Lower Airway Flashcards
(49 cards)
Wheezing
Occurs when air enters narrowed or constricted areas of the lungs
Intermittent Asthma
Asthma is considered intermittent if without treatment ANY of the following are true:
- Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
- —Occur on fewer than 2 days/ week
- —Do not interfere with normal activities
- —Nighttime symptoms occur on fewer than 2 days/month
Mild Persistent Asthma
Asthma is considered Mild Persistent if w/o treatment ANY of the following are true:
- -Symptoms occur on more than 2 days/week, but do not occur everyday
- -Attacks interfere with daily activities
- -Nighttime symptoms occur 3-4 times/month
- -Lung function tests are normal when the person is not having an asthma attack. The results of these tests are 80% or more of the expected value and may vary a small amount (PEF varies 20%-30%) from morning to afternoon
Moderate persistent asthma
Asthma is considered Moderate Persistent if w/o treatment ANY of the following are true:
- -Symptoms occur daily. Inhaled short-acting asthma medication is used everyday.
- -Symptoms interfere with daily activities
- -Nighttime symptoms occur more than 1 x/week, but do not happen everyday.
- -Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than 30% from morning to afternoon
Severe persistent asthma
Asthma is considered severe persistent if without treatment ANY of the following are true:
- -Symptoms occur throughout each day.
- -Symptoms severely limit daily physical activities.
- -Night time symptoms occur often, sometimes every night
- -Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to afternoon
Acute Asthma Mild Symptoms
- Increased RR
- Accessory muscles of respiration are NOT used
- HR 95%
Acute Asthma Moderate Symptoms
- Increased RR
- Accessory muscles are typically used
- Suprasternal retractions are present
- Loud expiratory wheezing heard
- Pulsus paradoxus may be present (10-20mmHg)
- O2 sat on room air is 91-95%
Acute Asthma Severe Symptoms
- RR >30
- Accessory muscles are usually used
- Suprasternal retractions are commonly present
- HR > 120
- Loud biphasic (expiratory and inspiratory) wheezing can be heard
- Pulsus paradoxus is often present (20-40 mmHg)
- O2 sat on room air is less than 91%
Pulsus Paradoxus
On inspiration, a drop in systemic arterial pressure greater than 10mmHg.
Asthma Action Plan
- Required by Joint commission for hospital discharge and continuing care
- Environmental controls
- Algorithm for use of long term and rescue meds
- Medication regimens and rescue meds
- Steps to take when treatment is not effective/emergent care
Stepwise approach in treating status asthmaticus
- Supplemental O2- FIRST PRIORITY
- Stacked inhaled bronchodilators (albuterol, levalbuterol)
- Continuous inhaled bronchodilators
- Prednisone or methylprednisolone
- Anticholinergics (ipratropium bromide) - promotes bronchodilation, used in ED to prevent admission
- MgSO4 as bolus
- Terbutaline (controversial) (IV Beta agonist)
- Methylxantines (aminophylline, theophylline)
- Helium-oxygen gas (Heliox) (Controversial)
- Noninvasive ventilation as BiPAP or CPAP for hypoxia
- Intubation and ventilation as a last resort
- Inhaled anesthesia or extracorporeal membrane oxygenation (ECMO) for severe refractory cases
Pneumonia- Definition/Etiology
Infection and inflammation of the lower respiratory tract in association with detectable radiographic changes of the lung parenchyma, interstitial disease. Bacterial or viral.
Pneumonia- Symptoms/characteristics
Prolonged URI, cough, lethargy, decreased appetite, fever, could be low grade or high depending on organism
Pneumonia- Diagnosis
Presence and longevity of symptoms, chest exam, CXR, CBC, CRP, cold agglutins
Pneumonia- Management
Oxygen, antibiotics, fluids, pulmonary toilet, bronchodilators on occasion
Pneumonia- indications for hospitalization
- Hypoxemia- saturation 70 for infants 50 for older children, retractions, nasal flaring, difficulty breathing, apnea, grunting
- Toxic appearance
- Underlying conditions that may predispose to a more serious course of pneumonia
- Complications (effusion/empyema)
- Suspicion or conformation that CAP is due to a pathogen with increased virulence, such as Staph aureus or Group A Strep
Parapneumonic Effusion - Definition/Etiology
Fluid leak into pleural space. Can be compilation of pneumonia.
2 Stages:
- ) Exudative: pleural fluid is free-flowing
- ) Fibrinopurulent: bacterial invasion, white cells and fibrin results in loculation
A parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis.
Parapneumonic Effusion - Symptoms/Characteristics
Persistent cough, hypoxia, lethargy, wheezing, persistent fever
Parapneumonic Effusion - Diagnosis
Lateral xray or ultrasound
CT may be obtained
Parapneumonic Effusion - Management
- VATS should be performed when there is persistence of moderate-large effusions and ongoing respiratory compromise despite 2-3 days of management with a chest tube and completion of fibrinolytic therapy
- Open chest debridement with decortication represents another option for management of these children but is associated with higher morbidity rates
VATS
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used to diagnose and treat problems in your chest
During a video-assisted thoracoscopic surgery procedure, a tiny camera (thoracoscope) and surgical instruments are inserted into your chest through several small incisions.
Decortication
Decortication is a surgical procedure that removes a restrictive layer of fibrous tissue overlying the lung, chest wall, and diaphragm. The aim of decortication is to remove this layer and allow the lung to reexpand. When the peel is removed, compliance in the chest wall returns, the lung is able to expand and deflate, and patient symptoms improve rapidly
Bronchiolitis - Definition/Etiology
Inflammation, edema, bronchospasm. Virus induces airways obstruction (increased airway secretions and mucosal edema and/or bronchospasm), can cause increased WOB resulting in tachypnea and subcostal retractions, gas trapping as manifested by hyperinflation and noisy breathing.
Acute inflammatory disease of the lower respiratory tract
Many different viral agents: RSV, influenza, rhinovirus, adenovirus, parainfluenza, human metapneumovirus, mycoplasma pneumoniae (in school age children)
Peaks in winter months, common fall-spring
Bronchiolitis - Symptoms/Characteristics
Most common: Premature infants age
