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Essentials of Acute Care > test 1 > Flashcards

test 1 Flashcards

1
Q

what does a one liner contain

A

Name
Age and occupation
Problem and diagnoses (or symptoms and differentials)

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2
Q

how is the patient in relation to their problem/diagnosis”

A

Impression statement

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3
Q

what is your assessment?

A

impression not your physical exam

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4
Q

what age is the airway anatomy and physiology similar to an adult

A

8 years old

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5
Q

in infants and young children what part is anatomically much larger in proportion to the rest of the skull and more protuberant than that in an adult

A

occiput

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6
Q

When the child is in a supine position, there is more neck ______ and potential for _______

A

flexion

airway obstruction

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7
Q

sinusitis can lead to _____ of the overlying dermal layers or ____ formation

A

cellulitis

abscess formation

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8
Q

where is the landmark for the tip into which the tip of a curved McIntosh laryngoscope blade is inserted during an intubation attempt

A

The vallecular space which is the area between the glossoepiglottic folds

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9
Q

resistance in a tube is inversely proportional to the radius to the fourth power

what is this
example?

A

Poiseuille’s law of resistance

demonstrated clinically when edema or secretions reduce the airway size in children and resp distress occurs

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10
Q

the amount of air that can occupy space in the lung

A

lung capacity

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11
Q

the amount of air that does occupy space in the lung

A

lung volume

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12
Q

the maximum amount of air the lung can hold after a maximal inspiration

A

Total lung capacity (TLC)

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13
Q

the maximal amount of air forcefully expired after a maximum inspiration

A

Vital capacity (VC)

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14
Q

the air present in the lung after completion of a forced expiration

A

Residual volume (RV)

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15
Q

the sum of vital capacity (VC) and residual volume (RV)

A

Total lung capacity (TLC)

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16
Q

___ decreases with increases in RV

examples

A

VC

as in the case of obstructive airway diseases such as asthma and emphysema

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17
Q

describes the lungs remaining volume at the end of normal expiration

A

functional residual capacity (FRC)

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18
Q

films useful in the evaluation of nasopharyngeal, oropharyngeal, and laryngeal pathology

A

lateral and AP films of neck

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19
Q

what x rays are useful in foreign body aspiration in cooperative patients and younger pt who may not be cooperative

A

inspiratory and expiratory AP CXR

decubitus CXR

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20
Q

if a tracheal compression is suspected, what test can you order

A

Barium esophagrams

further imaging such as MRI or angiography is warranted prior to surgical correction

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21
Q

imaging for soft tissue and pathology of face and neck

A

ultrasound

examples retropharyngeal or peritonsillar abscess

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22
Q

useful for difficulties involving nasal and paranasal structures

A

CT

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23
Q

ABG values that support the diagnosis of resp failure

A

PaO2 less than 60

PaCO2 of greater than 50

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24
Q

fluid resuscitation

A 
isotonic crystalloids (NS or LR)
10-20ml/kg
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25
Q

if hemorrhage is known or highly suspected in rescusitation

A

administration of PRBCs

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26
Q

Fluid resuscitation increases

A

preload

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27
Q

signs of deteriorating cardiac function after fluid bolus

A

increase HR
decrease BP
crackles
tachypnea

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28
Q

choice of vasopressor for hypovolemic or distributive

A

drugs with A agonist such as epinephrine or norepinephrine (increase systemic vascular resistance)

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29
Q

choice of vasopressor for cardiogenic shock

A

positive chronotropy
epi
norepi
dopamine

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30
Q

drugs for afterload reduction

A

dobutamine
nitroprusside
milrinone

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31
Q

Higher MAP =

A

improved oxygenation

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32
Q

average pressure that distends the alveolus and chest wall

A

Mean airway pressure

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33
Q

PaO2

A

80 to 100 mm Hg

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34
Q

SaO2

A

95% to 100%

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35
Q

pH

A

7.35 to 7.45

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36
Q

PaCO2

A

35 to 45 mm Hg

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37
Q

HCO3-

A

22 to 26 mEq/L

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38
Q

compliance formula

A

change in volume over the

change in pressure

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39
Q

mean airway pressure is reflected by

A

the mean alveolar pressure

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40
Q

the volume of gas actually exchanged across the alveolar membrane

A

Alveolar ventilation

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41
Q

a practical metric representing the resting volume of air in the lungs after a spontaneous breath

A

FRC

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42
Q

At FRC the tendency of the lungs to collapse is exactly balanced by the

A

tendency of the chest wall to expand

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43
Q

restrictive lung disease results in

A

an abnormally low FRC

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44
Q

mechanical ventilation that delivers a set total volume to the patient during a preset inspiratory time

A

Volume regulated ventilation

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45
Q

what kind of ventilation has a decelerating flow

A

pressure control ventilation

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46
Q

advantages to volume regulated ventilation

disadvantages

A

reduce risk for volutrauma due to to preset TV or minute ventilation

disadvantages
delivering higher peak pressures to achieve the goal TV or minute ventilation

risk of not meeting pt demands due to continuous flow pattern gas delivery

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47
Q

volume ventilation is clinically useful when

A

lung compliance is relatively static bc this reduces likelihood of excessive pressure generated during mandatory volume delivery should compliance abruptly decrease

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48
Q

Cold shock give (cold extremities, think vasoconstriction)

A

epi

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49
Q

warm shock give (warm extremities, thing vasodilation)

A

norepi

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50
Q

the amount of pressure to put the breath in

A

PIP

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51
Q

sick lungs respond better to ____

healthy lungs respond better to ____

A

pressure (pt with stiff lungs due to decelerating flow)

volume

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52
Q

higher rate on vent will ____ CO2

A

lower

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53
Q

a form of assist-control ventilation which the vent breath is delivered as a set TV

A

PRVC (pressure regulated volume control)

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54
Q

time triggered pressure limited time cycled mode of ventilation that also allows unrestricted spontaneous breathing throughout the entire breath cycle

A 
APRV (Airway pressure release ventilation)
last ditch before oscillator
to promote gas exchange
for pt with poor lung compliance 
long inspiration, short expiration
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55
Q

last ditch before oscillator
to promote gas exchange
for pt with poor lung compliance

A

APRV (Airway pressure release ventilation)

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56
Q

if you are maxed out at vent settings, high risk for barotrauma so switch to

A

High frequency oscillatory ventilation

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57
Q

APRV is more for

A

oxygenation than ventilation

not for asthmatic

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58
Q

you would increase your PEEP for

A

high inspiratory pressures

peep is the lowest pressure that your lung should see

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59
Q

PIP is the

A

highest pressure that your lungs will see

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60
Q

if pressure controlled what if variable

A

volume

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61
Q

if volume controlled then what is variable

A

PIP

62
Q

what setting is constant not variable

A

PEEP

63
Q

CPAP is just a

A

PEEP

64
Q

BiPap has what

A

PIP and a PEEP

65
Q

the improvement of mucociliary transport system, the recruitment of atelectatic areas and the improvement of oxygenation while maintaining very low low TVs to avoid lung barotrauma

A

High frequency jet ventilation

66
Q

used to treat hypoxemic lung diseases such as ARDS and persistent pulmonary hypertension in infants

A

Inhaled nitric oxide - vasodilates- more blood flow to lungs. Its continuous and if suddenly stopped they clamp down.

67
Q

HFOV is characterized by high resp rates up to

A

15 HZ

68
Q

using an oscillator, how to lower CO2 on ABG

A

increase amplitude

69
Q

increase oxygenation on oscillator

A

increase mean airway pressure

70
Q

higher frequency means

A

higher CO2

71
Q

what is flow volume or pressure volume loops used for

A

the effectiveness of the breaths they are receiving.

aid in the evaluation of lung compliance and resistance

72
Q

failure criteria for extubating trials

A 
diaphoresis
nasal flaring
increased resp effort
apnea
hypotension
cardiac arrhythmias
increased CO2
decreased pH
73
Q

predict risk for extubation failure due to swelling

A

airway leak test
absence of a leak around the endotracheal tube at a pressure > or equal to 30 increases risk of post extubation stridor and extubating failure

drain out air out of cuff -
if air leaks - no need for steroids
if air leaks - steroids are given prior to extubating

74
Q 
Sepsis
Thermal injury
Pancreatitis
Trauma
transfusion
A

indirect lung injury

ARDS

75
Q

Pneumonia
Aspiration of stomach contents
Submersion injury
Inhalation injury

A

direct lung injury

ARDS

76
Q

will determine severity of ARDS

A

Calculate PaO2/FiO2 ratio

OI (oxygenation index)

77
Q

diagnostic tests for ARDS

A 
BMP
CBC with diff
CXR
echocardiography
bronchoalveolar-lavage (BAL)
78
Q

3 phases of ARDS

A

Phase 1: Acute/Exudative
Initial injury disrupts epithelial fluid transport & removal of fluid from the alveolar space → pulmonary edema
Impaired gas exchange d/t pulmonary edema, V/Q mismatch, increase in the A/a gradient
Inflammatory stage begins with neutrophil activation and cytokine release

Phase 2: Proliferative phase
Resolution can begin with improvement of alveolar surfactant release, promote fluid transport, and proliferate injured cells
If resolution doesn’t occur → persistent respiratory failure, hypoxemia, decreased lung compliance, fibrosis

Phase 3: Chronic/Fibrotic phase
Can be as early as 5-7 days after onset of ARDS

79
Q

rapid onset of dyspnea leading to hypoxia and respiratory failure, SpO2 < 90% on room air, crackles, increased WOB

A

presentation of ARDS

80
Q

management of ARDS

A

lung protective strategies, supplemental oxygen, non-invasive ventilation → mechanical ventilation → ECMO
Adjunct: nitric oxide, prone, surfactant administration
Conservative fluid management
Enteral nutrition

81
Q

the differential diagnosis of airway obstruction subdivided to

A

supraglottic
glottic
subglottic

82
Q

what upper airway noise is suggestive of vocal cord involvement

A

hoarseness or phonia

83
Q

low pitched sound like a snore and suggests implosion of pharyngeal soft tissue structures

A

stertor

84
Q

harsh sound caused by vibration of the airway structures, suggests vocal cord involvement, decreases during sleep, increases during agitation

A

stridor

85
Q

risk factors BPD

A

prematurity, low birth weight, white males, genetic heritability

86
Q

what is BPD

A

Disruption of lung development, alveolar hypoplasia (fewer & larger alveoli) which leads to less surface area for gas exchange

87
Q

Stages of BPD for <32 weeks gestation mild

A

room air by 36 weeks (gest) or discharge (whatever is first)

88
Q

Stages of BPD for <32 weeks gestation moderate

A

need for oxygen <30% at 36 wks/discharge

89
Q

Stages of BPD for <32 weeks gestation: severe

A

need for oxygen > 30% and/or positive pressure at 36wks/discharge

90
Q

BPD for >32 wks gestation

A

*for >32 wks gestation: same criteria but by day 56 of life

91
Q

Treatment goals for BPD

A

supportive care with minimum additional injury, prevent hyperinflation or distention of airways

92
Q

Treatment BPD

A

CPAP if possible (better outcomes than mechanical ventilation)
Fluid restriction to avoid pulmonary edema
Maximized calories to promote good nutrition and growth
Diuretics to improve lung compliance and decrease airway resistance
Watch for electrolyte imbalances
Bronchodilators (only for rescue, acute bronchoconstriction)
Corticosteroids (reserved for mechanically ventilated BPD with substantial support)

93
Q

Prevention BPD

A

antenatal steroids - all pregnant women from 23-34weeks gestation with intact membranes at risk for preterm delivery within the next 7 days

fluid restriction - Positive fluid balance : a lack of postnatal weight loss during immediate postnatal period thought to be a predisposing risk factor for BPD

Protective ventilation strategies
Minimal ventilation with protective hypercapnia

High frequency oscillatory ventilation

Early continuous positive pressure ventilation

Noninvasive mechanical ventilation (NIPPV)

caffeine therapy
Used in same doses used to treat apnea of prematurity

Recommended for all infants < 1250 grams at birth

Usually continue until PMA of 35-36 weeks (until the infant is no longer at significant risk for apnea of prematurity)

Vitamin A: deficiency may promote development of BPD
Appears to reduce risk of BPD in susceptible
infants
5000 units IM 3 times a week X 4 weeks
Late surfactant therapy: between 3-10 days of age

Superoxidase dismutase: antioxidant, remains an investigational drug

94
Q

clinical manifestations BPD

A 
High CO2 (hypercapnia)
ABG compensated - Bicarb elevated to compensate for the hypercapnia

R sided heart failure
poor growth
most require bronchodilators

95
Q

Diuretics BPD

A

Thiazide diuretics: Chlorothiazide and/or
spironolactone produce short-term improvement in
lung mechanics

 Loop diuretics: Furosemide (Lasix) in infants > 3
 weeks of age results in improved pulmonary
 mechanics and oxygenation
96
Q

what is primary problem with BPD

A 
impaired gas exchange
leads to impaired growth
neurocognitive problems
R heart failure
pulmonary HTN
cor pulmonale
systemic HTN
prone to asthma and resp infections
prone to  rehospitalizations in the first year
97
Q

leading causes of hospitalization in children under 1 yr

A

Bronchiolitis

98
Q

Bronchiolitis typically occurs in children less than
Peak incidence between
highest risk for death at

A

2 yrs
3-6 mths
infants less than 2-3 months of age, premature birth history, infants with an underlying cardiopulmonary, immunodeficiency or neuromuscular disorder

99
Q

In bronchiolitis, the obstructed airways increase airway resistance during expiration and inspiration, which leads to

A

retained gas, air trapping and hyperinflation

100
Q

As bronchiolitis progresses, what happens

A

cellular debris and mucous can form into plugs within the bronchiole lumens leading to obstruction, air trapping and lobar collapse

101
Q

what virus causes more hospitalizations with bronchiolitis

A

RSV

102
Q

risk factors for complications from bronchiolitis

A

male sex, chronic co-existing medical conditions, prematurity, low birth weight, immunodeficiency, exposure to cigarette smoke, lower socioeconomic status, lack of breastfeeding, exposure to crowded environments

103
Q

Bronchiolitis presentation

A

Presents with rhinorrhea, leads to coughing, 2-4 days of low grade fever, congestion, mild conjunctivitis, pharyngitis, otitis media, dehydration if feeding poorly

and progresses to airway obstruction
Bronchiolar obstruction: prolonged exhalation, nasal flaring, intercostal retractions, suprasternal retractions, and air trapping with hyperinflation
Obstructed airways (air trapping, hyperinflation), mucus plugs (obstruction, air trapping, lobar collapse), increased airflow resistance (increased RR, respiratory failure)
Can also manifest with apnea (especially in infants with history of prematurity)
104
Q

Treatment Bronchiolitis

A

Treatment: CXR (hyperinflation + atelectasis), PCR (viral detection), HFNC/CPAP, Heliox (via face mask, improves airway resistance)
Self-limiting disease, generally self-resolves with supportive therapy, excellent prognosis overall

105
Q

a complex constellation of inflammation, hyperresponsiveness, and airway obstruction, usually following a trigger or stimulus.

A

Asthma

106
Q

Blood gas will reveal what during an asthma exacerbation

A

Blood gases reveal respiratory acidosis during acute exacerbations

107
Q

Pt on continuous albuterol with have a transient low ______

A

Patients on continuous albuterol will have a transient low Potassium level (however it is not necessary to bolus potassium chloride unless the patient is on continuous Albuterol for periods longer than 24h or drops to less than 2.0 or the patient is otherwise hemodynamically unstable

108
Q

At risk population for asthma

A

is more common in males than females, in African Americans and Hispanics, and in children from lower socio-economic households

109
Q

asthma triggers

A

Allergens: dust mites, animal dander, cockroaches, mold pollen
Irritants: cigarette smoke, air pollution, chemicals/dust, aerosol sprays
Viral URIs
Medications: aspirin, NSAIDS, Non-Selective Beta Blockers
Sulfites in food and drugs
Acute weather changes
Physical Activity (the only trigger that should not be avoided)

110
Q

rescue med for asthma

A

Short acting Bronchodilator
(a.k.a “rescue” or “quick relief”)
Treatment of bronchospasm
provide rapid relief but no long term effects on inflammation
Short acting (i.e. albuterol, levalbuterol, pirbuterol acetate, terbutaline and ipratropium)
Side Effects: palpitation, tremor
If asthma is well controlled, rescue medications should not be necessary more than two times per week

111
Q

In asthma when should a spirometry be taken

A

Spirometry before and after administration of a short-acting bronchodilator
Reduced FEV1 and FEV1/FVC ratio
Reduced PEF

112
Q

daily control for asthma pt

A

long acting Bronchodilator
Non-steroidal medications that are meant to be used in conjunction with an anti-inflammatory medication on a daily basis (not as a rescue for acute asthma symptoms)
Ex: Arformoterol, Salmeterol and Formoterol (are commercially available in combination with a corticosteroid within one inhaler)

113
Q

Asthma med used in addition to a short acting B2 Agonist

A

anticholinergic

Block the action of acetylcholine at parasympathetic sites in bronchial smooth muscle resulting in bronchodilation
Not indicated as initial rescue therapy for acute bronchospasms when rapid treatment is required
Used only in addition to a short acting Beta 2-agonist
SE: dry mouth

Ex: Ipratropium Bromide

114
Q

Non steroidal medication used in Asthma

intended as maintenance treatment for mild to moderate asthma

A

Mast Cell Stabilizers-reduce inflammation by preventing mast cell release of leukotrienes, and slow down the anaphylactic response to a trigger by inhibiting degranulation after contact with antigens. Thereby, preventing asthma symptoms
Relatively safe
Less effective than inhaled corticosteroids, intended as maintenance treatment for mild to moderate asthma
Ex: Cromolyn and Nedocromil

115
Q

inhaled corticosteroids for asthma

A

Most effective control (maintenance and prevention of asthma)
Use for any severity and age
Once daily to twice daily use offers symptom reduction and improvement in lung function (Adjustable dose approach can result in effective cumulative dose decrease over time without decreasing asthma control)
Decrease exacerbations
Common Side Effects: oral candida, hoarseness
Examples: Beclomethasone Dipropionate, Budesonide, Ciclesonide, Flunisolide, Fluticasone, Mometasome

116
Q

systemic corticosteroids for asthma

A

Used in severe acute exacerbation recovery
Effective secondary to anti-inflammatory or immunosuppressant properties
Once transitioned from intravenous to oral administration, may be continued for 5-10 days post exacerbation
SE: hyperglycemia, adrenal suppression, depression of growth velocity
Examples: Methylprednisolone, Prednisone, Prednisolone

117
Q

Leukotriene-Receptor Antagonist

asthma treatment

A

Selectively inhibits the cysteinil leukotriene receptor (thereby blocking the symptoms of asthma)
Less effective than inhaled corticosteroids
Thought to help prevent exercise-induced bronchospasm
Example: Singulair

118
Q

difference in a dry metered inhaler vs MDI

A

Delivers medication without using chemical propellants BUT requires that the user learn to produce a strong and fast inhalation.

119
Q

Mild intermittent asthma:

A

< = 2 days per week
night wakenings 0 for 4 and younger
<=2x/mth in 5 and older
oral steroid use 0-1x/year

controlled with as needed B2 agonist (SABA)

120
Q

Mild persistent asthma

A 
> 2 days per week
night wake - 1-2/mth 4 and younger
3-4x/mth 5 and older
oral steroid use >=2x in 6 mths or >= 4x/year 4rs and younger
>2x/yr in 5 and older

Low dose ICS
SABA PRN

121
Q

Moderate persistent asthma

A 
symptoms daily
night wake - 3-4x/mth 4yr and younger
>1x/week for 5 and older
oral steroid use >=2x in 6 mths or >= 4x/year 4rs and younger
>2x/yr in 5 and older

Med dose ICS or
Low dose ICS + LTRS or
Low dose ICS + LABA
SABA PRN

122
Q

Severe persistent asthma

A 
symptoms throughout the day
night wake >1x/week for 4 and younger
7x/week for 5 and older
oral steroid use >=2x in 6 mths or >= 4x/year 4rs and younger
>2x/yr in 5 and older
Med dose ICS or 
Low dose ICS + LTRS or
Low dose ICS + LABA
SABA PRN
referral to subspecialist
123
Q

Treatment of moderate to severe asthma exacerbation

A

Identified by non-responsiveness to intermittent or nebulized Beta 2-agonist treatments
Require continuous Beta 2-agonist infusion, oxygen and Steroids (prednisolone, prednisone or dexamethasone) and may receive:
1. Ipratropium bromide x3 doses
4. IV Magnesium sulfate bolus
5. IV Terbutaline bolus and may require continuous infusion
6. Non-invasive ventilation or if not improving, lead to intubation

124
Q

Pertussis caused by

mode of transmission

A

Bordetella pertussis, aerosol transmission

gram neg coccobacillus

125
Q

Individuals with pertussis are most contagious during the

A

Catarrhal stage - first 2 weeks

increased secretions and low-grade fever

126
Q

characteristic cough of pertussis develops during the

A

Paroxysmal phase:

127
Q

Phases of pertussis

A

Catarrhal stage: most contagious stage, URI symptoms, begins insidiously (first 2 weeks), increased secretions and low-grade fever

Paroxysmal phase: increase in severity & frequency of cough, rapidly consecutive forceful coughs in a single exhalation followed by a “whoop”, post-tussive emesis and copious mucus
Cough occurs in paroxysms (pattern during expiration needed to dislodge plugs of necrotic bronchial epithelial tissues and thick mucus)

Convalescent phase: symptoms slowly diminish, but cough recurs easily with triggers

128
Q

the problem when an infant gets pertussis

A

infants can easily become fatigued with the incessant coughing and post-tussive emesis leading to inadequate oral intake, dehydration, or resp failure. Intermittent apnea can also occur in infants associated with paroxysmal coughing - may be related to vagal stimulation

129
Q

incubation period that precedes the 3 phases of pertussis lasts

A

7-14 days

130
Q

secondary sequelae to forceful coughing

A

chest/abd pain
rib fractures
air leak syndromes
facial petechiae

131
Q

Pertussis treatment

A

Treated with macrolide antibiotics
erythromycin most commonly - 14 days -

Bactrim-14 days >2 mos of age

Clarithromycin - also likely to be effective

Azithromycin- for infants

hospitalization for young infants

132
Q

what type of isolation for pertussis

A

standard and droplet precautions

133
Q

after diagnosis of pertussis, children must be excluded from school or daycare for how many days?

A

Must complete 5 days of effective therapy

if not treated, min of 21 days after onset of cough

134
Q

Bronchiolitis Risk factors

A

Premature infants, children with chronic lung disease, congenital heart disease, neuromuscular weakness, and immunodeficiency.

135
Q

Bronchiolitis s/s

A 
Cough
Rhinorrhea
Noisy, raspy breathing and wheezing.
Low grade fever
Irritability
Apnea
136
Q

Bronchiolitis Evaluation

A

Nasal flaring, intercostal retractions, subcostal retractions.

Airway trapping with hyperexpansion of lungs.
Wheezing and hyperresonance on percussion.
Crackles throughout
Severe—grunting, cyanosis.
No routine testing required.
Rapid viral PCR: RSV, parainfluenza, influenza, and adenovirus to confirm diagnosis.
Optional x ray not routine

137
Q

Bronchiolitis Treatment

A

control fever

Hydration
Upper airway suctioning
Oxygen if needed.
Hospitalization with ventilator support if severe

138
Q

Croup or LTB (laryngotracheobronchitis) signs/symptoms

A 
Parainfluenza viruses or RSV
6 months to 3 years of age
12-48 hours after URI
Barking cough
Low grade fever
Inspiratory stridor
Hoarseness
Increased work of breathing or apnea
139
Q

Croup or LTB (laryngotracheobronchitis) evaluation

A

Edema of the upper airway
Steeple sign on AP Chest X-ray
Suprasternal and/or intercostal retractions
Westley Croup Score
Routine labs not useful in establishing diagnosis

140
Q

Croup or LTB (laryngotracheobronchitis) treatment

A 
Antipyretics
Oxygen if needed
Dexamethasone
Nebulized epinephrine
Endotracheal intubation with tube 0.5 to 1 size smaller
141
Q

Pertussis risk factors

A

less than 6 months of age, waning immunity from previous vaccine, under-immunized

142
Q

Pertussis signs by stages

A

Catarrhal stage- Increased nasal secretions and fever
Paroxysmal stage- cough during expiration
Convalescent stage- gradual resolution of symptoms

143
Q

Pertussis evaluation

A

shortness of breath, whooping cough due to forceful inhalation against narrow glottis

Posttussive emesis
Copious, viscid mucus
Whooping cough
The neonate may show signs of apnea and choking spells
Young infants have CNS damage due to hypoxia
Adolescents have a persistent, nonproductive cough

144
Q

Pertussis treatment

A

Hospitalization, and elimination of Bordetella pertussis

Macrolide antibiotics- erythromycin is the treatment of choice
Azithromycin for neonates
Treatment during catarrhal stage eradicates organism within 3-4 days
Treatment in paroxysmal stage only reduces the risk of spreading infection
Trimethoprim-sulfamethoxazole in children older than 2 months old
Vaccination

145
Q

Pneumothorax risk factors

A

trauma (open, communicating or “sucking” chest wound), acute changes in lung compliance, rupture of blebs in patients with CLD, potentially spontaneous

146
Q

Pneumothorax signs/symptoms

A

chest pain
dyspnea
tachycardia
acute change in lung compliance in the mechanically ventilated patient

147
Q

Pneumothorax evaluation

A 
ipsilateral hyperresonance to percussion
ipsilateral decreased air entry
ipsilateral decreased vocal fremitus
decreased oxygen saturations
increased peak inspiratory pressure
changes in expired tidal volumes on vent
CXR will show line displaced from the chest wall (see air without vascular markings on one side of line)
ABG will show impaired oxygenation
ABG will show larger A-a gradient
148
Q

Pneumothorax treatment

A

provide supplemental oxygen to ensure adequate oxygenation
some small pneumos can be treated with close observation
remove pathological air from cavity with placement of thoracostomy tube
if recurrent pneumos or CLD, consider thoracoscopy or pleurodesis
if cardiopulmonary compromise, emergent needle thoracentesis warranted
consider surgical consultations if emergent airway/ventilatory support needed

149
Q

Pulmonary edema risk factors

A

Risk Factors

Changes in pulmonary capillary permeability
Abnormalities in lymphatic drainage and surfactant
Congenital pulmonary disease
Cardiogenic:

Left sided heart failure
CHD, HTN, cardiomyopathy
Pulmonary (intrinsic):

Infectious processes (pneumonia, ARDS, & Pulmonary Embolism)
Neurogenic:

Surgery, trauma, seizures
Noncardiogenic:

Blood product transfusion
High altitude

150
Q

Pulmonary edema symptoms

A 
SOB
Tachypnea
Tachycardic
Hypoxia
Weakness
Cough w/ frothy sputum
Diaphoresis
Orthopnea
Paroxysmal Nocturnal dyspnea

Pediatrics:

Cyanosis
Subcostal retractions
Crackles on auscultation
S3 in those with cardiogenic Pulmonary edema

151
Q

Pulmonary edema evaluation

A

CXR: haziness

  • ABG: Lower PaO2 & increase A-a Gradient
  • BNP: Elevated
  • Pulmonary Capillary Wedge Pressure: Elevated
152
Q

Pulmonary edema treatment

A

Airway management: ABC
Supplemental Oxygen: Noninvasive + Invasive with higher PEEP levels
Diuretics: Restore euvolemic body fluid balance to improve oxygenation and relieve dyspnea. (Loop, Potassium Sparing, Thiazide diuretics)
Inotropes/ ACE inhibitors in HF cases
ULTIMATE GOAL: Reverse the cause of airway obstruction, fix the failing heart and/or reverse the lung damage/disease.

Essentials of Acute Care (9 decks)

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