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Flashcards in Respiratory Deck (33):
1

5 steps to airway obstruction

1 - try to open airway: jaw thrust, tongue pull... in line with head and neck
2 - Look inside: foreign body?
3 - Residual air to clear (chest compression or abdomen thrust)
4 - Firm back blow between shoulder blades
5 - PPV (esp if obstruction is from swelling, see anaphylaxis & asthma)

2

Anaphylaxis: name 6 S/Sx

1-generalized hives, itching, swelling
2-tight, scratchy throat
3-vascular and volume shock (High heart rate, Low BP, skin redness... vascular dilation, lower airway construction)
4-nausea, vomiting, diarrhea
5-altered MS

3

Anaphylaxis: 5 high risks

1- History of hospitalization for anaphylaxis
2-persistent abnormal MS
3-incomplete response to Rx
4-Pt getting worse
5-Second RX needed

4

Anaphylaxis: Rx (3 drugs)

1-Epinephrine: reverses effects of histamine (vasoconstrictor & bronchodilator)
0.3-0.5mg intramuscular
(1:1000 soln or 1mg:1000 mL)
Pediatric: 0.15mg (under 15 kg)

2-Diphenhydramine: blocks histamine receptors
25-50mg by mouth, immediately following epinephrine

3-Prednisone: anti-inflammatory, helps prevent biphasic rxn.
1mg/kg up to 60mg by mouth daily up to 5 days.

5

Respiratory Problems: S/Sx (3 stages)

1- Respiratory DISTRESS: difficulty breathing, A on AVPU, anxious (wheezing, coughing, use of accessory muscles to breathe when at rest)

2- Respiratory FAILURE: able to speak only 1 or 2 words at a time, wheezing; A, lethargic to V or P

3- Respiratory ARREST: no breathing, U on AVPU

6

Respiratory Failure: BLS Rx

PROP:
Position - clear airway
Reassurance
Oxygen
Positive Pressure Ventilation

7

Positive Pressure Ventilation

- immediate response to respiratory failure or arrest
- if heart still beating, PPV can help maintain oxygenation for many hours
- if you don't think Pt is breathing well enough, begin PPV
- position neck for best airflow
- rate: ~ 12 breaths/ min (slowly breathe into mouth over 2-3 seconds... any faster you just blow air into stomach)
- if not working, maybe upper airway obstruction (complete or partial)

8

Respiratory Problems: generic Rx

PROP

9

Respiratory Problems: Rx for Upper Airway

PROP...remove object (do no harm w/ partial obstruction!)... meds... Evac

1-Corks: pop
2-Kinks: position
3-Fluid: "pop"
4-Swelling: meds (infection, anaphylaxis)

10

Respiratory Problems: Rx for Lower Airway (trachea, bronchi, bronchioles)

PROP + Rx cause (asthma, anaphylaxis) + Evac

1- swelling
2- spasm
3- infection

(Alveoli, chest wall + decreased NS drive = separate card)

11

Normal Respiratory Rate: adult, child

Adult: 12-20 breaths/min
(<12, >25 is abnormal)

Child: faster...
Birth-6wks: 30-40 b/m
6 mo: 25-40 b/m
3 yr: 20-30 b/m
6 yr: 18-25 b/m
10 yr: 17-23 b/m

Elderly can increase again

12

Lower Airway Constriction: MOI

1- Swelling (anaphylaxis)
2- Spasm (asthma)
3- Infection (bronchitis)

13

Lower Airway Constriction: S/Sx

1- wheezing, cough, respiratory distress
2- Exposure & Sx anaphylaxis
3- History of asthma or illness

14

Lower Airway Constriction: Rx

1- PROP
2- Treat cause
3- Evac

15

Chest Wall Trauma: MOI

1- Blunt trauma w/ fracture or contusion
2- Puncture from outside w/ pneumothorax
3- Rupture from inside with pneumothorax

16

Chest Wall Trauma: S/Sx

1- Deformity, tenderness, wounds (open vs closed... hemo pneumothorax)
2- Respiratory distress, cough, pain
3- Unequal breath sounds

17

Chest Wall Trauma: Rx

1- PROP, cover leak (consider plastic bag/glove; if makes worse, take off)
2- Treat pain
3- Evac to ALS

18

Fluid in Alveoli: MOI

1- Swelling (water inhalation, HAPE, trauma)
2- Congestive heart failure
3- Infection (pneumonia)

19

Fluid in Alveoli: S/Sx

1- crackles, cough, gurgling, respiratory distress
2- exposure to inhalation injury, altitude, trauma
3- History of illness

20

Fluid in Alveoli: Rx

1- PROP, esp PPV
2- Treat cause
3- Evac

21

Decreased Nervous Drive: MOI

1- STOPEATS
2- Stroke
3- TBI

22

Decreased Nervous Drive: S/Sx

1- slow, shallow, or irregular breathing… Sub normal respiratory rate (hypo ventilation)
2- signs of hypoxia (cyanosis, pallor)

23

Decreased Nervous Drive: Rx

1- PROP, esp O2 & PPV
2- Treat cause if possible
3- Evac

24

MDI (rescue inhaler) instructions (5 steps)

1- Shake
2- Hold upright ~4 cm in front of open mouth (or use spacer)
3- Pt fully exhale, administer spray on inhale (fully inhale)
4- Hold breath 10 sec (long as possible)
5- Repeat after 1 min

25

Asthma/ Respiratory Distress not responding to MDI: Rx

1- PROP
2- Epinephrine (0.3 mg IM)
3- Albuterol MDI: 5-10 puffs up to 3x in Hour, then as prescribed
4- Prednisone: 1 mg/kg up to 60 mg PO (by mouth)
5- Evac

26

Epinephrine: 8 steps

1- hold in fist w/o thumb on end!
2- thigh muscle (bare...)
3- press firmly (don't need to jam, it springs)
4- Hold 5 sec
5- take out of thigh
6- dispose of needle
7- doesn't fix prob but reduces from Failure to Distress...
8- Albuterol, PROP, etc

27

Hypoventilation: MOI

Low blood sugar
Hypothermia
Toxins
(STOPEATS)

28

Hypoventilation: S/Sx

LOC reduced due to NS problem, MS is not reliable, Pt may be awake enough to tell you, but you need to look for reduced respiration

29

Hypoventilation: arc

PPV = at any point with slow or irregular breathing & Pt not awake

30

Hyperventilation: MOI

Altitude, exercise, injury, illness (normal response to needing more 02)
ASR (but w/o needing O2... hyperventilation in ASR can lead to hyperventilation syndrome: low blood CO2, high blood pH)

31

Hyperventilation: S/Sx

Tingling hands, feet, numbness around mouth, vision impaired
Ultimately self corrects with fainting.

32

Pneumothorax

Abnormal collection of air in the plural space between the lung and chest wall. Symptoms are typically sudden onset of sharp, one sided chest pain and shortness of breath. Can result in death. Often called collapsed lung.

33

Tachypnea

Abnormally rapid breathing. (Similar to hyperventilation, but different paradigms distinguish differently.)