Respiratory Emergencies and Mechanical Ventilation Flashcards
Bare minimum history you need to obtain from a pulmonary patient
allergies, medications, past illnesses, last meal, events preceding episode that brought them in
Partial pressures for qualification of acute respiratory failure
PO2 is < 60 mmHg or PCO2 is > 50 mmHg
What sign of hypoxemia is usually observed before a patient crashes?
restlessness
Patients who should be considered for non-invasive positive pressure ventilation
patients who can protect/maintain their airway. Commonly used for COPD exacerbations
Most common cause of ARDS
sepsis
Why should you use the lowest level of PEEP (positve end expiratory pressure) when treating ARDS?
too much can decrease cardiac output
Which of the following describe hypobaric hypoxic condition: fluid retention, vasoconstriction, pulmonary artery HTN, increased endothelial permeability, edema?
All of them describe hypobaric hypoxic condition
Medical treatment for acute mountain sickness
Acetazolamide. Or alternative dexamethasone
Hallmarks of high altitude cerebral edema
altered consciousness and ataxic gait
What is the most common fatal manifestation of high altitude illness?
High altitude pulmonary edema (HAPE)
Important clinical sign of high altitude sickness
dyspnea at rest
Medical therapy of high altitude pulmonary edema
Acetazolamide, dexamethasone, sildenafil, nifedipine, salmeterol
What factors contribute to the impaired oxygenation of smoke inhalation?
Hypoxemic gas mixture, Carbon monoxide, Cyanide, and V/Q mismatching
Causes of thermal injury of the upper airway
mucosal edema, upper airway obstruction, inability to clear oral secretions
Treatment of smoke inhalation
humidified O2, bronchodilators, intubation, PEEP if bronchiolar edema
How many peach pits would you have to ingest for a lethal dose os cyanide poisoning?
4
Pathophysiology of cyanide poisoning
patients CANNOT release oxygen from oxyhemoglobin which results in higher venous PaO2 and severe tissue hypoxia
Signs of cyanide poisoning
Increased lactate production, Anion gap metabolic acidosis, and Elevated venous oxygen saturation
three pronged approach to the treatment of cyanide poisoning
Inhaled nitrites (amyl nitrites), Injected nitrites (sodium nitrite), and Injected Sodium Thiosulfate
Under what conditions is the three pronged approach to cyanide poisoning contraindicated?
concomitant carbon monoxide poisoning
Pathophysiology of carbon monoxide poisoning
inability to transport O2 via hemoglobin. CO binds with Hgb 230-270 times stronger than with O2
Classic sign of carbon monoxide poisoning
“cherry red” coloring of the skin
Treatment for carbon monoxide poisoning
administration of 100% O2 for 4 hours. Hyperbaric oxygen therapy in severe cases
Classic EKG findings of pulmonary embolism
S1Q3T3 (S waves in lead I, Q waves in lead III, and inverted T waves in lead III) and tachycardia
Treatment of PE
O2, heparin, fibrinolytics if hemodynamic compromise, anticoagulation for 3-6 months. Inferior vena cava filter if large clot burden or unable to anticoagulate the patient
At what peak flow is an acute asthma attack considered severe?
Peak flow less then 40 % of predicted
When should you give magnesium sulfate for an acute asthma attack?
For life threatening exacerbations that remain severe after 1 h of intense bronchodilator therapy
What two meds should not be used together for severe asthma attack unresponsive to bronchodilatrs?
epi and terbutaline
What is the difference between wet and dry drowning?
Wet- Aspiration of fluid or foreign material
Dry- Laryngospasm or airway obstruction
Pathophysiology of drowning
V/Q mismatch, Intrapulmonary shunting, Decreased compliance
End organ effects of drowning
metabolic and/or respiratory acidosis. sinus bradycardia and V. fib
How long should resuscitative efforts be continued in hypothermic patients?
continued until the pts temperature is 32-35C (90-95F)
When should you suspect a tension pneumothorax?
labored breathing, tachycardia, hypotensive, tracheal shift, JVD
Treatment for pneumothorax
needle decompression chest tube
Name two advantages of negative pressure ventilation (“iron lung”)
Allows long-term ventilation without artificial airway. Maintains normal intrathoracic hemodynamics
For abnormal ABGs in a mechanically intubated patient, how can you adjust pH/pCO2?
vent settings- TV, RR, PS
For abnormal ABGs in a mechanically intubated patient, how can you adjust pO2, SO2?
vent settings - FIO2, PEEP/CPAP
