airway and respiratory emergencies

Question 1

time of complete airway obstruction to brain damage

Answer 1

• 4 minutes

Question 2

swallowed FB is most likely to be stuck where

Answer 2

right main stem of lung

Question 3

clinical presentation in toddler

• persistent cough
• unilateral wheezing
• decreased breath sounds

Answer 3

foreign body aspiration

Question 4

anaphylaxis is mediated by what antibody

Answer 4

IgE -> histamine release

Question 5

DOC for anaphylaxis if hypotension present

Answer 5

epinephrine

Question 6

dosage and route for epinephrine in anaphylaxis

Answer 6

• IV 0.3 - 0.5 mg of 1:10,000
• SC 0.3 - 0.5 mg of 1:1,000

Question 7

what type of antihistamines should be given in anaphylactic shock

Answer 7

• H1 and H2

Question 8

hereditary cause of angioedema

Answer 8

• insufficient synthesis of C1-esterase inhibitor (rare)

Question 9

medication associated with angioedema

Answer 9

ACE-inhibitor

Question 10

function of Danazol in tx of angioedema

Answer 10

• increase the synthesis of C1-esterase inhibitor

Question 11

causes of retropharyngeal abscess

Answer 11

• tonsillitis
• otitis media
• pharyngeal trauma

*mixed gram negative and anaerobic bacteria

Question 12

clinical presentation

• fever
• odynophagia: painful swallowing
• neck swelling
• drooling
• torticollis
• cervical adenopathy
• stridor
• airway obstruction

Answer 12

retropharyngeal abscess

Question 13

how is retropharyngeal abscess diagnosed

Answer 13

• clinical
• soft tissue lateral neck xray
• CT neck

Question 14

tx of retropharyngeal abscess

Answer 14

• airway management
• abx
• admission
• surgical drainage

Question 15

an infection of the supraglottic structures including the epiglottis, lingual tonsillar area, epiglottic folds, and false vocal cords

Answer 15

epiglottitis

Question 16

cause of epiglottitis

Answer 16

• H influenza B, strep, staph

Question 17

clinical presentation

• abrupt onset over several hours
• fever
• stridor
• dysphagia
• odynophagia
• drooling
• tripod

Answer 17

epiglottitis

Question 18

what should never be done if you suspect epiglottitis

Answer 18

never stick a tongue blade in throat

Question 19

how is epiglottitis diagnosed

Answer 19

• clinically
• soft tissue lateral neck xray if very stable
  
  • thumb sign

Question 20

thumb sign is consistent with

Answer 20

epiglottitis

Question 21

tx of epiglottitis

Answer 21

• control airway
• abx once airway is secured
  
  • 3rd generation cephalosporin: ceftriaxone

Question 22

croup: laryngotracheobronchitis

Answer 22

inflammatory condition of the trachea below the level of the vocal cords (subglottic)

Question 23

croup: laryngotracheobronchitis is usually caused by what pathogen

Answer 23

• parainfluenza virus
• RSV

Question 24

croup: laryngotracheobronchitis usually affects what age population

Answer 24

• 6 months - three years
• inc in winter

Question 25

clinical presentation * 2-3 day h/o URI * low grade fever * gradual, worsening "barking seal" cough, especially at night * dyspnea, retractions, stridor

Answer 25

croup: laryngotracheobronchitis

Question 26

PA CXR showing **steeple sign** is consistent with

Answer 26

croup: laryngotracheobronchitis

Question 27

tx of croup: laryngotracheobronchitis

Answer 27

* nebulized epinephrine (must obsreve for 3-4 hours after tx) * steriods * prednisolone * dexamethasone (decadron)

Question 28

whooping cough is caused by what pathogen

Answer 28

* bordetella pertussis * gram neg aerobe

Question 29

who is at the highest risk for developing whooping cough

Answer 29

* unvaccinated infants and toddlers

Question 30

clinical presentation * URI symptoms * fever usually absent * coughing * **post-tussive vomiting**

Answer 30

whooping cough

Question 31

how is whooping cough diagnosed

Answer 31

* **nasopharyngeal swab**: gold standard * PCR: shorter turn around time

Question 32

tx of whooping cough

Answer 32

* **erythromycin/azithromycin** * need to tx unprotected contacts too

Question 33

bronchiolitis is a clinical syndrome in infancy characterized by what 3 things

Answer 33

* rapid respiration * chest retractions * wheezing

Question 34

bronchiolitis is caused by what pathogen

Answer 34

* RSV: respiratory syncitial virus

Question 35

bronchiolitis most commonly affects what age range

Answer 35

* 0-2 years * peak 2-6 months

Question 36

what is bronchiolitis

Answer 36

* bronchiolar obstruction from submucosal edema and mucous plugging

Question 37

how is bronchiolitis diagnosed

Answer 37

* clinical * CXR: hyperinflated lungs * hypoxia * viral cultures/fluorescent monoclonal antibody testing of nasopharyngeal swabs

Question 38

treatment of severe bronchiolitis

Answer 38

* admit * oxygen, beta 2 agonist * steroids **not indicated** * Ribavirin for severely ill or intubated

Question 39

paroxysmal attacks of reversible bronchospasm

Answer 39

asthma

Question 40

tx of acute emergent asthma

Answer 40

* beta 2 agonist: albuterol * steriods: prednisone PO or solumedrol IV

Question 41

what is the protocol for stacked SVN tx of acute asthma

Answer 41

* 0.5 cc albuterol in 2.5 cc normal saline, **3** treatments given every **30 minutes** * peak flow rate before 1st and 3rd

Question 42

what is status asthmaticus

Answer 42

* FEV1 that does not increase to greater than 40% of predicted value with treatment * pt who develops major complications like pneumothorax

Question 43

tx of status asthmaticus

Answer 43

* **admit** * beta agonist * high dose steroids * oxygen

Question 44

clinical presentation * fever * cough * dyspnea * pleuritic CP * respiratory failure

Answer 44

PNA

Question 45

what is a pneumothorax

Answer 45

* any breech of the lung surface or chest wall allowing air to enter the pleural cavity, causing the lung to collapse

Question 46

treatment for pneumothorax **\< 15-20% involvement**

Answer 46

* observation only * repeat CXr in 48 hours

Question 47

treatment for pneumothorax **\>20%** involvement

Answer 47

* needle decompression * tube thoracostomy: mid axillary incision at 5th interspace, tunnel to 4th rib * simple aspiration