs may reveal what?

A

Kerley B lines

  • Equidistant, normally spaced lines
  • “comet tails”
33
Q

CHF: treatment

A
  1. Diuretic (Furosemide)

2. Dobutamine (sympathomimetic Beta 1 agonist)

34
Q

What treatments should be avoided in CHF (3)

A
  1. CCB
  2. NSAIDs
  3. Anti-arrhythmics
35
Q

Most common cause of nonsurgical maternal death in peripartum period

A

PE

36
Q

Virchow’s Triad

A
  1. Venous Status
  2. Venous Injury
  3. Hypercoagulable state
37
Q

PE symptom triad

A
  1. Pleuritic chest pain
  2. SOB
  3. Hemoptysis
38
Q

What scoring system is used for risk assessment of PE and DVT?

A

Wells criteria

39
Q

What does a Wells score of >6 mean?

A

high probability (>6)

40
Q

What does a Wells score of 3 mean?

A

Moderate risk (2-6)

41
Q

What is PERC criteria used for?

A

Rule out pulmonary embolism

42
Q

What are the 3 characteristic signs on CXR for PE?

A
  1. Hampton’s Hump - triangular pleural based infiltrate with apex pointed toward hilum (toward clot)
  2. Westermark’s sign - dilated pulmonary vessels proximal to embolus with sharply demarcated cutoff
  3. Fleishner sign - distended central pulmonary artery
43
Q

What is the best diagnostic test for PE?

A

CT scan

44
Q

D-Dimer

A

If negative –>very unlikely to have a clot (false negative: warfarin, or recent onset <5 days)

If positive–>not very specific (could be cancer, infection, surgery, >70 years old, trauma, MI, liver disease pregnancy…)

45
Q

What is the most common finding on an EKG for PE?

A

sinus tachycardia

46
Q

Classic EKG for PE

A

S1Q3T3 - demonstrating heart heart strain

47
Q

PE: Treatment (anticoagulation)

A
  • Heparin
  • Coumadin
  • Lovenox
  • Rivaroxaban (Xeralto)
  • Filter in Vena Cava
48
Q

Thrombolytic treatment: Indications

A
  • Hemodynamically unstable
  • Massive ileofemoral DVT
  • Large DVT with significant vascular compromise
49
Q

Thrombolytic Treatment: contraindications

A
  • Major bleeding within 6 months
  • Intracranial bleed, trauma, or surgery wihtin 2 months
  • Peri/endocarditis
  • Uncontrolled HTN
  • Pregnancy
50
Q

What is the only FDA approved Thrombolytic treatment?

A

Alteplase (Activase) tPA

51
Q

Asthma pathophysiology triad

A
  1. Airway inflammation
  2. Obstruction
  3. Bronchial hyperresponsiveness
52
Q

Asthma: clinical triad

A
  1. Dyspnea
  2. Wheezing
  3. Cough
53
Q

Chronic bronchitis

A

presence of a chronic productive cough for 3 months for 2 years in a row

54
Q

When is the cough for COPD worst

A

in the mornings

55
Q

What is the best route for administering epi?

A

IM, more dependable absorption

56
Q

BiPAP contraindications

A
  • If the patient is going to be intubated
  • cardiac or respiratory arrest
  • Facial trauma
  • Recent esophageal surgery
57
Q

When is the peak age(s) for foreign body aspiration?

A

<1yr and >75yrs

58
Q

What is a helpful CXR finding in a foreign body aspiration?

A

unilateral hyperinflation

59
Q

MC location for a foreign body

A

thoracic inlet (level of the clavicles, site of anatomical change from skeletal to smooth muscle)

Disciplines (Emergency) (5 decks)

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