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SD- ER pt 2 > Respiratory Emergencies Lecture > Flashcards

Respiratory Emergencies Lecture Flashcards

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1
Q

Prior intubations
Previous ICU admissions for asthma
Recent or frequent ED visits for asthma excaberations
Hospitalizations or ED visits in the last month
Use of 2 or more Albuterol inhalers in the last months
Use of air conditions

A

Risk factors for death from asthma

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2
Q

Pulse ox monitor
IV
+/- cardiac monitor
Initial peak flow and treatment
Oxygen to maintain SA-O2 or above 95%
Sit patient up
Act quickly before pt fatigues

A

General measures to take with asthma pts

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3
Q

What is the onset for inhaled beta2 agonists (ie Albuterol)

A

~5 mins

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4
Q

Relax bronchial smooth muscle
decrease histamine release
inhibit microvascular leakage into the airways
increase mucociliary clearance

A

MOA of beta 2 agonist (ie Albuterol)

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5
Q

Continuous nebulization of albuterol is used for what kind of asthma cases?

A

Moderate to severe

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6
Q

What is the nebulized albuterol dosage for an adult/child over 50 kg?

A

15 mg (18 ml)

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7
Q

What is the nebulized albuterol dosage for a child under 50 kg

A

7.5 mg (9 ml)

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8
Q

How frequently should you….

evaluate patient’s subjective response, physical exam and lung function (PFM)?

A

after each treatment

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9
Q

2 common side effects of albuterol

A

Tachycardia
Tremor

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10
Q

This is an alternative to albuterol

beta 2 receptor with some beta 1 activity

dosage: 0.63-1.25 mg neb TID (adult)
6-11 yo= 0.31 mg neb TID

A

Levalbuterol

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11
Q

_________ speed recovery and reduce reucrrence

A

steroids

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12
Q
  • Inhibit airway inflammation,
  • Reverse β-receptor down-regulation,
  • Block leukotriene synthesis,
  • Inhibit cytokine production and adhesion protein activation
A

Steroids

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13
Q

Do inhaled corticosteroids play a role in acute asthma exacerbation?

A

NO!

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14
Q

Solumedrol 125 mg IV

PO Prednisone 1-2 mg/kg

..which one is pediatric dosing and which one is adult dosing

A

Solumedrol IV= adult

Prednisone PO= kid

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15
Q

Standard of care for severe asthma exacerbations!

*produces bronchodilation

A

Epinepherine

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16
Q

What route is best to give Epinepherine during an acute asthma exacerbation?

A

IM!

(adult dose= 0.3-0.5 mg IM q20 mins for up to 3 doses)

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17
Q

Why is Terbutaline a good alternative to Epinepherine?

A

Less cardiac side effects!

(it is more expensive tho)

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18
Q

Selective beta2-agonist acts directly on beta2-receptors,
relaxing bronchial smooth muscle, relieving bronchospasm,
and reducing airway resistance.

A

Terbutaline

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19
Q

Why isn’t Theophyline great?

A

Mild bronchodlator effects
Toxicity levels are common

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20
Q

What does Magnesium Sulfate do to smooth muslce?

A

Relaxes it!

*efficacy is controversial, but essentially no down side

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21
Q

Helium is about ___% as dense as room air

A

25

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22
Q

Heliox-driven nebulizer treatments should have the gas set at a rate of _____

A

8-10 L/min

(with double the usual amount of albuterol)

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23
Q

A warning sign of severe asthma exacerbation:

an impaired pulmonary function with peak flow (PFM) less than…

A

80-100 L/min

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24
Q

pO2 <60 mmhg

pCO2 > 45 mmhg

A

Signs of severe asthma exacerbation

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25
Q

Mental status changes
Cardiac arrhythmias
Pulsus paradoxus >20 mmhg
Pneumothorax

A

Signs of severe asthma exacerbation

26
Q

Severe, prolonged asthma attack which cannot be broken by usual treatment

severe acidosis

A

Status asthmaticus

27
Q
  • Repeat visit within the last 3 days without improvement of symptoms
  • Changes in mental status
  • *-Failure of post-treatment PFM to increase by more than 15% above initial value, or if absolute PFM is <200 lpm**
  • Persistent hypoxia
  • Persistent increase in work of breathing
A

Criteria for admission

28
Q

First line agents used to treat acute bronchospasm in COPD and asthma

A

Beta-Adrenergic agonists

(ie Albuterol)

29
Q

Levalbuterol can be given at ________ the dose of Albuterol

A

one half

30
Q

Beta-Adrenergic agonists (1st line)
Anticholinergics (adjunct)
Steroids (all acute exacerbations)

A

treatments for acute exacerbations of COPD and asthma

31
Q

What percentages of Heliox are Helium and Oxygen?

A

80% Helium
20% Oxygen

32
Q

Weight loss- thin
Dyspnea on exterion
Cough only in AM
Barrel chest
Tachypnea

..COPD or Asthma?

A

COPD

33
Q

Enlarged accessory muscles
Clubbing of fingers
Pursed lips
Prolonged expiratory phase
+/- Wheezing or rhonchi

COPD or asthma?

A

COPD

34
Q

step 1= medication therapy and supplemental oxygen

step 2= positive pressure ventilation

step 3= intubation

A

Step-wise approach to management of COPD

35
Q

A useful alternative to intubation

*can be given by continuous positive airway pressure (CPAP)

improves gas exchange, decreasing hypoxia and reducing work of breathing

A

Noninvasive partial pressure ventilation (NPPV)

36
Q

Any patient with changes in mental status, increased respiratory distress with cyanosis, acute deterioration or exhaustion should be…..

A

Intubated or mechanically ventilated

37
Q

Marked increase in intensity of symptoms, such as sudden development of resting dyspnea

Severe background COPD

Onset of new physical signs (e.g.,cyanosis, peripheral edema)

Failure of exacerbation to respond to initial medical management

Newly occurring arrhythmias

Older age

Insufficient home support

A

Criteria for hospital admission

38
Q

Are sputum cultures really helpful in choosing antibiotic therapy?

A

NO

39
Q

Which 2 antibiotics are generally appropriate for outpatient therapy of COPD excaberations with pneumonia , fever, etc.

A

Macrolides
Fluoroquinolones

40
Q

Pts with COPD often develop hypoexemia and hypercarbia over time, which normally causes:

1.
2.
3.

A
  1. respiratory acidosis
  2. tachypnea
  3. hyperventilation
41
Q

Excessive supplemental oxygen can cause respiratory depression and respiratory arrest secondary to loss of their…

A

Hypoxemia-induced ventilatory drive

42
Q

Congenital lack of primary lung antiprotease- alpha 1 antirypsin

*leads to increase protease tissue destruction and emphysema in adults

A

Alpha-1 Antitrypsin deficiency syndrome

43
Q

a neutrophil elastase inhibitor whose major function of which is to protect the lungs from protease-mediated tissue destruction

A

Alpha 1 Antitrypsin

44
Q

6: 1 male:female
20: 1 smoker:non smoker

Abrupt pleuritic chest pain +/- dyspnea
Can occur with increased intrathoracic pressue
Often tachycardc, tachypneic, decreased breath sounds

A

Spontaneous pneumothroax

45
Q

MC risk factor for spontaneous pneumothorax?

A

Smoking

(chronic lung disease and infections are also predisposing factors)

46
Q

________ pneumothorax occurs secondary to invasive procedures such as transthoracic needle biopsy, subclavian line placement, nasogastric tube, etc

A

Iatrogenic

47
Q

Likely occurs after rupture of sub-pleural bulla allows air to enter the potential space between the parietal and visceral pleura, leading to partial lung collapse

A

Pneumothorax

48
Q

________ pneumothorax is caused by positive pressure in the pleural space leading to decreased venous return, hypotension and hypoxia

A

Tension pneumothorax

49
Q

Tx depends on size and patient
*often do nothing
*repeat CXR in 24 hours

Can range from asymptomatic to life threatening
chest tube if urgent treatment
needle decompression for emergent treatment

A

Pneumothorax

50
Q

True or False…

A signs/symptoms of a trauma to the chest do not often correlate to the extent of lung collapse

A

True

51
Q

Exam will often show…

Abnormal wall movements
Hyperresonance, tympany
Subcutaneous emphysema
Look for flail chest and sucking chest wound

A

Trauma exam of chest

52
Q

In unstable patients (those with tension pneumothorax or pneumothorax with underlying lung disease), when should needle thoracostomy and tube thoracostomy be done?

A

BEFORE radiography!

*you want to do this ASAP

53
Q

Needle decompression
Chest tube placement

..should be done for?

A

Trauma patients

54
Q

Any concern for tension pneumothorax, what must you do early?

A

Needle decompression

55
Q

Pleuritic CP
Dyspnea
Hemoptysis

A

PE “classic triad”

56
Q

Dyspnea
Pleuritic CP
Cough
Hemoptysis

Atypical symptoms not uncommon:
syncope, wheezing, AMS

A

PE

57
Q

Physical exam can be normal
Tachycardic, tachypneic, hypoxic
Pleural friction rub
Diaphoresis
S3, S4 gallop

A

PE

58
Q

Recent long distance travel
Recent surgery
Recent immobilization
Hemoptysis
Hx of clotting disorder
Hx of cancer

A

Risk factors for PE

59
Q

Clinical signs and sxs compatible with DVT
PE judged to be most likely diagnosis
Surgery or bedridden for 3 days during past 4 weeks
Previous DVT or PE
HR > 100 bpm
Hemoptysis
Active cancer (treatment or ongoing within previous 6 mos)

A

WELLS score for PE

under 4, PE unlikely
4.5-6: moderate PE likelihood
>6: high PE likelihood

60
Q

Streptococcus pneumonia
Staph aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Haemophilus influenza

A

Common bacterial caues of pneumonia

61
Q

Cough
Fatigue
Fever
Dyspnea
Sputum production
Pleuritic chest pain

A

Pneumonia

62
Q

Outpatient community aquired pneumonia (CAP) treatment

A

Azithromycin

SD- ER pt 2 (6 decks)

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