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Emergency Med > respiratory emergency > Flashcards

respiratory emergency Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

first line imaging for hemoptysis

A

CXR. will follow up with CT if needed

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2
Q

RF for PE

A

injuries to the vascular epithelium (CAD, AMI, etc), Venous stasis (Vfib, Pregnancy, Obesity, varicose veins), State of coagulopathy (pregnancy, OCP, neoplasm), previous PE

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3
Q

there is no classic picture of PE, but have a high suspicion if see any sign

A

RR > 16, Chest pain, Dyspnea, Apprehension, Rales, Cough, Pulse >110, fever, Sweating, gallop, phlebitis, hemoptysis

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4
Q

Wells prediction criteria for PE

A

takes into account of you have had previous PE or DVT, if HR > 110, if recent surgery or immobilization in past month, if clinical sings of DVT, if any alternative diagnosis is unlikely, if hemoptysis and if cancer was treated in the last 6 mos

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5
Q

Homan sign

A

dorsiflex and squeeze the calf. If pain is + sign for DVT.. Document it for completeness but really it doesn’t mean anything

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6
Q

ABG results in PE

A

will show hypoxemia

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7
Q

D-Dimer results in PE

A

Will be positive. If it is negative, can r/o PE. If positive, it is not definitively PE, could be something else

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8
Q

Classic ECG findings in PE

A

S1, Q3, T3 pattern in up to 20% of cases. Large S wave in lead I, large Q wave in lead III, and inverted T wave in lead III. Remember, a normal ECG does not r/o PE

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9
Q

Most common ECG finding in PE

A

transient, non-specific ST changes

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10
Q

Pt comes in with severe dyspnea. CXR is normal.

A

PE should be on the top of differential

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11
Q

CXR findings in PE

A

elevation of one diaphragm, Hampton hump (transient wedge shaped infiltrates), Pleural effusions and atelectasis

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12
Q

Gold standard for PE diagnosis

A

pulmonary angiography “angiogram”. This is not the test of choice though- which is D-dimer and CT-angio because pulmonary angio is very invasive.

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13
Q

Chest CT angio findings in PE

A

saddle embolus

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14
Q

Pt with PE who is hypotensive, has sever tachycardia, hypo perfusion, or low SpO2

A

this pt is unstable. To tx, consider placing a central catheter and giving Fibrinolytic therapy via the catheter. This has a high mortality rate. Can also consider surgical pulmonary embolectomy

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15
Q

Tx for PE

A

LMWH (Lovenox) 1 mg/kg q 12 hrs SQ and then begin Warfarin 72 hrs after lovenox.

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16
Q

Indications for Greenfield IVC filter

A

if heparin/LMWH are c/i or ineffective

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17
Q

the primary factors contributing to asthma morbidity and mortality

A

under-diagnosis and inappropriate treatment

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18
Q

When to consider getting an ABG in an asthmatic exacerbation

A

SpO2

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19
Q

Asthmatic exacerbation comes to ED what do you do?

A

First check the airway and assess breathing. Intubate if in respiratory arrest. If not in arrest, give O2, check pulse ox and give albuterol nebulizer. can give up to 3 bolus doses in 1 hour or can give continuously if severe. Consider starting PO corticosteroids. If severe exacerbation can add ipatropium nebulizer to albuterol.

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20
Q

Other medication treatment options for asthma

A

can give Magnesium sulfate to help avoid intubation and can also give ketamine in refractory disease

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21
Q

anaphylactic asthma treatment

A

epinephrine, 0.5 mg SC or IM. Can also use if have been trying albuterol tx for over an hour with little response in a non- anaphylactic attack

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22
Q

respiratory failure

A

arterial PaO2

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23
Q

Respiratory acidosis

A

PCO2 > 44 mmHg and acidotic

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24
Q

serum changes in acute respiratory acidosis

A

for every 10 mmHg increase in Co2, there is a 1mEq increase in bicarb.

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25
Q

serum changes in chronic respiratory acidosis

A

for every 10 mmHg increase in CO2 there is a 3.5 mEq increase in bicarb

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26
Q

ER management of COPD exacerbation

A

if SpO2

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27
Q

When to admit your COPD exacerbation patient

A

if they cannot ambulate without their O2 dropping below baseline, they get admit.d If they have significant co-morbidities, newly occurring cardiac issues, or if they are on a ventilator, they get admitted. If their pulse ox is 92% or below you should consider observation overnight.

28
Q

Type 1 ARF

A

ABG shows hypoxemia PaO2

29
Q

Type 2 ARF

A

ABG shows hypercapnic PaCO2 > 50

30
Q

asterixis is a sign of

A

hypercapnia. ASterixis is flapping tremor of hand

31
Q

Indications for intubation

A

Persistant Hypoxemia, Progressive acidemia, Progressive hypercapnea, AMS, evidence of respiratory muscle fatigue

32
Q

ARF management in the ER

A

stabilize the airway and breathing and circulation. Put them on O2, get ABGs, intubate if necessary and send them off to ICU

33
Q

a major indication of ARDS

A

pulmonary cap wedge pressure

34
Q

the most common cause of ARDs

A

pneumonia (direct lung injury) That is followed p by sepsis (indirect lung injury)

35
Q

rosk factors for ARDS

A

pre-existing lung disease, chronic EtOHism, Sepsis

36
Q

top of the Ddx list for ARDs

A

pulmonary edema from Left HF

37
Q

medications that do not help with ARDs

A

steroids, ketoconazonle, inhaled NO, surfactant

38
Q

Most frequent sx in the ED of pneumonia

A

Fatigue, Cough, Fever

39
Q

The two best things to order in the ED if suspect pneumonia

A

CXR and SpO2

40
Q

Pt presents with sudden onset cough, fever and rigors, has rust colored sputum and CXR shows lobar infiltrates with occasional patches and effusions. What is the most likely organism?

A

Streptococcus pneumoniae

41
Q

Pt presents with gradual onset cough and fever, has purulent sputum and CXR shows patchy, multi lobar infiltrates. What is the most likely organism?

A

Staph aureus. Can also cause empyema and abscess.

42
Q

Pt presents with sudden onset rigors, dyspnea, and bloody sputum. CXR shows upper lobe infiltrate with a bulging fissure sign. What is the most likely organism?

A

Klebsiella. May also have currant jelly sputum

43
Q

Pt presents after recently being hospitalized, and has fever and cough. CXR shows patchy infiltrates. What is the most likely organism?

A

P. Aeruginosa

44
Q

Pt presents with gradual onset fever and pleuritic chest pain. CXR sows patchy basilar infiltrate. What is the most likely organism?

A

H. Influenzae. more common i elderly and COPD pts

45
Q

pt presents with fever, chills, HA, dry cough and vomiting. CXR shows multiple patchy infiltrates with occasional civilization. What is the most likely organism?

A

Legionalla pneumonia

46
Q

Pt presents with long course of a cough, fever, chest pain and sputum that shows gr- diplococci. CXR shows diffuse infiltrates. What is the most likely organism?

A

M. catarrhalis

47
Q

Pt present with gradual onset fever, dry cough, wheezing and sinus sx. CXR shows patchy sub-segmental infiltrates. What is the most likely organism?

A

Chlamydophilia pneumoniae

48
Q

Pt presents with upper and lower respiratory tract sx, nonproductive cough, HA and fever. CXR shows interstitial infiltrates. What is the most likely organism

A

Mycoplasma pneumona

49
Q

Pt presents with gradual onset of putrid smelling sputum. What is the most likely organism?

A

an anaerobic collection of organisms.

50
Q

First line treatment for uncomplicated pneumonia

A

Z-pack or clariththromycin x7d.

51
Q

Pt presents with pleuritic chest pain, dyspnea and cough. What is their most likely diagnosis?

A

pleural effusion.

52
Q

Pleural effusion CXR findings

A

air-fluid lines, blunting of the costophrenic angle, meniscus sign

53
Q

Transudate PE

A

there is no local pleural disease, rather the fluid in the lungs is do to some other cause that is causing pooling of fluid into lungs, like CHF, acute atelectasis, hypoalbuminemia, etc

54
Q

Excudate PE

A

there is altered permeability of the pleural membranes, increased capillary permeability or backup from the lymphatics

55
Q

Pleural fluid is excudate if

A

ratio of pleural fluid: serum protein > 0.5, if ratio of pleural fluid: serum LDH > 0.6

56
Q

Normal pleural fluid

A

pH 7.6, clear, protein

57
Q

Primary spontaneous PTX

A

there is no underlying lung disease. Think tall, thin, young males

58
Q

secondary spontaneous PTX

A

there is underlying lung disease like COPD

59
Q

tension PTX

A

defined as having POSITIVE PRESSURE in the pleural space

60
Q

Immediate management of PTX

A

give oxygen, aspiration and Chest tube if aspiration doesn’t work

61
Q

needle aspiration/decompensation

A

use 14/16 g needle, go 2nd ICS MCL, above the 3rd rib space.

62
Q

Chest tube placement for PTX

A

4th ICS anterior axillary line, point up

63
Q

Chest tube placement for HTX

A

4th ICS, mid axillary line

64
Q

pt presents with absent breath sounds, distended neck veins and Hypotension. What is it?

A

could be a tension PTX, EMERGENCY

65
Q

Pt presents with absent breath sounds, hypovolemia and dullness to percussion over lung fields. What is it?

A

HTX!

Emergency Med (10 decks)

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