Respiratory Management Flashcards

1
Q

EPIGLOTTITIS Adult S/S (7)

A
– Difficulty swallowing
– Painful swallowing
– Sore throat
– Muffled voice
– Tachycardia
– Pain on palpation of anterior neck
– Sniffing position
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2
Q

EPIGLOTTITIS Peds S/S (8)

A
– Acute High fever
– Anxious
– Sniffing position
– Breathing difficulty
– Stridor
– Voice absence
– Drooling
– Difficulty swallowing
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3
Q

EPIGLOTTITIS Tx (5)

A

– 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

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4
Q

CROUP S/S (5)

A
  • 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

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5
Q

CROUP Mild S/S (5)

A
– Minimal distress
– Normal mental status
– Well hydrated
– Stridor when agitated
– Intermittent cough
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6
Q

CROUP Moderate S/S (6)

A
– Stridor at rest
– Alert, interactive, irritable
– Classic cough
– Tachypnea
– Retractions at rest
– Good air movement
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7
Q

CROUP Severe S/S (5)

A
– Stridor and retractions at rest
– Poor air entry
– Impending respiratory failure
– Altered mental status
– Fatigue
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8
Q

CROUP Tx: Mild/Moderate/Severe

A

– 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
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9
Q

BACTERIAL TRACHEITIS S/S (5)

A
  • 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!
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10
Q

BACTERIAL TRACHEITIS Tx (8)

A
– 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
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11
Q

PERITONSILLAR ABSCESS S/S (4)

A

– Fever
– Difficult, painful swallowing, neck pain
– Hot potato voice
– Unilateral swelling of posterior throat

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12
Q

PERITONSILLAR ABCESS Tx (6)

A
– Supportive care
– Position of comfort
– O2, pulse oximetry
– IV, EKG
– Antipyretics per protocol
– Alert for signs of failure / arrest
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13
Q

PE Contributing Factors (5)

A

– 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

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14
Q

PE Pathophys (6)

A
– Hypoxemia
– Shunting
– Bronchoconstriction
– Pulmonary hypertension / systemic hypotension
– Shock
– Death
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15
Q

PE S/S (8)

A
– Sudden dyspnea
– Cough / hemoptysis
– Pleural friction rub
– CP arrest
– Fever
– Hypotension
– JVD
– Chest pain
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16
Q

PE Tx

A

Urgent Supportive Care

17
Q

Pleurisy S/S (3)

A

– Pain worsened by breathing / coughing
– Pleural friction rub
– Shallow breathing due to pain

18
Q

Pleurisy Tx

A

Supportive care

19
Q

Pleural effusion Tx

A

Supportive care

20
Q

ARDS Causes (8)

A
– Aspiration
– CP bypass surgery
– Sepsis
– Trauma
– Multiple blood transfusions
- Oxygen toxicity
- Burns      
-Pneumonia- TB
21
Q

ARDS S/S (5)

A
– SOB
– Decreased lung compliance
– Hypercarbia / hypoxia
– Rales / crackles
– “Non-cardiogenic pulmonary edema”
22
Q

ARDS Tx (4)

A

– O2, ventilation, pulse oximetry, capnography
– IV
– EKG
– CPAP?

23
Q

BRONCHIOLITIS S/S (5)

A
– Inflammation and edema obstructs small airways
– Hyperinflation can occur
– Wheezing, rhonchi, coarse crackles
– Atelectasis
– Dehydration can be severe
24
Q

BRONCHIOLITIS Tx (5)

A
– Suction excessive secretions
– Humidified O2
– Beta agonists may be helpful, but can worsen symptoms in some patients
– Saline neb
– Hydrate
25
Q

CYSTIC FIBROSIS Tx

A

Tx like COPD

26
Q

PNEUMONIA S/S (9)

A
– Acute onset
– Fever, chills
– Productive cough, purulent sputum
– Pleuritic chest paint
– Pulmonary consolidation
– Crackles
– Anorexia
– Tachypnea, tachycardia
– Chest, side, back pain
27
Q

PNEUMONIA Atypical S/S

A
– Nonproductive cough
– Extrapulmonary symptoms
– Headache
– Myalgias
– Fatigue
– Sore throat
– Nausea, vomiting, diarrhea
– Fever, chills
28
Q

PNEUMONIA Tx (8)

A
– PPE
– Optimize oxygenation
– Bronchodilators
– IV, fluids for dehydration
– EKG
– Pulse oximetry, capnography
– Be alert for sepsis
– Antibiotics
29
Q

Stethoscope Sides

A

Diaphragm is for high-pitched sounds.

Bell is for low-pitched sounds.

30
Q

ASPIRATION Tx (3)

A

– Avoid gastric distention when ventilating.
– Monitor the patient’s ability to protect the airway.
– Treat with suction and airway control.

31
Q

COPD S/S (4)

A

– Pursed lip breathing
– Increased I/E ratio
– Abdominal muscle use
– Jugular venous distention

32
Q

STATUS ASTHMATICUS S/S

A
  • Struggling to move air through obstructed airways
  • Prominent use of accessory muscles
  • Hyperinflated chest
  • Inaudible breath sounds
  • Exhausted, severely acidotic, and dehydrated
33
Q

ASTHMA Tx

A

– 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

34
Q

BASIC RESPIRATORY Tx

A
ABCs
O2 as needed
Vital Signs
EKG
EtCO2
Meds as benefit pt condition
35
Q

S/S of Deteriorating Asthma

A
Diaphoresis
Declining to lay back
Silent chest
O2 <88%
ALOC
Increasing EtCO2 shark fins
Pulsus paradoxous >12mm
36
Q

ASTHMA Med Tx

A

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

37
Q

CPAP Contras

A
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
38
Q

Unique CPAP Indications

A
flail chest wo pneumo
pneumonia
ARDS
near drowning
pallitative care
toxic inhalation
CO poisoning
Altitude injuries- HAPE
39
Q

Other conditions that wheeze

A
CHF
Pneumonia
PE
Pneumo
FBAO
Toxic inhalation
Cystic fibrosis