Respirology Flashcards
Definition of apnea
Respiratory pause > 20 sec, or associated with pallor, cyanosis, bradycardia
Differential diagnosis of apnea (ie. causes)
CNS infection - meningitis, encephalitis Seizure Head trauma Intracranial bleed ICP Breath-holding spell Pertussis Botulism Sepsis Toxins
Low risk features of a BRUE
- age > 60 days
- born > 32 weeks gestation, and cGA > 45 weeks
- no CPR required
- event lasted < 1 min
- first event
Definition of a BRUE
Sudden, brief, now resolved episode in child < 1 year old, with:
- cyanosis or pallor
- absent or irregular breathing
- change in tone
- altered responsiveness
Suggested management of a low-risk BRUE
- education
- CPR training
- may obtain pertussis swab, 12 lead ECG
- may briefly monitor with Sat monitor and serial observations
Anatomic/ physiologic differences of infant airway vs. older individuals
- Obligate nasal breathers < 4 months old
- Larynx is higher, softer, more elastic
- Trachea has smaller diameter
- Chest wall more compliant
- Respiratory control system is more immature
Laboratory criteria for respiratory failure (list 3)
PaCO2 > 50 with acidosis (pH < 7.25)
PaCO2 > 40 with severe distress
PaO2 < 60 (or O2 sat < 90%) on 40% FiO2
List 6 life-threatening causes of stridor
epiglottitis, RPA, diphtheria, tracheitis, foreign body, anaphylaxis, neck trauma, neoplasm, caustic or thermal injury, hereditary angioedema
List 6 congenital causes of stridor
laryngomalacia, laryngeal webs, laryngeal diverticula, vocal cord paralysis, subglottic stenosis, tracheomalacia, vascular anomalies (double aortic arch, vascular sling)
List 4 typical viral causes of bronchiolitis
RSV, rhinovirus, parainfluenza, adenovirus, influenza, coronavirus, humanmetapneumovirus
List causes of pneumonia
viral causes most common
bacterial (S. pneumo, S. aureus, mycoplasma, chlamydia, group A strep)
Chronic wheezing not responsive to asthma management, consider these 4 diagnoses
- CF (recurrent wheeze, FTT, chronic diarrhea –> sweat chloride test)
- GERD
- Recurrent aspiration
- Retained airway foreign body
- Mediastinal tumor
Management of brionchiolitis
Recommended: oxygen, hydration
Equivocal: epi nebs, nasal suction, epi+dex
Not recommended: ventolin, steroids, antibiotics, antivirals, hypertonic saline, chest physio, CXR, NP swab
Features associated with mycoplasma pneumonia
age > 5 years, insidious onset, headache, sore throat, prominent cough, diffuse rales, bilateral interstitial infiltrates
ED management of asthma
o Inhaled beta-2 agonists (ie. Salbutamol) via MDI (preferred over neb)
o Inhaled anticholinergics (ie. Atrovent = ipratropium bromide) –> reduced hospitalizations
o PO corticosteroids (IV if vomiting, NPO)
o IV MgSO4
o Continuous Ventolin nebs
o IV Ventolin
o Heliox (contraindicated in pneumothorax – obtain CXR prior)
o Terbutaline bolus and infusions
o CPAP or BiPAP to prevent intubation
- Discharge on inhaled corticosteroids
DDx of resp distress in cystic fibrosis
viral illness
bacteria infection
bacterial colonization and subacute exacerbation
GERD
pneumothorax
hemoptysis
allergic bronchopulmonary aspergillosis (ABPA)
Most common newborn presentation of CF
Meconium ileus
Common CF infectious organisms
staph aureus, MRSA, pseudomonas aerugiona, stenotrophomonas maltophilia, B. cepacia, A. xylosoxidas, non typable H influenza
Management of severe hemoptysis in CF
get IV access, CBC/INR/PTT/liver and renal function/gas/type and cross/sputum culture; emergency bronchoscopy to locate site of bleed; consider activation MTP if severe; IV antibiotics (most pulmonary exacerbation); placing bleeding lung dependent position
Causes of pulmonary hemorrhage
acute infection, exacerbation of pulmonary disease (CF), thoracic trauma, vasculitis (GPA, Goodpasture’s), non-lung sources (hematemesis/GI bleeding, tonsillar or nose bleed)
Diagnostic test for PE in children
CT-angiography
Which body systems are affected by sarcoidosis
lungs, lymph nodes, joints, eyes, skin, liver, spleen
What is Hamman’s sign
crunching sound obscuring heart sounds (occurs in pneumomediastinum)
Typical location of diaphragmatic hernia
Usually posterior left side (Bochdalek = back to the left)
Less common Morgagni on the right
How to perform a needle thoracostomy
2nd intercostal space, midclavicular line.
Use a 14 or 16G needle with 10 mL syringe attached with some water (bubbling), insert perpendicular to chest, over the rib. Remove the needle (keep catheter in place). Prepare for a chest tube. Don’t close the catheter (keep it open to air), or pneumothorax will re-accumulate
List 4 complications of chest tube insertion
bleeding, damage to lung (pneumothorax), bronchopleural fistula, damage to visceral organs, re-expansion pulmonary edema
Management of trach obstruction
suction, assess if cannula is in place (may be false tract in recent change), apply O2. Change the trach if no response to suctioning
Describe the difference between BiPAP and CPAP and when would you use each modality?
CPAP: fixed positive pressure throughout the cycle (use in Acute pulmonary edema, Obstructive sleep apnea, Acute respiratory failure with normal lung function)
BiPAP: Different levels of pressure during inspiration and expiration (use in Complex msk disease with weak respiratory muscle function, Asthma in resp failure)
List four factors that determine oxygen delivery by the orofacial delivery route
Oxygen concentration given
Mixing (non-rebreather vs simple mask)
Patency of nares and mouth
Ability to self-ventilate
List 6 clinical findings of respiratory failure
Vital signs: tachycardia, tachypnea or bradypnea, hypoxemia
General appearance: cyanosis, diaphoresis, confusion, restlessness, fatigue, shortness of breath, apnea, grunting, stridor, retractions, decreased air entry, wheezing
Pulsus paradoxus > 30 mmHg
DDx (causes) of pulmonary edema - list 6
Cardiogenic and non-cardiogenic (ARDS) are 2 broad categories
By etiology:
- CHD associated left sided HF: hypoplastic left heart syndrome, severe AS, coarctation of the aorta, MS, HOCM
- Over circulation within pulmonary vasculature: VSD, PDA
- Iatrogenic: overaggressive administration of IV fluids
- Neurogenic pulmonary edema: increase ICP or seizure
- Decrease plasma oncotic pressure: nephrotic syndrome, protein losing enteropathy, massive burns, severe malnutrition
- Breakdown alveolar-capillary barrier: ARDS, toxins
- Negative pressure pulmonary edema/post obstructive pulmonary edema
List 4 central (CNS) causes of respiratory depression
- Intoxication (ex alcohol, benzos, opioids)
- CNS malformation (ex hydrocephalus)
- Immaturity
- Trauma: Intracranial/brain stem bleed
- Mass (ex brainstem tumor, intracranial with raised ICP)
- Infection (ex meningitis)
List 3 signs and 3 symptoms of HAPE
HAPE = high altitude pulmonary edema
3 symptoms: SOB, cough, decreased LOC
3 signs: tachypnea, tachycardia, hypoxia, chest crackles
Emergency management of total upper airway obstruction (ie. unable to phonate)
- Heimlich maneuver or back blows for infant
- start CPR when unconscious
- Emergency laryngoscopy, intubation, cricothyrotomy or tracheostomy
Resistance to airflow in the airway is inversely proportional to what? What is the corresponding law called?
Radius of airway lumen
Poseuille’s law
What condition should be ruled out when nasal polyps are found?
Cystic fibrosis
A chest Xray shows honeycombing, atelectasis, and increased bronchial markings. What is the diagnosis?
Interstitial lung disease/ bronchiectasis
Name 2 mechanisms for acidosis in severe Asthma
- increased CO2 = respiratory acidosis
- ventolin –> lactic acidosis
Name main mechanism for decreasing O2 sats after beta agonist treatment in asthma
V:Q mismatch
