Bronchospasm Flashcards
(22 cards)
What are the primary actions in managing bronchospasm?
- Maintain a secure and patent airway.
- Administer 100% FiO₂.
- Manual ventilation.
- Diagnose and treat the underlying cause.
What is the management for mild to moderate bronchospasm?
- Increase anesthetic depth.
- Increase inhalational anesthetic concentration.
- Administer albuterol.
What actions should be taken for severe bronchospasm?
- Call for help.
- Stop surgery.
- Implement treatment as indicated above.
- Administer epinephrine.
What are the secondary actions in bronchospasm management?
- Mechanical ventilation: Tidal volume 4-6 mL/kg, adjust I:E ratio to allow for longer expiratory time.
- Obtain arterial blood gas to assess ventilation, acid-base status, and treatment efficacy.
- Preoperative optimization with bronchodilators for patients with bronchospastic respiratory disease.
What is the dosage for epinephrine in bronchospasm management?
10-100 mcg IV bolus, repeat PRN or 0.01-0.5 mcg/kg/min IV infusion.
What is the dosage for albuterol in bronchospasm management?
2.5-5 mg nebulized every 20 minutes for 3 doses, or 4-8 puffs by metered dose inhaler every 20 minutes for 3 doses.
What is the dosage for Ipratropium Bromide (Atrovent) in bronchospasm management?
500 mcg nebulized every 20 minutes for 3 doses, or 4-8 puffs by metered dose inhaler every 20 minutes for 3 doses.
What is the dosage for terbutaline in bronchospasm management?
0.25 mg SC injection every 20 minutes, max 3 doses.
What is the dosage for magnesium sulfate in bronchospasm management?
40-50 mg/kg IV or 2 g over 20 minutes infusion.
What is the dosage for hydrocortisone in bronchospasm management?
150-200 mg IV.
What is the dosage for aminophylline in bronchospasm management?
6 mg/kg IV loading dose, then 0.5-0.7 mg/kg/hr infusion.
What is bronchospasm?
Acute and reversible narrowing of bronchopulmonary segments.
What are common causes of bronchospasm?
- Airway manipulation.
- Endotracheal tube stimulation.
- Surgical stimulation.
- Light anesthesia.
What is the key pathophysiology of bronchospasm?
Increased airway resistance and turbulent airflow lead to wheezing and respiratory distress.
What does a sloped expiratory limb (shark fin morphology) indicate in capnography?
Indicates air trapping and bronchoconstriction.
What does an absent or decreased ETCO₂ waveform indicate?
Severe bronchospasm.
What are respiratory signs and symptoms of bronchospasm?
- Decreased bag compliance during manual ventilation.
- Decreased breath sounds.
- Desaturation.
- Hypercarbia.
- Hypoxemia.
- Increased peak inspiratory pressure.
- Minimal or absent ETCO₂/breath sounds (severe bronchospasm).
What are cardiovascular signs and symptoms of bronchospasm?
- Cardiac arrest.
- Dysrhythmias.
- Hypertension.
- Tachycardia.
What are some differential diagnoses for respiratory issues similar to bronchospasm?
- Acute gastric aspiration.
- Asthma exacerbation.
- Chronic obstructive pulmonary disease (COPD).
- Endotracheal tube contacting carina or mainstem bronchus.
- Laryngospasm.
- Mechanical airway obstruction.
- Pneumothorax.
- Pulmonary edema.
- Pulmonary embolism.
- Upper respiratory tract infection with swelling.
What are some pharmacologic causes of bronchospasm?
- Airway irritation (e.g., desflurane).
- Anticholinesterase agents.
- Beta blockers.
- Histamine-releasing drugs (e.g., atracurium, morphine).
- NSAIDs (e.g., ketorolac).
What are other considerations in bronchospasm management?
- Anaphylaxis.
- Carcinoid syndrome.
- Endobronchial intubation.
- Light anesthesia or surgical stimulation.
What diagnostic test is recommended for bronchospasm?
Preoperative pulmonary function testing.
