Flashcards in Airway and Respiratory Emergencies Deck (68)
How does a pt look with respiratory failure?
Hypoxemia and hypercarbia
Use of accessory muscles
What does 4 min signify with complete obstruction?
From the time of complete obstruction to onset of brain damage (FRC has 21% oxygen)
Most common cause of airway obstruction
Progression of airway obstruction
Partial will often go to complete if not cleared
Complete with progress to respiratory arrest if not cleared
How does a pt look with complete airway obstruction?
Chest will move in "rocking motion" with abdomen going in opposite direction
Who must perform the most invasive airway management?
Most experienced practitioner
Types of airways
Laryngeal mask airway
Presentation of foreign body aspiration in a toddler
Persistent cough and unilateral wheezing if gone down 1 bronchi
No URI sxs
Decreased breath sounds
Post-obstructive atelectasis, pneumonia
Location of foreign bodies
Right lung (MOST- most here is main bronchus)
Left lung (second most common)
What is important to remember with intubation and facial burns?
Intubate early with facial or large scale burns because if you wait too long the trachea will close and can't intubate
Types of Le Forte fractures
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
What fractures are likely to have cribriform fractures?
LeForte II and III
What MUST you remember with LeForte II and III?
No nasal airways!!! (b/c possible cribriform)
What is seen on a pt with a basilar skull fracture?
Battle's sign (bruising of mastoid- mid skull fracture)
Raccoon eyes (frontal fracture)
CSF from nose and/or ears
Pathophysiology of anaphylaxis
Antigen-antibody binds to mast cells
IgE-mediated histamine release
Increased vascular permeability, vasodilation
Increased mucous gland secretion
Common causes of anaphylaxis
ASA and NSAIDs
Shellfish, nuts, eggs, milk
Hymenopytera (bee) stings, grasses
Presentation of anaphylaxis
Onset in seconds to hours
Tightening sensation in throat and chest
Laryngeal swelling and bronchial spasm, hoarseness, stridor, wheezing (BILATERAL)
Respiratory distress and apnea
Tx for anaphylaxis
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)
What can also be considered in some anaphylaxis cases?
Beta 2 agonists (albuterol)
IV bolus if hypotensive
What is angioedema?
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
2 types of angioedema
Hereditary- insufficient synthesis of C1-esterase inhibitor (rare and autosomal dominant)
Tx for angioedema
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)
What does C1 esterase inhibitor usually do?
Prevent the build up of bradykinin
What is ludwig's angina?
Bilateral, rapidly spreading submandibular cellulitis
Usually originating from 2nd or 3rd molars
Sxs of ludwig's angina
Hard, firm induration of floor of the mouth
Tx for ludwig's angina
Must be surgery
Awake fiberoptic nasal intubation
Sometimes awake tracheostomy
What is the retropharyngeal abscess?
Localized collection of pus in the retropharyngeal space (rare)
Causes of a retropharyngeal abscess
Mixed gram - and anaerobic bacteria
Sxs of a retropharyngeal abscess
Fever, odynophagia (classic!), neck swelling, drooling, torticollis, meningismus, cervical LAD, stridor, airway obstruction