Respiratory Emergencies Lecture Flashcards

(62 cards)

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
Mental status changes Cardiac arrhythmias Pulsus paradoxus \>20 mmhg Pneumothorax
Signs of **severe asthma exacerbation**
26
Severe, prolonged asthma attack which cannot be broken by usual treatment ## Footnote **severe acidosis**
Status asthmaticus
27
- 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
Criteria for admission
28
First line agents used to treat **acute bronchospasm in COPD and asthma**
Beta-Adrenergic agonists | (ie Albuterol)
29
Levalbuterol can be given at ________ the dose of Albuterol
one half
30
Beta-Adrenergic agonists (1st line) Anticholinergics (adjunct) Steroids (all acute exacerbations)
treatments for acute exacerbations of COPD and asthma
31
What percentages of Heliox are Helium and Oxygen?
80% Helium 20% Oxygen
32
Weight loss- thin Dyspnea on exterion Cough only in AM Barrel chest Tachypnea ..COPD or Asthma?
COPD
33
Enlarged accessory muscles Clubbing of fingers Pursed lips Prolonged expiratory phase +/- Wheezing or rhonchi COPD or asthma?
COPD
34
step 1= medication therapy and supplemental oxygen step 2= positive pressure ventilation step 3= intubation
Step-wise approach to management of **COPD**
35
A useful alternative to intubation \*can be given by continuous positive airway pressure (CPAP) improves gas exchange, decreasing hypoxia and reducing work of breathing
Noninvasive partial pressure ventilation (NPPV)
36
Any patient with changes in mental status, increased respiratory distress with cyanosis, acute deterioration or exhaustion should be.....
Intubated or mechanically ventilated
37
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
Criteria for hospital admission
38
Are sputum cultures really helpful in choosing antibiotic therapy?
NO
39
Which 2 antibiotics are generally appropriate for outpatient therapy of COPD excaberations with pneumonia , fever, etc.
Macrolides Fluoroquinolones
40
Pts with COPD often develop hypoexemia and hypercarbia over time, which normally causes: 1. 2. 3.
1. respiratory acidosis 2. tachypnea 3. hyperventilation
41
Excessive supplemental oxygen can cause **respiratory depression** and **respiratory arrest** _secondary to loss of their..._
Hypoxemia-induced ventilatory drive
42
Congenital lack of primary lung antiprotease- alpha 1 antirypsin \*leads to increase protease tissue destruction and emphysema in adults
Alpha-1 Antitrypsin deficiency syndrome
43
a neutrophil elastase inhibitor whose major function of which is to protect the lungs from protease-mediated tissue destruction
Alpha 1 Antitrypsin
44
6: 1 male:female 20: 1 smoker:non smoker ## Footnote **Abrupt pleuritic chest pain +/- dyspnea Can occur with increased intrathoracic pressue Often tachycardc, tachypneic, decreased breath sounds**
Spontaneous pneumothroax
45
MC risk factor for spontaneous pneumothorax?
Smoking (chronic lung disease and infections are also predisposing factors)
46
\_\_\_\_\_\_\_\_ pneumothorax occurs secondary to invasive procedures such as transthoracic needle biopsy, subclavian line placement, nasogastric tube, etc
Iatrogenic
47
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
Pneumothorax
48
\_\_\_\_\_\_\_\_ pneumothorax is caused by positive pressure in the pleural space leading to decreased venous return, hypotension and hypoxia
Tension pneumothorax
49
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**
Pneumothorax
50
True or False... A signs/symptoms of a trauma to the chest do not often correlate to the extent of lung collapse
True
51
Exam will often show... Abnormal wall movements Hyperresonance, tympany Subcutaneous emphysema Look for flail chest and sucking chest wound
Trauma exam of chest
52
In unstable patients (those with tension pneumothorax or pneumothorax with underlying lung disease), when should **needle thoracostomy and tube thoracostomy be done?**
BEFORE radiography! \*you want to do this ASAP
53
Needle decompression Chest tube placement ..should be done for?
Trauma patients
54
Any concern for tension pneumothorax, what must you do early?
Needle decompression
55
Pleuritic CP Dyspnea Hemoptysis
PE "classic triad"
56
Dyspnea Pleuritic CP Cough Hemoptysis Atypical symptoms not uncommon: syncope, wheezing, AMS
PE
57
Physical exam can be normal Tachycardic, tachypneic, hypoxic Pleural friction rub Diaphoresis S3, S4 gallop
PE
58
Recent long distance travel Recent surgery Recent immobilization Hemoptysis Hx of clotting disorder Hx of cancer
Risk factors for PE
59
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)
**WELLS score for PE** under 4, PE unlikely 4.5-6: moderate PE likelihood \>6: high PE likelihood
60
**Streptococcus pneumonia** Staph aureus Klebsiella pneumoniae Pseudomonas aeruginosa Haemophilus influenza
Common bacterial caues of pneumonia
61
Cough Fatigue Fever Dyspnea Sputum production Pleuritic chest pain
Pneumonia
62
Outpatient community aquired pneumonia (CAP) treatment
Azithromycin