Respiratory Management Flashcards
EPIGLOTTITIS Adult S/S (7)
– Difficulty swallowing – Painful swallowing – Sore throat – Muffled voice – Tachycardia – Pain on palpation of anterior neck – Sniffing position
EPIGLOTTITIS Peds S/S (8)
– Acute High fever – Anxious – Sniffing position – Breathing difficulty – Stridor – Voice absence – Drooling – Difficulty swallowing
EPIGLOTTITIS Tx (5)
– O2 if it does not agitate patient
– Do not look into the airway!
– Rapid transport
– Keep advanced airway equipment available
– Maintain high suspicion for impending respiratory failure
CROUP S/S (5)
- Upper airway infection
- Just below the glottis
- Swollen and inflamed mucosa
- Seal bark cough, 3-4 days
- Hoarse, inspiratory stridor
- No difficulty swallowing, drooling
- Low grade fever
• Patient population: 6 mo to 6 yrs
CROUP Mild S/S (5)
– Minimal distress – Normal mental status – Well hydrated – Stridor when agitated – Intermittent cough
CROUP Moderate S/S (6)
– Stridor at rest – Alert, interactive, irritable – Classic cough – Tachypnea – Retractions at rest – Good air movement
CROUP Severe S/S (5)
– Stridor and retractions at rest – Poor air entry – Impending respiratory failure – Altered mental status – Fatigue
CROUP Tx: Mild/Moderate/Severe
– Position of comfort
– Pulse oximetry
– Mild:
– saline nebs
– Moderate / Severe: – racemic epinephrine nebs – Corticosteroids per protocol – Be alert for signs of respiratory failure / arrest –BVM 100% O2
BACTERIAL TRACHEITIS S/S (5)
- 4 y/o more common but can be any age
- 2:1 males to females
- Fever / chills• Inspiratory stridor
- Brassy, barking cough
- Hoarseness
- Dyspnea may be present
- Features of Croup / Epiglottitis but no drooling
- Potential for complete airway obstruction!
BACTERIAL TRACHEITIS Tx (8)
– Antibiotics – Supportive care – IV / fluids PRN – Antipyretics per protocol – Position of comfort – Supplemental O2 – If ETI is needed use 0.5 – 1.0 smaller tube
PERITONSILLAR ABSCESS S/S (4)
– Fever
– Difficult, painful swallowing, neck pain
– Hot potato voice
– Unilateral swelling of posterior throat
PERITONSILLAR ABCESS Tx (6)
– Supportive care – Position of comfort – O2, pulse oximetry – IV, EKG – Antipyretics per protocol – Alert for signs of failure / arrest
PE Contributing Factors (5)
– Venous stasis
–> travel, prolonged bed rest, obesity, burns, varicose veins
– Venous injury
–> surgery, fractures, multi-trauma
– Increased blood coaguability
–> malignancy, BCPs
– Pregnancy
–> delivery (amniotic fluid, clots)
– Disease
–> COPD, CHF, A-fib, MI, DVT, DM, infections
PE Pathophys (6)
– Hypoxemia – Shunting – Bronchoconstriction – Pulmonary hypertension / systemic hypotension – Shock – Death
PE S/S (8)
– Sudden dyspnea – Cough / hemoptysis – Pleural friction rub – CP arrest – Fever – Hypotension – JVD – Chest pain
PE Tx
Urgent Supportive Care
Pleurisy S/S (3)
– Pain worsened by breathing / coughing
– Pleural friction rub
– Shallow breathing due to pain
Pleurisy Tx
Supportive care
Pleural effusion Tx
Supportive care
ARDS Causes (8)
– Aspiration – CP bypass surgery – Sepsis – Trauma – Multiple blood transfusions - Oxygen toxicity - Burns -Pneumonia- TB
ARDS S/S (5)
– SOB – Decreased lung compliance – Hypercarbia / hypoxia – Rales / crackles – “Non-cardiogenic pulmonary edema”
ARDS Tx (4)
– O2, ventilation, pulse oximetry, capnography
– IV
– EKG
– CPAP?
BRONCHIOLITIS S/S (5)
– Inflammation and edema obstructs small airways – Hyperinflation can occur – Wheezing, rhonchi, coarse crackles – Atelectasis – Dehydration can be severe
BRONCHIOLITIS Tx (5)
– Suction excessive secretions – Humidified O2 – Beta agonists may be helpful, but can worsen symptoms in some patients – Saline neb – Hydrate
CYSTIC FIBROSIS Tx
Tx like COPD
PNEUMONIA S/S (9)
– Acute onset – Fever, chills – Productive cough, purulent sputum – Pleuritic chest paint – Pulmonary consolidation – Crackles – Anorexia – Tachypnea, tachycardia – Chest, side, back pain
PNEUMONIA Atypical S/S
– Nonproductive cough – Extrapulmonary symptoms – Headache – Myalgias – Fatigue – Sore throat – Nausea, vomiting, diarrhea – Fever, chills
PNEUMONIA Tx (8)
– PPE – Optimize oxygenation – Bronchodilators – IV, fluids for dehydration – EKG – Pulse oximetry, capnography – Be alert for sepsis – Antibiotics
Stethoscope Sides
Diaphragm is for high-pitched sounds.
Bell is for low-pitched sounds.
ASPIRATION Tx (3)
– Avoid gastric distention when ventilating.
– Monitor the patient’s ability to protect the airway.
– Treat with suction and airway control.
COPD S/S (4)
– Pursed lip breathing
– Increased I/E ratio
– Abdominal muscle use
– Jugular venous distention
STATUS ASTHMATICUS S/S
- Struggling to move air through obstructed airways
- Prominent use of accessory muscles
- Hyperinflated chest
- Inaudible breath sounds
- Exhausted, severely acidotic, and dehydrated
ASTHMA Tx
– Bronchospasm• Treatment:
nebulized bronchodilator medication (Albuterol and Ipatropium)
– Bronchial edema• Treatment:
corticosteroids (Solu-Medrol, Decadron)
– Excessive mucus secretion• Treatment:
improve hydration, mucolytic agents
Consider Mag Sulfate and Epi in severe cases
BASIC RESPIRATORY Tx
ABCs O2 as needed Vital Signs EKG EtCO2 Meds as benefit pt condition
S/S of Deteriorating Asthma
Diaphoresis Declining to lay back Silent chest O2 <88% ALOC Increasing EtCO2 shark fins Pulsus paradoxous >12mm
ASTHMA Med Tx
Albuterol 2.5mg
Ipatropium 0.5mg (moderate to severe) added to Albuterol
Epi 1:1000 0.3mg
Mag Sul 1-4g diluted
SoluMedrol 125mg
IV fluid
Can repeat Epi and Albuterol
Consider Epi 1:10,000 IVP IF SEVERE
CPAP low flow with inline neb to push meds deep
DSI/RSI
CPAP Contras
ALOC Lack of airway patency aspiration risk (Nauseous) slow RR SBP <90 Hypovolemia ECG instability facial trauma poor mask seal morbid obesity recent GI/face/abdomen surgery tension pneumo respiratory arrest clausterphobia nosebleed GI distension
Unique CPAP Indications
flail chest wo pneumo pneumonia ARDS near drowning pallitative care toxic inhalation CO poisoning Altitude injuries- HAPE
Other conditions that wheeze
CHF Pneumonia PE Pneumo FBAO Toxic inhalation Cystic fibrosis
