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Nayla clinical disciplines > Respiratory emergencies > Flashcards

Respiratory emergencies Flashcards

1
Q

What is pneumonia

A

infection of alveoli d/t bacteria, viruses, fungi, or yeast

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2
Q

What pathogens cause PNA based on presentation

A

Strep Pneumo: Rust sputum
Klebsiella: red currant jelly sputum (alcoholics/NH)
Pseudomonas, Heamophilus: green sputum
Anaerobes: foul smelling, bad tasting sputum
Legionella: Bradycardia, Hyponatremia
M. Pneumo: Bullous myringitis, OM
(Staph. Aureus more common after a virus, like influenza)

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3
Q

How does PNA present symptomatically

A

Triad: Fever + Dyspnea + cough
sudden onset fever
Rigors
Productive cough

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4
Q

What are pathogen specific CXR findings in PNA

A

Strep pneumo: Lobar infiltrate +/- parapneumonic pleural effusion
Staph Aureus: extensive infiltrates

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5
Q

What is CURB 65

A 
Confusion 
Uremia (BUN >20) 
Respiratory Rate >30 
BP <90/60
65+ y/o
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6
Q

How do you treat PNA

A 
IV fluids 
O2
anti-pyretics
Bronchodilator 
Abx
Cough suppressant 
Steroids 
HCAP: Cefipime/Ceftazadime/Zosyn, Cipro/Levo/Vanco
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7
Q

What is Acute Mountain Sickness

A

High altitude sickness 2/2 hypobaric hypoxia

Cerebral blood icreases, brain enlarges, vasogenic edema develops

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8
Q

What are Sx of acute mountain sickness

A 
Light headed 
HA (bi-frontal, worse w/ valsalva) 
Breathless w/ activity 
Anorexia
Nausea
weakness
irritable
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9
Q

What are PE findings of Acute Mountain Sickness

A

Postural hypotension
Localized rales
Retinal hemorrhage
Fluid retention (anuresis)

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10
Q

How do you treat acute mountian sickness

A 
Stop ascending 
Acetazolamide 125mg PO BID 
ASA/APAP/Motrin 
Dexamethasone 
Prevent w/ radual ascent, aovid alcohol or resp depresant, eat high carbs, Acetazolamide 24 hr prior, dexamethasone
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11
Q

What are Sx of High Altitude Cerebral edema

A

Ataxia
stupor
coma
CN 3, 6 palsy

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12
Q

How do you treat high altitude cerebral edema

A

Oxygen
Descent
Dexamethasone
Loop (Furosemide, Bumetanide)

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13
Q

What are symptoms of high altitude pulmonary edema

A 
Dry cough progressive to productive 
Decreased exercise 
rales s/p exercise 
increasing dyspnea 
coma
death
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14
Q

How do you treat high altitude pulmonary edema

A

Recognition
Immediate descent
O2 (takes 3 days)
Nifedipine

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15
Q

What is CHF

A

LV dysfunction (2/2 aortic stenosis, HTN, AFib, or CAD) causing hypoxemia, HTN, tachy, dyspnea, weight gain, and rales

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16
Q

What are L and R symptoms of CHF

A 
L= Lungs (dyspnea, fatigue, cough, PND, orthopnea) 
R= Swollen (peripheral edema, JVD, RUQ pain)
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17
Q

What are PE findings in CHF

A

CXR: dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulmonary artery, pleural effusion, Kerley B lines)
Pro BNP >200
Get a CXR, EKG, lung US, and echo- CBC, CMP, cardiac enzymes, pro-BNP

18
Q

How do you treat CHF

A 
O2 
Vent 
Nitro 
Morphine 
Furosemide
Dobutamine
19
Q

What do you AVOID in CHF

A

CCB (pulm edema or shock)
NSAID (inhibit diuretic)
Anti-arrhythmics (pro-arrhythmics)

20
Q

What is a PE

A

Proximal portion of venous thrombosis breaks off and travels to lung (MC pelvic or LE veins)
Big cause of non-surgical maternal death in peripartum period

21
Q

What are Sx of PE

A

Virchows triad (Hypercoagulable + venous stasis + vessel wall inflammation)
Dyspnea, pleuritic CP, syncope, LE pain/edema, confusion, anxiety, hypoxemia
PE Triad: Pleuritic CP + SOB + hemoptysis

22
Q

What are some PE findings in PE

A

Calves >2cm difference
Wells score 2-6 = moderate, 6+ high risk
Geneva score 3+ high risk

23
Q

What are diagnostic findings due to PE

A

CT*: pref Dx
CXR: Hampton’s hump, westermark’s sign, fleischner sign
VQ scan: mismatch
Echo: RV enlargement
Cardiac enzymes: pro-BNP or trop
ECG: sinus tach common (S1Q3T3 classic R heart strain)
Venous compression, ABG, D-dimer

24
Q

How do you treat PE

A 
Heparin (monitor aPTT) 
Coumadin 
Lovenox 
Rivaroxaban 
IVC filter if coags C.I. 
Thrombolytics (streptokinasse, urokinase, tPA) 
Embolectomy if massive and tPA C.I. 
Catheter thrombolysis (tPA then heparin)
25
Q

What is Asthma

A

Chronic reversible inflammatory d/o affecting mostly kids

*Causes Dyspnea, wheezing, coughing

26
Q

What is the triad associated with Asthma

A

Airway inflammation + Airflow obstruction + Hyperresponsiveness

27
Q

What is COPD

A

Chronic, IRreversible disorder
Chronic Bronchitis (cough 3+ mo for 2+ yrs)
Emphysema (destroyed bronchioles and alveoli

28
Q

RF for COPD are

A

Tobacco use*****
occupational, environmental
AAT deficiency
IVDA

29
Q

What are Sx of COPD

A

Cough, worse in AM
SOB, wheezing, tachypnea, cyanosis
Progress to chest tightness, prolonged expiration, accessory muscle use, AMS

30
Q

What diagnostics should you do in COPD

A 
FEV1 
Pulse ox (+/- CXR, blood test)
31
Q

What are goals of therapy and two preferred treatments of COPD

A

Reverse obstruction, provide oxygen, relieve inflammation
Beta Agonist (broncho/vasodilate, relax uterus, cause tremor)
Steroids (DXm, methylpred- not high dose)
(Can also Tx with epinephrin, SAMA, Mag/sulfate if severe, Ketamine)
BiPAP

32
Q

When does FB aspiration usually occur

A

1-3 y/o (they put everything in their mouths, large food particles)
85+ y/o (ALOC, dysphagia 2/2 stroke, impaired swallowing, alzheimers, parkinsons)

33
Q

What are Sx of FB aspiration

A 
Cough 
stridor (if laryngotracheal) 
wheezing (if bronchial) 
SOB 
Universal choking sign
34
Q

Where are FB MC found

A
  1. Thoracic inlet (level of clavicles on XR)
  2. Mid-esophagus (aortic arch and carina overlap)
  3. Distal esophagus (LES)
35
Q

What are your diagnostics for FB

A

CT, Laryngoscopy*

CXR can be normal in 50%

36
Q

How do you manage a FB aspiration

A

Ask if choking and if you can help- “Abdominal Thrust”
If alone: put fist at navel, lean over chair, dive fist up
Infant: face down across forearm and give 5 forceful quick blows with heel of hand
Child: 2 fingers in middle of infant’s chest and 5 quick thrusts downward
Unconscious: CPR (NO BLIND FINGER SWEEP)
Magil forceps to remove

37
Q

What is right to left shunting

A

A cause of Hypoxemia

Hallmark is failure to increase oxygen levels with supplemental oxygen

38
Q

What are the different kinds of PNA

A

CAP: strep pneumo, not in hospital in last 14 days
VAP: PNA 48 hrs s/p intubation
HAP: PNA 48 hr s/p admit
HCAP: in hospital >2 days in last 3 mo. in NH, IV abx, dialysis, chronic wound, chemo, immunocompromised

39
Q

How do you compensate Metabolic acidosis

A

Respiratory alkalosis (low CO2)= Hyperventilation, Kussmaul breathing

40
Q

How do you compensate Metabolic Alkalosis

A

Respiratory acidosis (high CO2)= hypoventilation

41
Q

What is a cause of Respiratory Alkalosis

A

high altitude illness causing hypoxic ventilator response–>hyperventilation

42
Q

What causes an increased osmolar gap

A 
ME DIE 
Methanol 
Ethanol 
Diuretics 
Isopropyl alcohol 
Ethylene glycol

Nayla clinical disciplines (8 decks)

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