SOB and Pulmonary emergencies

Question 1

Respiratory Distress

Answer 1

● Dyspnea is a subjective feeling of difficult, labored, or uncomfortable
breathing, which patients often describe as “shortness of breath,”
“breathlessness,” or “not getting enough air.”

Question 2

_____ is difficulty breathing in the recumbent position.

Answer 2

Orthopnea

Question 3

_____ is orthopnea that
awakens the patient from sleep and prompts an upright position to resolve breathlessness.

Answer 3

Paroxysmal nocturnal dyspnea

Question 4

If a patient does have signs of impending respiratory failure what intervention should you give?

Answer 4

■ Give oxygen
■ Prepare for more advanced measures
● Such as Non-Invasive Airway Management, or Rapid Sequence
Intubation

Question 5

Most common causes of respiratory distress:

Answer 5

■ Obstructive airway disease
● Asthma, COPD
■ CHF/Cardiogenic pulmonary edema
■ Ischemic heart disease
● Unstable angina, AMI
■ Pneumonia
■ Psychogenic

Question 6

Immediately Life-Threatening causes of respiratory distress

Answer 6

■ Upper airway obstruction
● Foreign body, angioedema,
hemorrhage
■ Tension Pneumothorax
■ Pulmonary Embolism
■ Neuromuscular weakness
● Myasthenia gravis, GuillainBarre Syndrome, Botulism

Question 7

Presence of S3 gallop is highly suggestive of ____

Answer 7

heart failure

Question 8

The presence of _____ on CXR suggest CHF

Answer 8

jugular venous distention and alveolar
edema

Question 9

_____ are polypeptides secreted by ventricular myocytes during volume expansion
and pressure overload.

Answer 9

B-type Natriuretic Peptide (BNP) or it’s precursor (Pro-BNP)

Question 10

This imaging Can differentiate acute decompensated heart
failure from noncardiac causes of acute dyspnea

Answer 10

Bedside Thorax Ultrasound

Question 11

This imaging is used to further evaluate pathology seen initially on a CXR, such
as hemothorax, empyema, abscesses, etc.

Answer 11

CT scan

Question 11

Goal PaO2 and O2sat in treating respiratory distress

Answer 11

Goal is PaO2 over 60 mmHg and/or O2Sat of greater than 90%

Question 11

The mainstay of asthma treatment in the emergency department includes
_____

Answer 11

Short-Acting Beta Agonist (SABA) therapy and systemic steroids
● Nebulized Albuterol or Levalbuterol should be
administered aggressively and right away
● Depending on response to breathing treatment, IV steroids may need to be administered and Rapid Sequence Intubation or Noninvasive Airway management may be required

Question 12

Treatment of anaphylaxis in the ER

Answer 12

● High flow oxygen (sometimes needed via bag-valve-mask), cardiac monitoring, and large-bore IV access are all important components of Tx.
● Airway management is extremely important, although intubation can become pretty much impossible if significant laryngeal inflammation
● IM Epinephrine immediately (may repeat q5-15 min).
● Antihistamines and corticosteroids have no immediate effect on anaphylaxis but are used as adjuncts to Epinephrine.

Question 13

Needle decompression location in a tension pneumothorax

Answer 13

● initial emergent
treatment may be placement of a
large bore needle at the ipsilateral
second intercostal space at the
midclavicular line.
● 14-gauge for adults, 18 for kids
● Attach the open end of the tube to a combination fluid-collection water-seal
suction device, with 20 to 30 cm H2O of suction.

Question 14

PE treatment in the ER

Answer 14

● Starting Low- Molecular Weight Heparin (LMWH) preferred over Unfractionated Heparin, Apixaban, Rivaroxaban, Fondaparinux
● Patient should be admitted to the hospital, location depending on acuity. Can be discharged in certain situations.
● If Warfarin is used, should be initiated at the time of diagnosis as well, and LMWH continued until INR is 2.0-3.0 for at least 24 hours

Question 15

_____ is an acute hypoxemic respiratory failure that can follow a systemic or pulmonary insult (with normal cardiac function).

Answer 15

Acute Respiratory Distress Syndrome (ARDS)

Question 16

Several disorders can cause acute pulmonary failure, but 75% of cases
follow one of these three settings:

Answer 16

○ Sepsis (the single most important)
○ Severe Multiple Trauma
○ Aspiration of Gastric Contents

Question 17

CXR findings with ARDS

Answer 17

● CXR will reveal diffuse, patchy infiltrates
and is often significant.