Respiratory Emergencies

Question 1

what are the phases of capnography?

Answer 1

Phase 1: beginning of exhalation (the air that is in the dead space)
Phase 2: CO2 from larger bronchioles resulting in upslope
Phase 3: Alveolar plateau, and end tidal CO2
Phase 0: Inhalation

Question 2

what can cause the CO2 number to be low?

Answer 2

Hyperentilation
Hypoperfusion
metabolic acidosis
decrease metabolism 
PE

Question 3

what do red blood cells break down to?

Answer 3

Bilirubin (dead red blood cells)

Question 4

what does mild tachypnea mean? and what is the biggest problem with this finding?

Answer 4

Pt is compensating (normal SpO2), and often overlooked until its too late.

Question 5

what is a peak flow meter?

Answer 5

a device that allows there to be a measurement of how powerful a pt can blow out.

Peak Expiratory Flow Rate (PEFR)

Question 6

will kids out grow asthma?

Answer 6

yes, usually around the age of 8

Question 7

What are the cartilaginous rings?

Answer 7

the rings that make up the trachea.

Good because they wont collapse when breath in

Bad because they can swell outward, they inflame inside.

Question 8

what does it mean if they have a thick green or brown sputum when cough?

Answer 8

pneumonia or infection

Question 9

what does it mean if a pt has hemoptysis?

Answer 9

TB or carcinoma/cancer

Question 10

what does it mean if they pt has a pink frothy sputum when they cough?

Answer 10

pulmonary edema

Question 11

what does a shark fin CAPNO mean?

Answer 11

broncho constriction
(they have to use muscle to blow out, slow expiration)

Question 12

what is a reverse shark fin CAPNO mean?

Answer 12

They have a neuromuscular disease (Guillan Barre, Myasthenia Gravis) Where no they use the muscles to pull air in more than normal (slow and prolonged inhalation, and quick exhale)

Question 13

what are some things that can cause hypoventilation?

Answer 13

overdose, alcohol, sedatives, analgesics, stroke, seizures

Question 14

what is the big key differences between rhonchi and rales?

Answer 14

Rhonchi are wet sounding and are more midline and in the bigger airways.

Rales are wet also, but that crackle sound is more peripheral, fluid in the alveoli.

Question 15

what is the steeple sign?

Answer 15

Its the X-ray finding of swelling of the cricoid ring, where you find croup.

Question 16

what are differentials you can consider rather than croup?

Answer 16

• foreign body
• epiglottitis
• allergic reaction
• Tracheitis

Question 17

what is Hering-Breuer?

Answer 17

a reflex/ stretch receptor on your lungs to keep your lungs from over inflating.

Question 18

what is the minuet volume?

Answer 18

the amount or air moved in and out of the lungs each minute

MV= tidal volume x respiratory rate

Question 19

Is Epiglottitis a rapid or slow onset?
High or low fever?
virus or bacteria?

Answer 19

rapid
High
bacteria

Question 20

In croup, what is narrowing?

Answer 20

larynx and the cricoid cartilage

Question 21

What is tracheitis?

Answer 21

Bacterial Infection of the trachea.

Looks like croup (has a higher fever), but wont respond to the same treatments.

Question 22

What is peritonsillar abscess?

Answer 22

its infection and puss filled abscess to the tonsils.

S/S: difficulty swallowing
“hot potato voice”

Question 23

what is bronchiolitis?

Answer 23

inflammation to the bronchioles.

Viral infection: Respiratory Syncytial virus (RSV)

S/S: less than 2 yo usually, wheezing, crackles, nose flailing, dehydrated.

Tx: O2, suction nose

Question 24

What is ARDS?

Answer 24

acute (adult) respiratory distress syndrome

alveoli damaged, lack of gas exchange, resp failure, hypoxia.

Tx: CPAP/PEEP

Question 25

what will long term treatment be for a small PE?

Answer 25

Heparin or Coumadin

Question 26

what are some things to ask your patient if you suspect a PE?

Answer 26

• stagnant life style?
• recent surgery?
• Hx of DVT?
• A fib?
• birth control?
• clotting issues or hx?

Question 27

why will capno be low on a PE patient?

Answer 27

an air embolism can decrease the amount of CO2 being released, its being blocked (there is more alveolar dead space, not getting rid of CO2)

Question 28

why would there be a higher number of CO2?

Answer 28

The pt is not breathing fast enough, and the body is still metabolizing (so there is a build up of CO2 in the lungs) and is being blown off.

Question 29

what is one concern that we should always assume with a COPD pt and their condition of breathing is worse one day?

Answer 29

infection

• COPD pt are prone to infection because they can not get air out.

Question 30

what is Alpha 1 antitrypsin

Answer 30

smoking break down alpha 1 antitrypsin

is the protective enzyme that prevents breakdown of the alveoli