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Sam: Emergency Medicine > Respiratory Emergencies - SD > Flashcards

Respiratory Emergencies - SD Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what vital sign is always the “right” answer?

A

Oxygen

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2
Q

Current steroid use or recent withdrawal from oral steroids, comorbid conditions, serious psychiatric illness, illicit drug use, and low socioeconomic class are risk factors for what disease?

A

Asthma

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3
Q

Which is illicit drug is very risk risky for asthma sufferers?

A

Crack cocaine

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4
Q

What are some questions you should get in your HPI when treating an asthmatic?

A
  1. Measures of home peak flow meter
  2. Recent illness/fever/cough
  3. Exposure to triggers
  4. Recent increase in use of rescue medications
  5. Duration of current exacerbation
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5
Q

According to Frank, what are some key questions to ask in your HPI?

A
  1. Have you ever been intubated?
  2. Are you taking steroids?
  3. Is that what your asthma feels like?
  4. Are you getting tired?
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6
Q

What are some “red flags” you might see on physical exam of someone who is profoundly SOB?

A

Respiratory distress, tachypnea/tachycardia/low SaO2 stats, unable to speak full sentences, audible wheezing, accessory muscle use, mental status change

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7
Q

Prior intubations, previous ICU admissions for asthma, recent or frequent emergency department visits for asthma exacerbations, hospitalizations or ED visits in the last month, use of 2 or more albuterol inhalers in the last month, use of air conditioning are all risk factors for?

A

Death from Asthma

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8
Q

What do we want to keep patient’s SaO2 levels above?

A

95%

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9
Q

When someone comes in for an asthma exacerbation, what 2 (maybe 3) things do we want to do (or monitor) right away?

A

Pulse ox monitoring, IV, +/- cardiac monitoring

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10
Q

What is a very simple thing you can ask your patient to do to help them breathe?

A

Sit patient up

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11
Q

What is our inhaled Beta2 agonist?

A

Albuterol

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12
Q

How quickly does albuterol work?

A

5 minutes

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13
Q

What drug acts by relaxing bronchial smooth muscle, decreasing histamine release, inhibiting microvascular leakage into airways, and increases mucociliary clearance?

A

Albuterol

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14
Q

What two side effects are typically seen after administration of albuterol?

A

Tachycardia and tremor

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15
Q

Which drug is a beta 2 receptor agonist with some beta 1 activity?

A

Levalbuterol

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16
Q

Steroids ________ recovery and ______ recurrence.

A

speed, reduce

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17
Q

When administering steroids, is onset faster PO or IV?

A

They are equal in onset

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18
Q

Which class of drugs works by inhibiting airway inflammation, reverse beta-receptor down-regulation, block leukotriene synthesis, and inhibit cytokine production and adhesion protein activation?

A

Steroids

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19
Q

_________ corticosteroids have no role in acute exacerbation

A

Inhaled

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20
Q

What drug is considered the standard of care for severe asthma exacerbations?

A

Epinephrine

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21
Q

true or false

IM route is superior to SC route when administering epinephrine

A

True

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22
Q

Which drug is a selective beta2-agonist that act directly on beta2-receptors, relaxing bronchial smooth muscle, relieving bronchospasm, and reducing airway resistance?

A

Terbutaline

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23
Q

Terbutaline serves as an alternative to epinephrine - whats the benefit to terbutaline?

A

less cardiac side effects

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24
Q

Which medication effects as a bronchodilator are mild, and toxicity is common?

A

Theophyline

*not commonly used anymore

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25
Q

Efficacy of this drug is controversial, but it relaxes smooth muscle and there is essentially no risk when administering it. What is it?

A

Magnesium sulfate

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26
Q

Which element is about 25% as dense as room air?

A

Helium

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27
Q

Heliox-driven nubulizer treatments should have more or less albuterol?

A

More – typically double the amount

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28
Q

What are some warning signs of a severe asthma exacerbation?

A

PFM less than 100-80L/min

PA02 less than 60mmHg
PCO2 greater than 45 mmHg

Pulsus paradoxus greater than 20 mmHg

Also, mental status change, cardiac arrhythmias, and pneumothorax

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29
Q

What is a severe, prolonged asthma attack which cannot be broken by usual treatment?

A

Status asthmaticus

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30
Q

Should we wait until the last possible second to intubate someone?

A

No – the decision to intubate is best done semi-electively before the crisis of respiratory arrest

31
Q

What are some criteria for admitting a patient with an asthma exacerbation?

A
  1. Changes in mental status

2. Failure of post-treatment PFM to increase by more than 15% above initial value, or if absolute PFM is

32
Q

When discharging a patient for an asthma exacerbation, what two things must we educate on?

A

Reinforce importance of PFM

Educate patient and family on triggers, proper use of meds and when to call for help

33
Q

What the hell do you do if your tanking asthmatic is pregnant?

A

You do everything exactly the same

34
Q

What are the four asthma take home points?

A
  1. lots of nebs
  2. Steroids, terbutaline, epinephrine
  3. Silent chest, not your friend
  4. Document re-examinations
35
Q

Weight loss, dyspnea on exertion, cough only in AM, barrel chest, and tachypnea are things seen on physical exam in what patients?

A

COPD

36
Q

Is wheezing or ronchi typically found in a COPD patient?

A

Depends – some do

37
Q

Enlarged accessory muscles, clubbing of fingers, pursed lips, and prolonged expiratory phase should make you think of?

A

COPD

38
Q

What are the three steps to managing a COPD patient?

A

Step 1: medication therapy and supplemental oxygen

Step 2: positive pressure ventilation

Step 3: intubation

39
Q

What bronchodilator do we typically use for COPD patients?

A

Ipratroprium

40
Q

When should we begin treating with corticosteroids for COPD patients?

A

Corticosteroid therapy should be started immediately for all but mild exacerbations

41
Q

How do we feel about inhaled corticosteroids?

A

Great for preventative care not great for emergent care

42
Q

What are advantages to NIPPV?

A

Decrease the need for intubation, reduce hospital stay, and reduce mortality in patients with severe exacerbations

43
Q

What actions should we take if a patient exhibits the following: Changes in mental status, increased respiratory distress with cyanosis, acute deterioration or exhaustion

A

Intubate and mechanically ventilate immediately!

44
Q

How do NIPPV’s work?

A

Improve gas exchange and decrease hypoxia by reducing the work of breathing

45
Q

When should we prescribe antibiotics during a COPD exacerbation?

A

Controversial – some recommend antibiotic therapy for patient with pneumonia, increased sputum production, fever, and worsening dyspnea

46
Q

What antibiotics do we typically prescribe if we are going to prescribe abx for a COPD exacerbation?

A

Macrolides and Flouroquinolones

47
Q

Why can’t we give COPD patients “too much” oxygen?

A

It can cause respiratory depression and respiratory arrest

48
Q

What is alpha1-antitrypsin deficiency syndrome?

A

Congenital lack of primary lung antiprotease (alpha1-antitrypsin) leading to increased protease tissue destruction and emphysema in adults

49
Q

What is alpha1-antitrypsin’s primary function?

A

Protect the lungs from protease-mediated tissue destruction

50
Q

What are the three take home points for COPD?

A
  1. Give as much oxygen as they need
  2. Steroids and lots of nebs
  3. Try to avoid intubation at all costs
51
Q

Who is the classic pneumothorax patient?

A

Max

52
Q

How does a pneumothorax present?

A

Abrupt pleuritic chest pain +/- dyspnea

Often tachy, tachypneic, and have decreased breath sounds

53
Q

What part of the lung do pneumothorax occur most frequently?

A

Apex

54
Q

What is the most common treatment for pneumothorax

A

Nothing and repeat chest x-ray in 24 hours

55
Q

If treatment for pneumothorax is urgent, what should we do?

A

Chest tube

56
Q

If treatment for pneumothorax is emergent, what should we do?

A

Needle decompression

57
Q

Pneumothorax caused by trauma, how do we treat?

A

Typically either emergent needle decompression or chest tube placement

58
Q

What are our four take home points for a pneumothorax?

A
  1. Remember the classic patient for spontaneous pneumo
  2. Needle early if any concern for tension
  3. In this case….size matters
  4. Know your landmarks for needle thorascotomy and chest tube
59
Q

What life-threatening condition is often missed initially?

A

Pulmonary embolism

60
Q

What is the classic triad for PE?

A

Pleuritic chest pain, dyspnea, and hemoptysis

61
Q

What is the most common presenting complaint for a PE?

A

dyspnea

62
Q

What might you hear on auscultation when assessing for a PE?

A

pleural friction rub, S3, S4 gallop

63
Q

Tell me 6 risk factors for PE

A
  1. Recent long distance travel
  2. Recent surgery
  3. Recent immobilization
  4. Hemoptysis
  5. History of clotting disorder
  6. History of cancer
64
Q

What is the first step in testing for a PE?

A

You MUST determine pretest probability

65
Q

What is the second step in testing for a PE? Third step?

A

Second step – testing if indicated

Third step – imaging if indicated

66
Q

What are three scoring system we can use to assess likelihood of a PE?

A

Wells score, Canadian PE score, Geneva PE score, PERC rule

67
Q

Loaded card – 8 parts to the PERC rule for PE

A
  1. Age less than 50
  2. Heart rate less than 100
  3. Oxygen saturation on room air greater than 94%
  4. NO prior hisotry of DVT?PE
  5. No recent trauma or surgery
  6. No hemoptysis
  7. No exogenous estrogen
  8. No clinical signs suggesting DVT?
68
Q

If you determine your patient is high risk do you do “testing”?

A

No – go straight to imaging

69
Q

What are the take home points from PE’s?

A
  1. DDimer is not a pregnancy test
  2. Pretest probability + decision rules = testing or no testing
  3. Anything but low risk = imaging study
70
Q

The mortality rate for pneumonia if left untreated is ________ percent.

A

thirty

71
Q

Cough, SOB, fever, malaise, vomiting, pleuritic CP, chills/sweats think of?

A

Pneumonia

72
Q

What are common pathogens for pneumonia?

A

Haemophilus influenzae

Klebsiella

Staphylococus

Legionella

73
Q

When should we consider admitting a patient for pneumonia?

A

VS unstable

Bilateral pneumonia

Significant comorbidities

Immune compromised

Eldery

Sam: Emergency Medicine (12 decks)

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