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foundations of paramedic practice 1 > respiratory system > Flashcards

respiratory system Flashcards

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1
Q

what is the primary survey you would do for respiratory system

A

Airway- noises- stridor, wheeze
- epiglottitis

Breathing - resp rate and depth
-equal rise and fall
- shape and size of chest

Circulation- cyanosis
- pink puffer/ blue floater
-pulse rate and strength
Disability -gcs
-drugs
-pupils
Exposure -track marks
-chest shape and rise/fall
-injuries

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2
Q

what type of drug is salbutamol

A

beta-2 agonist

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3
Q

how would you deliver salbutamol

A

nebulised with oxygen

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4
Q

how does salbutamol work

A

Salbutamol relaxes the smooth muscles of all airways, from the trachea to the terminal bronchioles. Salbutamol acts as a functional antagonist to relax the airway irrespective of the spasmogen involved, thus protecting against all bronchoconstrictor challenges. Increased cyclic AMP concentrations are also associated with the inhibition of release of mediators from mast cells in the airway.

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5
Q

how much salbutamol would you give an adult

A

5mg

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6
Q

how much salbutamol would you give a child

A

2.5mg

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7
Q

how long does salbutamol take to deliver

A

10mins

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8
Q

what are the indicators for salbutamol

A

asthma, COPD, wheeze, airway constriction

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9
Q

what are the contraindicators for salbutamol

A

allergies

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10
Q

what are the cautions for salbutamol

A
  • shield eyes in patients with glaucoma,
  • may cause tremor and tachycardia,
  • half doses should be used in patients beta blocked (bisoprolol – severe hypertension may occur),
  • neb for 6 mins for COPD (O2 driven) unless sats low.
  • angina
  • overactive thyroid
  • late pregnancy
  • bronchomalacia/ laryngomalacia/ tracheomalacia
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11
Q

how many litres of oxygen do you nebulise salbutamol with

A

6-8

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12
Q

what type of drug is ipratropium bromide

A
  • antagonist
  • anitmuscarinic bronchodilator
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13
Q

how does ipratropium bromide work

A

Works on the muscarinic acetylcholine receptors by competitive inhibition

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14
Q

what is the dose of ipratropium bromide for adults

A

500mcg

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15
Q

what is the dose of ipratropium bromide for children

A

250 mcg

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16
Q

what is the order of nebulisation of salbutamol and ipratropium bromide

A

salbutamol first then ipratropium bromide
one after the other if the wheeze has not resolved
then continue with salbutamol

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17
Q

how many times can you give ipratropium bromide

A

once

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18
Q

how many times can you give salbutamol

A

no upper limit

19
Q

what are the indications for ipratropium bromide

A
  • acute/severe life threatening asthma,
  • asthma or COPD unresponsive to salbutamol,
  • expiratory wheeze.
20
Q

what are the contraindications of ipratropium bromide

A

none

21
Q

what are the cautions of ipratropium bromide

A

glaucoma (protect mist from eyes)

22
Q

what type of drug is adrenaline

A
23
Q

how does adrenaline work

A
  • Epinephrine acts on alpha and beta-adrenergic receptors.
  • Epinephrine acts on alpha and beta receptors and is the strongest alpha receptor activator.
  • Through its action on alpha-adrenergic receptors, epinephrine minimizes the vasodilation and the increased vascular permeability that occurs during anaphylaxis, which can cause the loss of intravascular fluid volume as well as hypotension.
  • Epinephrine relaxes the smooth muscle of the bronchi and iris and is a histamine antagonist, rendering it useful in treating the manifestations of allergic reactions and associated conditions.
  • This drug also produces an increase in blood sugar and increases glycogenolysis in the liver.
  • Through its action on beta-adrenergic receptors, epinephrine leads to bronchial smooth muscle relaxation that helps to relieve bronchospasm, wheezing, and dyspnea that may occur during anaphylaxis.
24
Q

what is the dose of adrenaline

A
  • 500 mcg every 5 mins
  • no limit
  • 1:1000 im only
25
Q

what are the indications for adrenaline

A
  • life threatening asthma that has not responded to nebulisation
26
Q

what are the contraindications for adrenaline

A

none

27
Q

what are the cautions for adrenaline

A

severe hypertension may occur in patients on non-cardioselective beta blockers

28
Q

what type of drug is hydrocortisone

A

corticosteroid

29
Q

what are the short term effects of hydrocortisone

A
  • The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation.
  • 10Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days.
30
Q

what are the indications for hydrocortisone

A
  • acute exacerbation of COPD or asthma,
  • established adrenal crisis,
  • prevention of adrenal crisis.
  • analphylaxsis
31
Q

what are the contraindications of hydrocortisone

A

allergies

32
Q

what are the cautions of hydrocortisone

A

none

33
Q

what is the doses of hydrocortisone

A

1x 100 mg IM for asthma
1x 200mg analphylaxsis

34
Q

how would you test for asthma

A

respiratory assessment - if wheeze in chest ask crew mate to prep neb whilst continuing ax

35
Q

what are the pertinent questions with asthma

A
  • ITU stays (if yes, should always go in)
  • Hospital admissions
  • Recent inhaler use
  • Effective inhaler use
  • Triggers
  • Type of asthma – brittle
36
Q

what is peak flow reading (PERF)

A

Measure of forced expiratory volume
Measure against normal or predicted normal and calculate percentage
Good for measuring treatment efficacy

37
Q

what are the additional considerations for COPD

A
  • oxygen levels – 88-92% or patients target range,
  • personalised care plans,
  • rescue meds.
38
Q

how can you treat PE

A

Oxygen to treat hypoxia

39
Q

how can you assess PE

A

ECG- slurred s in 1
slurred q wave in 3
t wave in 3

entidal co2

40
Q

what are PE predictions

A

wells criteria
geneva score

41
Q

what is urti/lrti

A

upper respiratory tract infection
lower respiratory tract infection

42
Q

what might you hear for lrti and what might you see

A
  • fine crackles
  • reduction in c02
  • cough with green/yellow/brown sputum
43
Q

what can you do for lrti

A
  • 02
  • refer to gp or transport depending on severity
  • check they dont score for sepsis

foundations of paramedic practice 1 (8 decks)

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