Respiratory emergencies Flashcards
What is pneumonia
infection of alveoli d/t bacteria, viruses, fungi, or yeast
What pathogens cause PNA based on presentation
Strep Pneumo: Rust sputum
Klebsiella: red currant jelly sputum (alcoholics/NH)
Pseudomonas, Heamophilus: green sputum
Anaerobes: foul smelling, bad tasting sputum
Legionella: Bradycardia, Hyponatremia
M. Pneumo: Bullous myringitis, OM
(Staph. Aureus more common after a virus, like influenza)
How does PNA present symptomatically
Triad: Fever + Dyspnea + cough
sudden onset fever
Rigors
Productive cough
What are pathogen specific CXR findings in PNA
Strep pneumo: Lobar infiltrate +/- parapneumonic pleural effusion
Staph Aureus: extensive infiltrates
What is CURB 65
Confusion Uremia (BUN >20) Respiratory Rate >30 BP <90/60 65+ y/o
How do you treat PNA
IV fluids O2 anti-pyretics Bronchodilator Abx Cough suppressant Steroids HCAP: Cefipime/Ceftazadime/Zosyn, Cipro/Levo/Vanco
What is Acute Mountain Sickness
High altitude sickness 2/2 hypobaric hypoxia
Cerebral blood icreases, brain enlarges, vasogenic edema develops
What are Sx of acute mountain sickness
Light headed HA (bi-frontal, worse w/ valsalva) Breathless w/ activity Anorexia Nausea weakness irritable
What are PE findings of Acute Mountain Sickness
Postural hypotension
Localized rales
Retinal hemorrhage
Fluid retention (anuresis)
How do you treat acute mountian sickness
Stop ascending Acetazolamide 125mg PO BID ASA/APAP/Motrin Dexamethasone Prevent w/ radual ascent, aovid alcohol or resp depresant, eat high carbs, Acetazolamide 24 hr prior, dexamethasone
What are Sx of High Altitude Cerebral edema
Ataxia
stupor
coma
CN 3, 6 palsy
How do you treat high altitude cerebral edema
Oxygen
Descent
Dexamethasone
Loop (Furosemide, Bumetanide)
What are symptoms of high altitude pulmonary edema
Dry cough progressive to productive Decreased exercise rales s/p exercise increasing dyspnea coma death
How do you treat high altitude pulmonary edema
Recognition
Immediate descent
O2 (takes 3 days)
Nifedipine
What is CHF
LV dysfunction (2/2 aortic stenosis, HTN, AFib, or CAD) causing hypoxemia, HTN, tachy, dyspnea, weight gain, and rales
What are L and R symptoms of CHF
L= Lungs (dyspnea, fatigue, cough, PND, orthopnea) R= Swollen (peripheral edema, JVD, RUQ pain)
What are PE findings in CHF
CXR: dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulmonary artery, pleural effusion, Kerley B lines)
Pro BNP >200
Get a CXR, EKG, lung US, and echo- CBC, CMP, cardiac enzymes, pro-BNP
How do you treat CHF
O2 Vent Nitro Morphine Furosemide Dobutamine
What do you AVOID in CHF
CCB (pulm edema or shock)
NSAID (inhibit diuretic)
Anti-arrhythmics (pro-arrhythmics)
What is a PE
Proximal portion of venous thrombosis breaks off and travels to lung (MC pelvic or LE veins)
Big cause of non-surgical maternal death in peripartum period
What are Sx of PE
Virchows triad (Hypercoagulable + venous stasis + vessel wall inflammation)
Dyspnea, pleuritic CP, syncope, LE pain/edema, confusion, anxiety, hypoxemia
PE Triad: Pleuritic CP + SOB + hemoptysis
What are some PE findings in PE
Calves >2cm difference
Wells score 2-6 = moderate, 6+ high risk
Geneva score 3+ high risk
What are diagnostic findings due to PE
CT*: pref Dx
CXR: Hampton’s hump, westermark’s sign, fleischner sign
VQ scan: mismatch
Echo: RV enlargement
Cardiac enzymes: pro-BNP or trop
ECG: sinus tach common (S1Q3T3 classic R heart strain)
Venous compression, ABG, D-dimer
How do you treat PE
Heparin (monitor aPTT) Coumadin Lovenox Rivaroxaban IVC filter if coags C.I. Thrombolytics (streptokinasse, urokinase, tPA) Embolectomy if massive and tPA C.I. Catheter thrombolysis (tPA then heparin)
What is Asthma
Chronic reversible inflammatory d/o affecting mostly kids
*Causes Dyspnea, wheezing, coughing
What is the triad associated with Asthma
Airway inflammation + Airflow obstruction + Hyperresponsiveness
What is COPD
Chronic, IRreversible disorder
Chronic Bronchitis (cough 3+ mo for 2+ yrs)
Emphysema (destroyed bronchioles and alveoli
RF for COPD are
Tobacco use*****
occupational, environmental
AAT deficiency
IVDA
What are Sx of COPD
Cough, worse in AM
SOB, wheezing, tachypnea, cyanosis
Progress to chest tightness, prolonged expiration, accessory muscle use, AMS
What diagnostics should you do in COPD
FEV1 Pulse ox (+/- CXR, blood test)
What are goals of therapy and two preferred treatments of COPD
Reverse obstruction, provide oxygen, relieve inflammation
Beta Agonist (broncho/vasodilate, relax uterus, cause tremor)
Steroids (DXm, methylpred- not high dose)
(Can also Tx with epinephrin, SAMA, Mag/sulfate if severe, Ketamine)
BiPAP
When does FB aspiration usually occur
1-3 y/o (they put everything in their mouths, large food particles)
85+ y/o (ALOC, dysphagia 2/2 stroke, impaired swallowing, alzheimers, parkinsons)
What are Sx of FB aspiration
Cough stridor (if laryngotracheal) wheezing (if bronchial) SOB Universal choking sign
Where are FB MC found
- Thoracic inlet (level of clavicles on XR)
- Mid-esophagus (aortic arch and carina overlap)
- Distal esophagus (LES)
What are your diagnostics for FB
CT, Laryngoscopy*
CXR can be normal in 50%
How do you manage a FB aspiration
Ask if choking and if you can help- “Abdominal Thrust”
If alone: put fist at navel, lean over chair, dive fist up
Infant: face down across forearm and give 5 forceful quick blows with heel of hand
Child: 2 fingers in middle of infant’s chest and 5 quick thrusts downward
Unconscious: CPR (NO BLIND FINGER SWEEP)
Magil forceps to remove
What is right to left shunting
A cause of Hypoxemia
Hallmark is failure to increase oxygen levels with supplemental oxygen
What are the different kinds of PNA
CAP: strep pneumo, not in hospital in last 14 days
VAP: PNA 48 hrs s/p intubation
HAP: PNA 48 hr s/p admit
HCAP: in hospital >2 days in last 3 mo. in NH, IV abx, dialysis, chronic wound, chemo, immunocompromised
How do you compensate Metabolic acidosis
Respiratory alkalosis (low CO2)= Hyperventilation, Kussmaul breathing
How do you compensate Metabolic Alkalosis
Respiratory acidosis (high CO2)= hypoventilation
What is a cause of Respiratory Alkalosis
high altitude illness causing hypoxic ventilator response–>hyperventilation
What causes an increased osmolar gap
ME DIE Methanol Ethanol Diuretics Isopropyl alcohol Ethylene glycol
