Pulmonary Emergencies Flashcards
What are the common Upper airway obstruction causes?
FB
Retropharyngeal abscess
Angioedema
Head and neck trauma
swelling/edema from inhalation injuries
Epiglottitis
Croup
Tonsillitis
Peritonsillar abscess
Ludwigs angina
Retropharyngeal abscess :
- causes in adults/children
- signs and sx
- imaging
- tx
- complications
Causes:
- Children: lymph node that drains head and neck
- adults: penetrating trauma, infection in mouth/teeth, lymph nodes that drain the head and neck.
Signs and Sx:
- fever
- dysphagia
- neck pain
- limited cervical motion
- cervical lymphadenopathy
- sore throat
- poor oral intake
- muffled voice
- resp distress
- stridor in children
- inflammatory torticollis
Imaging:
- Lateral Xray
- CT scan of neck is “GOLD STANDARD”
Tx:
- ENT consult
- I&D
- IV hydration and IV abx (clindamycin or unasyn = ampicillin-sulbactam)
Complications:
- extension of the infection into the mediastinum (pleural or pericardial effusion)
- upper airway asphyxia
- sudden rupture (aspiration pna, widespread infection)
Angioedema:
- signs and sx
- cause
- tx of each cause/type
Signs and Sx:
- diffuse, NON-pitting edema
- affects the face, lips, mouth, throat, larynx, extremities, genitalia, and bowel.
- ASYMMETRIC edema.
Cause:
- mast cell mediated (allergic)
- Bradykinin mediated (ACEi (lisinopril) or hereditary angioedema)
Tx:
Mast:
-allergic: intubate if signs of resp distress. Epi IM, glucocorticoids, benadryl
Bradykinin:
-ACEi induced: intubate if resp distress, d/c drug, if no improvement after 24hrs you could try antihistamines, glucocorticoids, Complement 1 inhibitor (C1)
- Hereditary:
- intubate if signs of resp distress, C1 inhibitor is 1st line. bradykinin receptor antagonists is 2n line.
Anaphylaxis:
- pathophys
- signs and sx
- tx
Patho:
-multisystem syndrome from the sudden release of mas cells and basophils into circulation.
Signs:
- sudden onset generalized urticaria (hives)
- angioedema
- flushing
- pruritus
- hypotension
sx:
- swelling of conjunctiva
- CNS: light-headedness, LOC, confusion, HA
- brady/tachycardia
- SOB, wheeze, stridor, pain with swallowing, cough
- loss of bladder control
- Crampy abd pain
Tx:
- epinephrine IM up to 3 doses q5-15min
- H1 blocker: benadryl
- H2 blocker: ranitidine(zantac)
- glucocorticoid
- albeuteral
- vasopressors for shock
- intubation if stridor or resp failure
non med tx:
- O2
- 2 IVs, NS bolus 1-2L iin adults, 20ml/kg in kids.
Head and Neck trauma:
- describe the causes of each of the following sounds:
- -gurgling
- -snoring
- -stridor
- -wheezing
-when do you use the Jaw thrust maneuver?
Gurgling: pooling of liquids in the oral cavity or hypopharynx
Snoring: partial airway obstruction at the pharyngeal level from the tongue
Stridor: inspiratory: obstruction at the level of the larynx. Expiratory: obstruction at the level of the trachea.
Wheezing:
-narrowing of lower airways.
Jaw thrust maneuver used when C-spine injury and unable to head-tilt chin-lift. And lauren says there are other reasons too..
What is the difference between stupor and coma?
Stupor: lack of critical cognitive function and level of conciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain.
Coma: state of unconsciousness lasting more than 6hrs, in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound. lacks normal sleep-wake cycle, and does not initiate voluntary actions.
Pneumothorax:
- what is this?
- risk factors
- signs and sx
- S&S tension pneumo
- tx
What: accumulation of air in the pleural space, can be spontaneous or trauma induced.
Risk factors:
- men
- 20-40YO
- thin build
- smokers
- FHx
- Marfans
- prior episode
Signs and Sx:
- sudden onset of dyspnea and pleuritic chest pain
- occurs at rest
- decreased chest excursion
- decreased breath sounds on the affected side*
- hypperresonant to percussion
- possible subQ emphysema
- hypoxemia
- Suspect tension pneuomthorax if:
- labored breathin g
- tachycardia
- hypotension
- tracheal shift
- JVD
Tx:
- O2
- Needle decompression followed by chest tube placement in the 2-3 ICS mid clavicular line.
Acute Pulmonary Edema:
- presentation
- pathophys
- acute and chronic causes of cardiogenic PE.
- causes of non-cardiogenic PE
Presentation:
- dyspnea
- frothy pink sputum
- pedal edema
- ascites
- rales
- wheezing
- HTN
- hypoxemia
- restlessness
- tachycardia
Pathophys:
-sudden increase in left sided intracardiac filling pressures
OR
-increased alveolar capillary membrane permeability
Acute Causes of Cardiogenic PE:
- ischemia
- acute severe mitral regurgitation
- acute aortic regurgitation
- HTN crisis 2ndry to bilateral renal artery stenosis
- stress induced cardiomyopathy
Chronic Causes Cardiogenic PE:
- decompenstated systolic or diastolic CHF
- left ventricular outflow tract obstruction
- valvular heart dz
Non-cardiogenic causes PE:
- ARDS***
- altitude
- Neurogenic
- narcotic overdose
- PE
- eclampsia
- transfusion related injury
- salicylate overdose
Pulmonary edema:
-a major cause is ARDS, what are some causes of ARDS?
ARDS:
- sepsis
- acute pulmonary infection
- trauma
- inhaled toxins
- DIC
- Shock lung
- freebase cocaine smoking
- post CABG
- inhalation of high concentration of O2
- Acute radiation pneumonitis
Pulmonary Edema:
-tx of cardiogenic and non-cardiogenic
Cardiogenic:
- O2 PLUS:
- -tx underlying cause
- -ischemia: Rx = nitrates, morphine, diuretics
- -Valvular dz = diuretics
- -treat arrhythmias = ACLS protocol and diuretics
Noncardiogenic:
- O2 PLUS:
- -treat underlying cause
- if ARDS = intubation, mechanical ventiallation with PEEP.
- diuretics may be somewhat helpful.
Aspiration:
-tx
Massive aspiration requires immediate protection of the airway from further injury by INTUBATION!
-once intubated can suction lower airway.
Treat underlying cause:
- -prolonged BVM during CPR
- neurologic compromise secondary to stroke, SAH, head injuries.
Acute Asthma:
- pathophysiology
- signs and sx
Pathophys:
- inflammation of the airways w/ abnormal accumulation of eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, and myofibroblasts
- reduction in airway diameter causedvby smooth muscle contraction, vascular congestion, bronchial wall edema, and thick secretions
Signs and Sx:
- accessory muscle use, fragmented speech, orthopnea, diaphoresis, agitation, low BP, severe sx that fail to improve with initial tx.
- impending resp failure: inability to maintain resp effort and rate, cyanosis, depressed mental status, severe hypoxemia despite high flow O2 via nonrebreather.
Acute Asthma:
- what test helps give an objective measurement as to the severity of airflow obstruction??
- tx
Peak flow gives an objective measurement of severity of airflow obstruction.
peak flow less than 40% = severe. Measure before and after neubulizer or MDI
Tx:
- you will look this up, but its going to be a bronchodilator and glucocorticoid.
Acute COPD Exacerbation:
- cause
- sx
- work up
- tx
Cause: MC precipitated by viral or bacterial infection.
Sx:
-increase or change in character of ususal sx of dyspnea, cough, or sputum production.
Work uP:
- O2 sat
- ABG
- CXR
- CBC, BMP, BNP
- EKG
Tx:
- O2
- solumedrol (methylprednisolone IV)
- ABX: levaquin IV
- Inhaled bronchodilators (albuterol AND Atrovent via nebulizer)
- admit to hospital if:
- -is severe sx inhibiting acts of daily living
- -failure to respond to therapy
- -high risk comorbidities like PNA, CHF, arrhythmia, liver failure, kidney failure, or DM
- -worsening hypoxemia
-if impending resp failure intubation vs NIPPV
Pulmonary Embolism:
- signs and sx
- risk factors
- wells criteria
- work up
- MC arrhythmia?
Signs and sx:
- dyspnea
- tachypnea
- cough
- hemoptysis
- syncope
- LE edema
- cyanosis
- diaphoresis
- hypotension
- rales
- LE pain/redness
- pleuritic chest pain
- 4th heart sound
Risk factors:
- pregnancy
- obesity
- prolonged immobilization
- HRT
- CA
- Trauma
- recent joint replacement surgery
- hx dvt
- autoimmune dz
- HTN
- Smoking
- CHF
Wells criteria…
Work up:
- CT angiogram
- CXR
- EKG
- ECHO
- V/Q scan?
- D-dimer?
- Doppler US of LE
MC arrhthmia in PE is sinus tachycardia
