Respiratory Emergencies and Ventilation

Question 1

Acute respiratory failure

Answer 1

Severe respiratory dysfxn that threatens the fxn of vital organs.
Consider of PO2 is 50

Question 2

Moderate altitude

Answer 2

8,000 - 10,000 ft

Question 3

High-altitude

Answer 3

10,000 - 18,000

Question 4

Pathophysiology of High-altitude

Answer 4

Hypobaric hypoxic condition
Fluid retention
Vasoconstriction
PA hypertension
Increased cap permeability
Edema

Question 5

Diamox dosage for high altitude

Answer 5

250 mg BID - TID

Question 6

Most common cause of ARDS?

Answer 6

Sepsis … probably.

Question 7

3 consequences of smoke inhalation

Answer 7

Impaired oxygenation
Thermal injury to upper airway
Injury to lower airway and lung parenchyma

Question 8

What is inhaled in a smoke mixture?

Answer 8

Hypoxemic gas mixture
Carbon monoxide
Cyanide
results in VQ mismatching

Question 9

Smoke inhalation tx

Answer 9

Supplemental O2 (humidified)
Bronchodilators
Suction of debris
Maintain airway
PEEP

Question 10

Cyanide Poisoning

Answer 10

Eating fruit pits
Product of burning wool, nylon, cotton, silk, plastics
May be inhaled or ingested

Question 11

Cyanide S/S

Answer 11

HA
dizziness, nausea, abd pain
anxiety, confusion
syncope, shock, seizures, coma, death

Question 12

What does cyanide do?

Answer 12

Prevents cellular oxygen utilization
Causes anion gap metabolic acidosis
Increased lactate production

Question 13

Cyanide toxicity tx

Answer 13

Inhaled and IV nitrites
- Amyl and sodium nitrite
Injected sodium Thiosulfate

Question 14

What is the problem with cyanide antidote?

Answer 14

It is contraindicated with concominant CO poisoning

Must use Cyanokit

Question 15

Carbon Monoxide Poisoning

Answer 15

Colorless, odorless gas
Causes tissue hypoxia
Binds hemoglobin with greater affinity than O2 (230-270x more affinity)

Question 16

What will skin look like with CO poisoning?

Answer 16

Cherry red

Question 17

CO poisoning tx

Answer 17

100% O2 for 4 hrs

Hyperbaric is better

Question 18

Pulmonary Embolism EKC findings

Answer 18

S1 QT3

Question 19

PE Tx

Answer 19

O2
Heparin
Fibrinolytics?
Outpatient anticoagulation
Maybe an IVC filter

Question 20

Acute Asthma

Answer 20

Severe hypoxia
inability to maintain airway
Advanced RR and effort
Symptoms are unresponsive to initial tx

Question 21

Peak flow of less than ___% of predicted =?

Answer 21

severe

Question 22

Acute asthma Tx

Answer 22

DuoNeb
Solu Medrol
If treatment is failing....
Magnesium sulfate
Epi
Terbutaline

Question 23

Drowning

Answer 23

3rd most common cause of accidental death in US

2nd most common in people <5

Question 24

Drowning Pathophysiology

Answer 24

Panic leads to loss of normal breathing pattern
Breath holding, air hunger, struggle to stay afloat
Aspiration
Reflex laryngospasm
V/Q mismatch
Intrapulmonary shunting
Decreased compliace

Question 25

Wet drowning

Answer 25

Aspiration of fluid or foreign material

Question 26

Dry drowning

Answer 26

Laryngospasm or airway obstruction

Question 27

Water in the lungs leads to

Answer 27

Decreased surfactant
ARDS
SOB, crackles, wheezing

Question 28

Drowning can lead to?

Answer 28

Cerebral edema
Acid/base inbalance
Arrhythmias
V-fib

Question 29

Drowning tx

Answer 29

CPR if needed
Support airway
Rewarm
Bronchodilators help
Admit for obs

Question 30

Pneumothorax

Answer 30

Accumulation of air in pleural space
Can be spontaneous or trauma indiced
Needly decompression
Chest tube

Question 31

PEEP Side effects

Answer 31

High intrathoracic pressure
Decreased CO
Can produce pulmonary barotrauma
May worsen air trapping

Question 32

Non-invasive PPV

Answer 32

Purpose is to prevent intubation