Reactive Airway - Adult Flashcards
(73 cards)
1
Q
What medication is indicated with wheezing?
A
Duoneb: 2.5mg/3ml nebulized. May repeat 5 times PRN.
2
Q
What is the dosage for a duoneb?
A
2.5mg/3mL
3
Q
How many times can you repeat a duoneb?
A
5 times, PRN
4
Q
What medication is indicated with stridor in reactive airway issues?
A
Epinephrine: Nebulized 2mg of 1:1,000 diluted in 3ml NS. May repeat once.
5
Q
What is the dosage for nebulized Epi?
A
2mg of 1:1,000 diluted in 3ml NS
6
Q
How many times can you repeat dose nebulized Epi?
A
May repeat once.
7
Q
Which concentration of Epi is used for nebulizer?
A
1:1 / 1:1,000
8
Q
What medication can be given after a Duoneb?
A
Solu-Medrol: 125mg IM/IV/IOP over 3min
9
Q
What is the dosage for Solu-Medrol?
A
125mg IM/IV/IOP over 3min
10
Q
What kind of medication is Solu-Medrol?
A
Inhibits cell-mediated immunologic functions, especially those dependent on lymphocytes
11
Q
How does Solu-Medrol work?
A
Decreases inflammation in bronchial tubes.
12
Q
What does Solu-Medrol NOT affect?
A
Air sacs in lungs.
13
Q
What is the onset time of Solu-Medrol?
A
Within 1 hour
14
Q
Why is Solu-Medrol pushed SLOWLY?
A
It can cause cardiac arrhythmias and arrest if pushed too rapidly.
15
Q
Over how long is Solu-Medrol pushed?
A
3 mins
16
Q
What is the other name for Solu-medrol?
A
Methylprednisolone
17
Q
What drugs are in a Duoneb?
A
Albuterol and ipratropium bromide.
18
Q
What are common side effects of a Duoneb?
A
Tachycardia, jitters, coughing
19
Q
What kind of medication is a Duoneb?
A
Bronchodilator
20
Q
What is the time onset of a Duoneb?
A
Within minutes.
21
Q
What other drugs commonly negatively interact with a Duoneb?
A
Beta-Blockers
22
Q
What is a medication that can be given after Solu-Medrol administration?
A
Magnesium Sulfate: 2g in 100mL IV infusion over 10min
23
Q
What is the dosage for Mag in reactive airway issues
A
2g in 100mL IV infusion over 10min
24
Q
Over how long should Mag for reactive airway issues be given?
A
10min
25
When is Mag indicated for a reactive airway issue?
When first-line treatments are not responsive. Duoneb (bronchodilator) and Solu-Medrol (cortico-steroid) has already been given.
26
What is the mechanism of action for Magnesium Sulfate?
Physiological blood coagulation mediator that aids in releasing histamine and acetylcholine. Acts as a bronchodilator.
27
What patient should NOT receive Mag?
Heart-block patients - Mag can make the conduction even slower. Any patient with heart damage, persistent HTN, and/or hypocalcemia.
28
Is asthma a ventilation or respiration issue?
Ventilation
29
What are some common medications a patient might take for asthma?
Albuterol, Symbicort (inhaled steroid), oral steroids, Omalizumab, Methylxanthines, salmeterol, formoterol, and vilanterol., terbutaline/Brethine.
30
What class of medication is Alubterol?
Beta-2 agonist
31
What class of medication is Solu-Medrol?
Corticosteroid
32
What are some common COPD medications?
Fluticasone (flovent), Beclometasone, Budesonide, ipatropium, albuterol, Doxycycline (rescue)
33
What medication can be given after Epi if stridor is present?
Magnesium sulfate: 2g in 100ml IV infusion over 10min.
34
If LIFE THREATENING airway issues are present, what medication is IMMEDIATELY adnimistered?
Epinephrine (1:1,000): 0.3 - 0.5mg IM ever 5-15min PRN
35
What is the dosage of IM Epi?
Epinephrine (1:1,000): 0.3 - 0.5mg IM every 5-15min PRN
36
How often can IM Epi be administered?
Every 5-15min PRN
37
When should CPAP be considered?
1. Signs of respiratory failure or fatigue
2. Pulse oximetry below 88% that doesn't improve with standard therapy
3. ETCO2 above 50mmHg
4. Accessory muscle use or retractions
5. Respiratory rate above 25
6. Wheezing, rales, or rhonchi
38
When should CPAP NOT be considered or is considered contraindicated?
AMS, failure to follow directions, failure to control own airway, respiratory arrest, obstruction, hypotension, airway or facial trauma, recent facial/esophageal/gastric surgery, barotrauma, N/V, suspected pneumothorax.
CAUTION with emphysema patients!
39
What could you consider to calm CPAP patients if verbal comfort does not work?
Chemical sedation
40
What medications can be used to sedate a CPAP patient?
Ketamine: 0.5mg/kg IV/IO
or
Versed: 2mg IV IO (if hypertensive)
41
When should you use Versed to sedate a CPAP patient instead of Ketamine?
If patient is hypertensive.
42
Can I get a refusal on a patient I gave airway medication to? Even if just a diagnosed asthmatic and a duoneb was given?
No refusal may be obtained in any patient receiving medication for respiratory distress.
43
What tool should be sued in addition to SPO2 monitoring?
ETCO2 / waveform capnography
44
If CPAP at 5cmH20 is ineffective to assist WOB, what can be done?
Ventilation assistance with BVM attached to PEEP valve.
45
When can CPAP be considered for CHF or pulmonary edema?
If WOB is effective
46
What setting should be used for starting CPAP?
5cmH20, titrate to effect
47
What medication can be given to a CHF/pulmonary edema patient that has rales and/or wheezing?
DuoNeb: 2.5mg/3ml nebulized. May repeat 5 times PRN.
48
If CHF/pulmonary edema patient is unresponsive to DuoNeb treatment and starts to present with stridor, what medication can be given?
Epinephrine (1:1,000): 0.3 - 0.5mg IM every 5-15min PRN
49
What medication can be given to a CHF/pulmonary edema patient as first line treatment?
Nitroglycerin
50
What forms of nitro can be given to a CHF/pulmonary edema patient?
NTG paste: 1-1.5 inch on left chest (additional dose of 0.5-1 inch can be placed on right side)
or
NTG infusion: 60mcg/min IV with rapid titration to relief of symptoms (max dose 200mcg/min)
51
If NTG is used for a CHF/pulmonary edema patient, what vital sign is imperative to maintain?
SBP over 90mmHG
52
If a CHF/pulmonary edema patient is being administered NTG and becomes hypotensive, what should be done?
Immediate reduction of NTG dose.
53
What is the max dose of a NTG infusion?
200mcg/min
54
What is the min dose of a NTG infusion?
60mcg/min
55
What class of medication is NTG?
Vasodilator
56
What are the contraindications of administering NTG?
ED / vasodilator medications (Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil or vardenafil) in the last 24hrs, hypotension
CAUTION: Women are also rx'd these meds
57
What is a sign to look for on ETCO2/waveform capnography for bronchoconstriction?
Shark fin
58
Can breath sounds be diminished or absent during an asthma attack?
Yes - these patients need IMMEDIATE intervention.
59
What is a normal ETCO2?
35-45mmHG
60
Other than shark fins, what is another sign of reactive airway issues on waveform capnography?
Air trapping
61
What is hypoxia considered in reactive airway issues?
A late finding. Pulse oximetry provides no indication of how hard the patient is working to breathe or if ventilation is effective.
62
What is another name for Ipatropium bromide?
Atrovent
63
What kind of medication is Atrovent?
Mucolytic, anticholinergic bronchodilator
64
How can hypotension be treated in a CHF/pulmonary edema patient if HypoTN stems from a cardiac origin?
Epinephrine (1:1,000): 2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals
or
///CRITICAL CARE ONLY///
Phenylephrine: 10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP
65
What can a critical care medic given for hypotension in a CHF/pulmonary edema patient?
///CRITICAL CARE ONLY///
Phenylephrine: 10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP
66
What can a medic given to a hypotensive CHF/pulmonary edema patient if they are NOT a critical care medic?
Epinephrine (1:1,000): 2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals
67
For critical care medics, what is the dosage of phenylephrine for a hypotensive CHF/pulmonary edema patient?
10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP
68
For non-critical care medics, what is the dosage of Epinephrine 1:1,000 for a hypotensive CHF/pulmonary edema patient?
2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals
69
For critical care medics, is phenylephrine a push dose or slowly given for a hypotensive CHF/pulmonary edema patient??
IVP, push dose pressor
70
For non-critical care medics, how is Epinephrine 1:1,000 titrated for a hypotensive CHF/pulmonary edema patient?
Titrate at 1mcg/min at 2min intervals
71
In what positioning should patients with CHF/pulmonary edema be placed?
High fowlers or head elevated to 45 degrees.
72
If a patient has taken a medication ending in -il within the last 24 hours, should they receive NTG?
No
73
What PEEP should be considered for an intubated CHF/pulmonary edema patient?
5-15cmH20
