Pulmonary emergencies Flashcards
(43 cards)
Signs and symptoms of anaphylaxis
Sx w/in 30 minutes of re-exposure Urticaria Laryngeal edema epiglottal edema hypotension seizures dyspnea Angioedema
Management of anaphylaxis
Maintain airway Pulse ox and cardiac monitor Epinephrine sub q or IV albuterol inhaler or nebulizer for bronchospasm Fluids for hypotension Antihistamines, corticosteroids
Angioedema:
MC cause
Patho:
Tx:
MC: ACE inhibitors
Accumulation of bradykinin leading to vasodilation, hypotension, angioedema
Tx: Airway, epineph, antihistamines, steroids
Definition of pnuemothorax?
abnormal collection of air in the pleural space
Spontaneous pneumothoraces occur most commonly in who?
Tall thin men in their 20-30’s
- Smokers 20x more likely to develop a spontaneous pneumothorax
- Recurrence is common, 20-50% of people suffering from a repeat pneumo.
Most common physiologic cause of spontaneous pneumo?
Subpleural bleb resulting in free communication of air to the pleura space.
Signs of suspected pneumothorax?
Signs of progression to tension pneumo?
S: tachypnea, tachycardia, decreased breath sounds on affected side
Tension pneumo: hypotension, tracheal deviation, elevated JVD
Treatment of pneumothoraces?
<15% involvement of hemithorax: conservative treatment.
Large pneumos or with comorbidities: needle or tube thoracostomies.
Virchow’s triad
Venous stasis
Vessel injury
Hypercoagulable states
Common signs and symptoms of DVT
Pain in extremity Tenderness in extremity Discoloration of erythema in ext Palpable venous chord Homans sign Unilateral swelling
Treatments for DVT
LMW heparin
Oral factor Xa: rivaroxaban, apixaban
Unfractionated heparin
Definition of PE
Occlusion of pulmonary arteries by the embolization of thrombi, air, fat, or other particulate mater.
MC: DVT 95%
Most common ECG changes for PE
Sinus tachycardia and nonspecific ST-T wave changes
Right sided heart strain:
- S wave lead 1, Q wave lead 3, T wave inversion lead 3.
- Right axis deviation
- New right bundle branch block
- T wave inversions in V1-V4
Treatment of PE?
Steps for stabilization…
plus treatement
ABCs first IV access O2 Cardiac monitoring CXR IV fluids and pressors if indicated. Thrombolytic therapy
Definition of asthma
Disease of the lower airways characterized by acute exacerbations.
Epidemiology of asthma
4-5% of the population
- Highest among african-american males
Pathogenesis of asthma
Chronic airway inflammation, heightened bronchial reactivity and mucus production
Symptoms of asthma
tachycardia, tachypnea, may be hypoxic
- wheezing and prolonged expiratory phase
- may appear over inflatted
- Pulsus paradoxus: SBP <10mmHg during inspiration
Diagnostic eval for asthma
Peak expiratory flow rates
Treatment of asthma
Reducing bronchorestriction and inflammation
- supplimental O2
- Beta2 agonist via neb or MDI
- aero antiChol (ipatropium bromide)
- prednisone 40-60mg
Definition of COPD
2 conditions:
Emphysema: dilation of air space destruction distal to the terminal bronchiol
Chronic bronchitis: excess mucus production and productive cough for at least 3 months a year for min of 2 years.
Pathogenesis of emphysema?
Reduction in elastic recoil of the lung parechyma resulting in physiologic dead space.
- The airway colapses during expiration
pathogenesis of chronic bronchitits?
Hypertropy of the mucus producing glands of the lung. Plus airway inflammation and hypertrophy of the airway smooth muscle.
Classic history of acute exacerbations of COPD
Varying degrees of respiratory distress
- history of progressive dyspnea
- increased sputum production
- decreased exercise tolerance
- fever and change in sputum herald superimposed pneumonia.
