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Disciplines 3 Shea > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

6 Ps of Dyspnea

A
  • Possible FB
  • Pulmonary Embolus (PE)
  • PNA
  • Pump failure
  • Pneumo-thorax
  • Pulmonary Bronchial Constriction
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2
Q
  • Dyspnea in recumbent position
  • Most commonly seen w/ congestive HF
A

Orthopnea

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3
Q

Dyspnea that awakens pt from sleep

A

Paroxysmal nocturnal dyspnea

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4
Q
  • Insufficient delivery of oxygen to tissues
  • Most say SaO2 is < ___ on room air
A

Hypoxia

<94%

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5
Q
  • Abnormally low arterial oxygen tension
  • PaO2 <____
A

Hypoxemia

<60 mmHg

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6
Q

5 causes of hypoxemia

A
  • Hypoventilation (Increased CO2)
  • R to L shunt (failure to increase oxygen levels w/ supplemental oxygen)
  • V/Q mismatch
  • Diffusion
  • Low inspired oxygen (high altitudes)
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7
Q
  • upper airway
  • inspiratory
  • FB / croup / epiglottitis / anaphylaxis
A

Stridor

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8
Q
  • lower airway
  • expiratory
  • asthma / COPD / FB / cardiogenic pulm edema
A

Wheezing

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9
Q
  • Lower airway
  • Sounds like velcro being pulled apart
  • CHF
A

Rales

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10
Q
  • Lower airway
  • PNA
A

Rhonchi

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11
Q
  • high pitched
  • inspiration
  • NOT cleared w/ cough
  • (discontinuous)
A

Crackles

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12
Q
  • Loud, low, course
  • Snore
  • inspiration or expiration
  • MAY clear w/ cough
  • (continuous)
A

Rhonchi

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13
Q
  • Muscal noise
  • inspiration or expiration
  • Louder during ____
  • (continuous)
A

Wheezing

Louder during expiration

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14
Q

3 early sxs of hypoxia

A
  • Restlessness
  • Anxiety
  • Tachycardia / Tachypnea

(RAT)

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15
Q

Late sxs of Hypoxia

A
  • Bradycardia
  • Extreme restlessness
  • Dyspnea

BED

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16
Q

Sxs of hypoxia in pediatrics

A
  • Feeding difficulty
  • Inspiratory stridor
  • Nares flare
  • Expiratory grunting
  • Sternal retractions

(FINES)

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17
Q

3 features of PNA

A
  • Increased Exudates
  • Decreased Gas exchange
  • Obstruction of bronchioles

(EGO)

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18
Q

Which organism for PNA?

  • Rust colored?
  • Green colored?
  • Red currant jelly?
  • Foul smelling or bad tasting?
A
  • Rust: Strep pneumo
  • Green: Pseudomonas / Haemophilus
  • Currant: Klebsiella
  • Foul: Anaerobes
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19
Q

Which organism for PNA?

  • Bradycardia , hyponatremia?
  • Bullous myringitis?
A
  • Legionella
  • Mycoplasma pneumo
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20
Q

PNA is the infection of _____.

w/ what 4 things?

A

alveoli

  • bacteria
  • viral
  • fungal
  • yeast
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21
Q

Environmental classifications of PNA

  • PNA in pt who has NOT been hospitalized or resident of long term care for 14 days prior to presentation
  • PNA occuring >48 hrs after admission
  • PNA occuring >48 hrs after intubation
A
  • CAP
  • HAP (nosocomial)
  • VAP
22
Q

Environmental Classification

  • PNA in pt hospitalized >2 days within past 90 days
  • Nursing Home resident
  • IV abx
  • Dialysis
  • Chronic wound pts
  • Pts receiving chemo
  • Immunocompromised
A

Health Care Associated PNA (HCAP)

23
Q

Environmental Classification of PNA

  • inhalation of oropharyngeal secretions
  • Risk increased w/
    • poor cough
    • poor gag reflex
    • Impaired swallowing
    • GI dysmotility
    • Alcoholism
    • CNS depression
A

Aspiration PNA

24
Q

What is the most common cause of PNA?

A

Streptococcus pneumoniae

25
Q

Sudden onset of fever, rigors, productive cough, dyspnea

26
Q

5 risk factors for PNA

A
  • Elderly
  • Children <2 yrs
  • Minorities
  • Day care
  • Underlying medical conditions
27
Q

Which PNA causes:

  • lobar infiltrate
  • 25% w/ para-pneumonic pleural effusion
A

Streptococcus pneumoniae

28
Q

What is shown here?

A

Lobar infiltrates from PNA

29
Q

What is shown here?

A

Lobar infiltrates from PNA

30
Q
A

Bullous Myringitis

31
Q
A

Otitis Media

32
Q

Which organism causing PNA?

  • Commonly follows viral infection
  • CXR usually shows extensive infiltrates
A

Staphylococcus aureus

33
Q

Which organism causing PNA?

  • Common in alcoholic and Nursing Home pts
A

Klebsiella

34
Q
  • IV fluids
  • Antipyretics
  • Oxygen
  • Bronchodilator
  • Abx
  • Cough suppressant w/ expectorant
  • Steroids
A

Therapy for PNA

35
Q

Mortality Predictor for PNA

A

CURB 65

  • Confusion
  • Uremia (BUN >20)
  • RR >30
  • BP <90/60
  • Age: >65
36
Q

W/ CURB 65, the patient gets a point for each item

  • 0-1
  • 2
  • 3-5
A
  • 0-1 low : Outpatient / Home
  • 2 moderate : Admission to Hospital
  • 3-5 high : ICU
37
Q
  • High altitude is a hypoxic environment.
  • Oxygen concentration changes or remains constant?
  • Partial pressure of oxygen _____ as barometric pressure changes w/ elevation
  • Seen at elevations >____feet
  • Most commonly seen at _____ to _____ feet
  • Most pronounced during ____
  • 2 most critical items to consider?
A
  • Remains constant
  • decreases
  • 5,000
  • 8,000 to 14,000
  • sleep
  • sleeping altitude & rate of ascent
38
Q

Altitude Acclimatization : Ventilation

Hypoxic Ventilatory Response:

  • ____ senses decrease in arterial oxygen
  • Stimulates ____ to increase ventilation rate
  • Induces respiratory _____
  • Response is lessened by _____ and ______
  • Acetazolamide causes _______
A
  • Carotid body
  • medulla
  • alkalosis
  • respiratory depressants & chronic hypoxia
  • bicarbonate diuresis
39
Q

Altitude Acclimatization : Blood

  • _____ increased plasma
  • Increases red cell ______
  • Begins as early as ___ hours after ascent
A
  • Erythropoietin
  • mass
  • 2
40
Q

Altitude Acclimatization : Fluid

  • Peripheral venoconstriction increases ______
  • ADH & aldosterone suppressed leads to what?
A
  • central blood volume
  • diuresis
41
Q

Altitude Acclimatization : Cardiovascular

  • Heart rate ___ to compensate for ____ stroke volume
  • Maximum exercise HR increases or decreases?
  • Pulmonary vessels constrict or dilate?
  • Cerebral blood flow increases or decreases?
A
  • HR Increases , decreased SV
  • Max exercise HR decreases
  • Pulm vessels constrict
  • Cerebral blood flow increases
42
Q

Altitude Acclimatization : Sleep

  • Cheyne-Stokes breathing is common above _____ feet
43
Q

Sxs of what?

  • lightheaded / dizzy
  • HA (bi-frontal, increases w/ bending over / valsalva)
  • breathlessness w/ activity
  • Anorexia, nausea
  • Weakness
  • Irritability
A

Acute Mountain Sickness

44
Q

Findings of what?

  • Postural hypotension
  • Localized rales, up to 20%
  • Retinal hemorrhages
  • Fluid retention, hallmark finding
A

Acute Mountain Sickness

45
Q

Pathophysiology of Acute Mountain Sickness

  • Due to ____ hypoxia
  • Cerebral blood increases –> brain enlarges –> ____ edema develops
A
  • hypobaric
  • vasogenic
46
Q

Tx for Acute Mtn Sickness

  • Halt further ascent until sxs resolve
  • ____ to _____ m descent is rapidly effective
  • Oxygen 0.5-1L/min
  • Which 5 drugs?
A
  • 500 to 1,000
  • Acetazolamide
  • ASA
    Tylenol
  • Motrin
  • Dexamethasone
47
Q

How do you prevent Acute Mtn Sickness?

  • ____
  • Avoid what 3 things
  • Eat meals high in _____
  • _______ started 24 hours before ascent
  • Can stop after __ days at altitude / resume after sxs recur
  • What other drug?
A
  • Gradual ascent
  • Avoid: overexertion, alcohol, respiratory depressants
  • Carbohydrates
  • Acetazolamide 24 hrs before
  • 2
  • Dexamethasone
48
Q

High Altitude Cerebral Edema

AMS w/ neurological sxs

  • “CASA C”
A
  • Coma
  • AMS
  • Stupor
  • Ataxia
  • CN palsy 3, 6
49
Q
A

CN 3 palsy

(high altitude cerebral edema)

50
Q
A

CN 6 Palsy

(High Altitude Cerebral Edema)

Disciplines 3 Shea (13 decks)

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