Respiratory Flashcards
(13 cards)
What is anaphylaxis
Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if typical skin features are not present OR any acute onset of illness with typical skin features (urticarial rash or erythema/flushing, and/or angioedema) PLUS involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms
If allergic reaction is deemed to involve more than two body systems and it is therefore no longer localised, anaphylaxis should be considered.
Mild/moderate vs anaphylaxis presentation
Mild to moderate
· Swelling of lips, face and eyes
· Tingling of mouths
· Abdominal pain, nausea/vomiting
· Urticaria, itching and welts
Anaphylaxis
· Chest tightness
· Decreased mental status
· Subjective airway impairment or swelling (swollen tongue, laryngeal oedema, stridor)
· Swelling/tightness in throat
· Difficult/ noising breathing
· Difficulty talking and/or hoarse voice
· Wheeze or persistent cough
· Hypotension
· Pale and floppy (children)
Treatment of anaphylaxis
· Remove trigger if possible
· Adrenaline IM, consider repeat dosages when no significant improvement
· Cardiac monitoring
· Obtain vascular access
· Consider fluid if required
· Consider salbutamol if persistent wheeze
· Peri-arrest & unresponsive to to 3x IM adrenaline and fluid therapy consider IV adrenaline (ensure correct preparation)
· Stridor unresponsive to 2x IM adrenaline consider Neb adrenaline
· Full observations every 10 minutes or 5 if time critical
· Pre notify if appropriate
What is asthma?
Characterised by hyper-reactive airways and inflammation leading to episodic, reversible bronchoconstriction in response to variety of stimuli.
Asthma presentation (adult/paed & mild/severe)
Adult presentation
· Respiratory distress
· Expiratory wheeze
· Hyper inflated chest
· Pulses paradoxes in severe
· Silent chest
Paediatric presentation
· Cough
· Short of breath, rapid respiration
· Recession; sternal, intercostal, subcostal, suprasternal-tracheal tug
· Nasal flaring
· Accessory muscle use
· Wheeze
· Difficulty speaking
· Pallor, cyanosis and exhaustion (late and pre terminal signs)
Severity
Mild = can walk, speaks whole sentences in one breath, >94%spo2, wheeze might be evident
Severe = use of accessory muscles of neck, intercostal muscles, or presence of tracheal tug during inspiration or subcostal recession, unable to complete a sentence in one breath due to dyspnoea, obvious resp distress, 90-94% spo2, and audible wheeze
Life threatening = reduced consciousness or collapse, exhaustion, cyanosis, <90%, poor respiratory effort, soft/absent breath sounds
Asthma risk factors
Prior icu
· Prior intubation
· >3 ed visits in past year
· >2 hospital admissions in past year
· >1 bronchodilator canister in >4 hours
· Chronic use of steroids
· Progressive symptoms in spite of aggressive treatment
· Unable to speak in sentences
If doubt exists as to whether patient is experiencing asthma or anaphylaxis treat as anaphylaxis
SpO2 is not a reliable indicator of severity, carbon dioxide rention
<12 months asthma is less likely to be cause of wheeze
Treatment of asthma
· Position appropriate
· Vital signs, particularly RR &SpO2
· Consider oxygen, titrate SpO2 using appropriate masks to target 92-95% adults and >95% children
· Ventilate if required, extreme care rate of no more than 4-6bpm allows adequate exhalation and avoid air trapping
· May assist patient in administering own medications
· Salbutamol MDI, NEB
· Ipratropium bromide NEB
· IM adrenaline if life threatening
· Cardiac monitor
· Vascular access
· Normal saline for hypotension
· Full observations every 10 minutes or 5 minutes if time critical
What is COPD
Lung disorder characterised by chronic lung airflow that interferes with normal breathing and is not fully reversible
Presentation of COPD
· Respiratory distress
· Sputum production
· Cough
· Hxof exposure to risking factors for the disease
Treatment of COPD
· Primary survey
· Position appropriately
· Vital, RR and SpO2
· Oxygen therapy – home oxygen can be left on, appropriate mask 88-92%
· Salbutamol
· Ipratropium bromide NEB
· Cardiac monitor
· Full observations every 10 minutes or 5 minutes
· Prenotify for P1
What is croup?
Acute laryngotracheobronchitis, more common childhood respiratory illness. Viral inflammation of upper airway, larynx, trachea and bronchi, symptoms usually peak at night around 2-3am
Presentation of croup and severity
Noisy breathing (stridor)
· Hoarse voice
· Harsh barking cough
· Increased respiratory rate
· Intercostal and supraclavicular recession
· Tracheal tug
· Nasal flaring
· Fever
Severity
Mild =barking cough, no stridor at rest, no sternal recession or tracheal tug and normal behaviour
Moderate = barking cough, audible stridor at rest, mild sternal regression +/- tracheal tug and may be irritable at times
Severe = persistent stridor at rest, pallor and mottling, severe sternal recession +/- tracheal tug, drooling and irritable or lethargic
Treatment of croup
· Do not forcibly change child’s posture they will adopt posture that minimises obstruction
· Vitals, RR and SpO2
· Oxygen
· Be alert for rapid deterioration
· Mild to moderate croup = prednisolone without adrenaline Neb
· Severe croup with signs of severe respiratory distress = Neb adrenaline than prednisolone
· Observations every 10 minutes or 5 minutes if critical
· Pre notify p1
· Neb adrenaline repeated after 15 minutes
