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Emergency Medicine > SOB > Flashcards

SOB Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

first thing to do when evaluating dyspnea

A

Look for evidence of a respiratory distress/failure

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2
Q

What are markers of respiratory distress/failure

A
  1. marked tachypnea and tachycardia
  2. stridor
  3. accessory respiratory muscles (during inhalation)
  4. inability to speak normally as a consequence of breathlessness
  5. agitation or lethargy as a consequence of hypoxemia
  6. depressed consciousness due to hypercapnia
  7. paradoxical abdominal wall movement
  8. the abdominal wall retracts inward with inspiration, indicating diaphragmatic fatigue (pushes out)
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3
Q

How MUST you check accessory respiratory muscle

A

clothes off

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4
Q

what are the accessory muscles that may be used with respiratory distress?

A

sternocleidomastoid, intercostals, sternoclavicular

SIS

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5
Q

What should you ask history-wise if someone has respiratory distress?

A

Need for mechanical ventilation

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6
Q

What medication can cause dyspnea

A

steroids

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7
Q

When is a patient NOT in respiratory distress

A

If they can talk to you

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8
Q

What must you look at for EENT for dyspnea?

A

Oral for angioedema (allergy)
FB

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9
Q

What do you do for cardio exam for dyspnea?

A

JVD
good cardio
look for acrocyanosis

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10
Q

what is the first sign of respiratory distress

A

acrocyanosis

because blood is diverted to vital organs

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11
Q

life-threatening causes of dyspnea

A

upper airway obstruction with object/ hemmorage
tension pneumo
PE
Neuromuscular weakness
Fat embolism

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12
Q

MCC of dyspnea

A

Obstructive airway disease (asthma)
decompensated HF
Ischemic heart disease
PNA
Psychogenic

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13
Q

HF history, symptoms, PE, and CXR, EKG with dyspnea

A

PND
Orthopnea
edema
dyspnea on exertion

S3
JVD
S4
wheezing

pulm venous congestion
cardiomegaly

EKG abnormalities

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14
Q

what do you order for diganostic evaluation of dyspnea?

A

CBC
CMP
Peak expiratory flow rate
will help differentiate asthma/COPD from other disorders
decreased in obstructive disease
pt noncompliance due to acute dyspnea will affect the results
ABG
EKG
Troponin
BNP or N-terminal pro BNP
D-Dimer
CXR
Bedside Point of Care Ultrasound
helps differentiate acute cardiac from noncardiac causes
pleural effusion, pneumothorax, pulmonary consolidation, intravascular volume status, cardiac tamponade, cardiac function
CT scan, CTA, V-Q scan

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15
Q

what is the INITIAL goal of dyspnea

A

admit to maintain O2 if hypoxemia

THEN see underlying cause

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16
Q

Goal O2 for hypoxia in general and for COPD

A

not black and white

O2 > 90 is MC (chronic COPD may have a lower O2 - so do not treat them too much or they will lose their drive

17
Q

How do you supply O2

A

depends on how bad their O2 stat

Simple mask is most (6-10 L)
NC (0.25 - 4)

18
Q

What is the high flow O2

A

High flow NC can be used up to 40 L/min

19
Q

what is the non-rebreather bpm?

A

O2 builds up in bag and goes through a one-way valve so that they are not breathing in their expired air

need to make sure that there is not an obstruction

20
Q

If there is help of O2, what is next?

A

a little more invasive

CPAP or BiPAP

CPAP = same during inhilation and exhalation (sometimes have trouble exhaling)

BiPAP higher pressure while breathing in

21
Q

MC sign of an upper airway obstruction

A

stridor

22
Q

explain stridor

A

high-pitched inspiratory stridor

23
Q

What is the MCC of stridor in neonates

A

Laryngotracheomalacia

24
Q

What are the infectious etiologies of upper airway

A

Croup (laryngotracheobronchitis)
Bacterial tracheitis
Retropharyngeal abscess
Peritonsillar abscess
Epiglottitis

not on exam?

25
Q

MC age and object for airway obstruction in a child

A

1-3 years
food and toys

26
Q

MC foods that lead to FB obstruction in child

A

peanuts, sunflower seeds, RAW carrots, raisins, grapes, and hot dogs

they cannot be chewed up enough

27
Q

Presentation of airway FB obstruction

A

sudden coughing/choking associated with gagging, stridor or cyanosis

28
Q

presentation of laryngotracheal FB

A

STRIDOR, hoarseness or complete apnea

PA and lateral soft tissue neck

29
Q

presentation of Bronchial FB and what you order

A

unilateral wheezing and decreased breath sounds

PA and lateral CXR
inspiratory and expiratory

30
Q

confirms or rules out diagnosis
therapeutic to remove FB

A

Bronchoscopy

31
Q

what does inspiratory and expiratory FB

A

inspiratory normal
expiration = lung will not collapse, get larger, and eventually pneumothroax

32
Q

what is atelectasis

A

alveoli do not open and do not enter sacs, so tissue looks lighter gray or white (because air is black)

33
Q

if a FB is stuck for a long time

A

Emergency Medicine (14 decks)

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