Airway and Respiratory Emergencies Flashcards

(68 cards)

1
Q

How does a pt look with respiratory failure?

A

Hypoxemia and hypercarbia
Respiratory exhaustion
Use of accessory muscles
Retractions

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2
Q

What does 4 min signify with complete obstruction?

A

From the time of complete obstruction to onset of brain damage (FRC has 21% oxygen)

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3
Q

Most common cause of airway obstruction

A

Tongue

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4
Q

Progression of airway obstruction

A

Partial will often go to complete if not cleared

Complete with progress to respiratory arrest if not cleared

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5
Q

How does a pt look with complete airway obstruction?

A

Chest will move in “rocking motion” with abdomen going in opposite direction

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6
Q

Who must perform the most invasive airway management?

A

Most experienced practitioner

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7
Q

Types of airways

A

Oral
Nasal
Laryngeal mask airway

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8
Q

Presentation of foreign body aspiration in a toddler

A

Persistent cough and unilateral wheezing if gone down 1 bronchi
No URI sxs
Decreased breath sounds
Post-obstructive atelectasis, pneumonia

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9
Q

Location of foreign bodies

A
Larynx
Tracheal/ carina
Right lung (MOST- most here is main bronchus)
Left lung (second most common)
Bilateral
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10
Q

What is important to remember with intubation and facial burns?

A

Intubate early with facial or large scale burns because if you wait too long the trachea will close and can’t intubate

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11
Q

Types of Le Forte fractures

A

I- maxilla is disconnected b/c fracture goes straight across and upper teeth are loose
II- through cheek bones and under the orbits
III- fractures through the orbits

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12
Q

What fractures are likely to have cribriform fractures?

A

LeForte II and III

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13
Q

What MUST you remember with LeForte II and III?

A

No nasal airways!!! (b/c possible cribriform)

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14
Q

What is seen on a pt with a basilar skull fracture?

A

Battle’s sign (bruising of mastoid- mid skull fracture)
Raccoon eyes (frontal fracture)
CSF from nose and/or ears

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15
Q

Pathophysiology of anaphylaxis

A
Antigen-antibody binds to mast cells
IgE-mediated histamine release
Increased vascular permeability, vasodilation
Bronchial constriction
Increased mucous gland secretion
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16
Q

Common causes of anaphylaxis

A

Abx
ASA and NSAIDs
Shellfish, nuts, eggs, milk
Hymenopytera (bee) stings, grasses

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17
Q

Presentation of anaphylaxis

A
Onset in seconds to hours
Angioedema
Tightening sensation in throat and chest
Laryngeal swelling and bronchial spasm, hoarseness, stridor, wheezing (BILATERAL)
Respiratory distress and apnea
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18
Q

Tx for anaphylaxis

A

Airway management and O2
Epi if severe hypotension (IV .3-.5 mg of 1:10,000 or SC .3-.5 mg of 1:1,000)
Antihistamines (H1 like diphenhydramine or H2 like cimetidine)

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19
Q

What can also be considered in some anaphylaxis cases?

A
Beta 2 agonists (albuterol)
Steroids
Endotracheal intubation
Surgical airway
IV bolus if hypotensive
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20
Q

What is angioedema?

A

Eruption similar to urticaria but with larger edematous areas that involve dermis and subQ structures
Frequently head and neck
Onset in minutes to hours and resolves in hours to days

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21
Q

2 types of angioedema

A

Hereditary- insufficient synthesis of C1-esterase inhibitor (rare and autosomal dominant)
Acquired (ACE-i)

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22
Q

Tx for angioedema

A

Airway and support
Plasma conc of C1 esterase inhibitor if hereditary
Epi, antihistamines, steroids
Danazol to increase synthesis of C1 esterase inhibitor
Ecallantide (kallikrein inhibitor)
Icatibant (bradykinin receptor antagonist)

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23
Q

What does C1 esterase inhibitor usually do?

A

Prevent the build up of bradykinin

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24
Q

What is ludwig’s angina?

A

Bilateral, rapidly spreading submandibular cellulitis

Usually originating from 2nd or 3rd molars

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25
Sxs of ludwig's angina
``` Tongue elevated Hard, firm induration of floor of the mouth Perioral edema Pain Trismus Mediastinitis ```
26
Tx for ludwig's angina
Must be surgery Awake fiberoptic nasal intubation Sometimes awake tracheostomy
27
What is the retropharyngeal abscess?
Localized collection of pus in the retropharyngeal space (rare)
28
Causes of a retropharyngeal abscess
``` Mixed gram - and anaerobic bacteria Tonsillitis Otitis media Pharyngeal trauma Odynophagia ```
29
Sxs of a retropharyngeal abscess
Fever, odynophagia (classic!), neck swelling, drooling, torticollis, meningismus, cervical LAD, stridor, airway obstruction
30
Ways to diagnose retropharyngeal abscess
Clinical Soft tissue lateral neck x-rays (gas, mass) CT neck
31
Tx for retropharyngeal abscess
Airway management | Abx, admit, drainage
32
What is epiglottitis?
Infection of the supraglottic structures including epiglottis, lingual tonsillar area, epiglottic folds and false vocal cords EMERGENCY
33
Who does epiglottitis happen in?
Age 2-7 (before H flu B vaccine) Sometimes in adults HIB, strep, staph
34
Sxs of epiglottitis
Abrupt onset over hrs | Fever, stridor, toxic appearance, dys and odynophagia, drooling, tripod, altered LOC, cyanosis, airway obstruction
35
What MUST you remember with epiglottitis?
Never stick a tongue blade in the throat (do a soft tissue lateral neck x-ray if stable)
36
X-ray for epiglottitis
Thumb sign
37
Tx for epiglottitis
Immediate control of airway | Abx when secure airway (3rd gen cephalosporin like ceftriaxone)
38
What is croup (laryngotracheobronchitis)?
Usually benign, self limited inflammatory condition of the trachea below level of vocal cords usually caused by parainfluenza virus
39
Who do you see croup in?
``` 6 mos-3 yrs Can see up 15 yrs tho Increased in winter Can be RSV *smaller pt, more likely to go into respiratory distress ```
40
Sxs of croup
2-3 day history of URI Low grade fever Gradual worsening, barking seal cough (especially at night) Stridor, dyspnea, retractions, tachypnea
41
Xray for croup
Steeple sign (not sensitive or specific)
42
Tx of croup
Airway management Cool mist, maybe O2 Nebulized epi (observe for 3-4 hrs after tx) Steroids (prednisolone for 1 mg/kg or dexamethazone for .15-.6 mg/kg IM or PO)
43
What causes whooping cough?
Bordetella pertussis (gram - aerobe)
44
Who is at highest risk for whooping cough?
Unvaccinated infants and toddlers
45
Sxs of whooping cough
``` URI sxs in early stage and paroxysms of cough later NO FEVER Inspiratory stridor in younger pts Post-tussive vomiting!! Increased WBCs and lymphocytes ```
46
How to diagnose whooping cough?
Nasopharyngeal swab on special culture media (gold standard) | -Can do PCR with shorter turn around
47
Who is the risk for with whooping cough in unvaccinated kids?
Sudden infant death and airway compromise | *also treat unprotected contacts
48
Sxs of lower respiratory tract infections
Usually start with URI and progress to lower | Dyspnea, hypoxemia, apnea, acute respiratory failure
49
What is bronchiolitis?
Clinical syndrome in infancy characterized by rapid respiration, chest retractions and wheezing
50
When is bronchiolitis seen in pts?
Winter Males more 0-2 YO (peaks at 2-6 mos) Most common cause is RSV!!
51
Pathophysiology of bronchiolitis
Bronchiolar obstruction from submucosal edema and mucous plugging and bronchoconstriction
52
When do you order an Xray in bronchiolitis?
Increased temp, choking, asymmetric chest exam, respiratory distress, sudden deterioration
53
Sxs of bronchiolitis
Runny nose/ sneezing, low grade fever, dyspnea, tachypnea, intercostal retractions, wheezing, cyanosis and apnea
54
How to diagnose bronchiolitis?
Clinical CXR- hyperinflated lungs Pulse ox to see hypoxia Viral cultures and fluorescent monoclonal antibody testing of NP swabs
55
Tx for bronchiolitis
``` Airway, support Mild cases can be observed at home and admit others O2, beta agonists NO STEROIDS Ribavirin for severely ill or intubated ```
56
What characterizes asthma?
Paroxysmal attacks of reversible bronchospasm, mucous plugging and inflammation of tracheobronchial tree
57
Sxs of acute exacerbation of asthma
Progressive dyspnea, chest tightness, wheezing, cough, respiratory distress
58
Tx for acute exacerbation of asthma
Airway and O2 Beta 2 agonists, steroids, anticholinergics (atrovent) Must decide admit or discharge quickly
59
Usual protocol for acute exacerbation of asthma
Stacked SVN txs with bronchodilators (.5 cc albuterol in 2.5 cc normal saline)--3 txs every 30 min Maybe steroids
60
What is status asthmaticus?
FEV1 that does not increase to greater than 40% predicted value with tx (develop major complications like a pneumo)
61
What to do with a pt with status asthmaticus?
Beta agonists, high dose steroids, O2 | ADMIT
62
What is pneumonia?
Inflammation of lung caused by infection which causes alveoli to become filled with pus so air is excluded
63
Sxs of pneumonia
Fever, cough, dyspnea, pleuritic chest pain, respiratory failure
64
Tx for pneumonia
Airway management and O2 | Abx, beta 2 agonists, analgesics
65
Sxs of pneumothorax
Chest pain on side of collapsed lung Dyspnea Occasional cough (but absence of other URI sxs)
66
How to diagnose tension pneumothorax
``` Decreased breath sounds Tachycardia and tachypnea Tracheal deviation Hypotension, cyanosis, respiratory distress CXR ```
67
Tx for pneumothorax with <15-20% involvement
Observe and repeat CXR in 48 hrs
68
Tx for pneumothorax with >20%
Needle decompression for tension pneumothorax Simple aspiration Tube thoracostomy (chest tube)