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Clinical Disciplines-ER > Respiratory > Flashcards

Flashcards in Respiratory Deck (69):
1

Define Dyspnea

SUBJECTIVE feeling of difficult, labored breathing

2

What is orthopnea MCly seen in?

CHF

3

Define hypoxemia

low ARTERIAL oxygen, Pa02 under 60 mmHg

4

Define stridor and causes for it

Upper airway, Inspiratory
Causes:
1. FB
2. Croup
3. Epiglottis

5

Define wheezing and causes

Lower airway, expiratory
Causes:
1. Asthma
2. COPD
3. FB
4. Cardiogenic pulmonary edema

6

Define Rales and causes

Lower airway, velcro sound
Causes:
CHF

7

Define Rhonchi/crackles and causes

Lower airway
Causes:
Pneumonia

8

Define Respiratory Distress or Failure

Inadequate oxygenation and/or ventilation

9

What organism is associated with bradycardia and hyponatremia in pneumonia?

Legionella

10

What organism is associated with bullies myringitis in pneumonia?

Mycoplasma pneumonia

11

Define CAP

PNA in patient who has not been hospitalized or resident of long-term care facility for 14 days prior to presentation

12

Define Hospital-acquired (nosocomial) and Ventilator-acquired PNA

PNA occurring > 48 hours after admission or intubation

13

MC cause of pneumonia

Streptococcus Pneumoniae

14

MC presentation in Streptococcus Pneumoniae

1. Sudden onset fever
2. Rigors
3. Productive cough
4. Dyspnea

15

CXR findings in Streptococcus Pneumoniae

1. Lobar infiltrate
2. Para-pneumonic pleural effusion (25%)

16

What organism causes a secondary bacterial pneumonia following influenza?

S. aureus

17

Define high altitude illness

1. Hypoxic environment
2. Partial pressure changes with elevation

18

@ what elevations do we see high altitude illness?

5,000 feet
MC @ 8,000-14,000 ft

19

Ventilation acclimization

Increased ventilation rate
Induces respiratory alkalosis

20

Blood acclimization

Increased red cell mass
Begins 2 hrs. after ascent

21

Fluid acclimization

1. Peripheral venoconstriction- increases central blood volume
2. ADH and aldosterone suppressed- Diuresis

22

Cardiovascular acclimization

1. Decreased SV, Increased HR
2. Pulmonary vessels constrict
3. Increased cerebral blood flow

23

Sleep acclimization

Cheyne-stokes breathing

24

Acute mountain sickness sx's

1. Lightheaded
2. HA-Worse with valsava or bending over
3. Breathlessness with activity
4. Weakness
5. Irritability
6. Nausea

25

What is the hallmark findings in Acute mountain sickness

Fluid retention

26

Pathophysiology of Acute mountain sickness

D/t hypobaric hypoxia
Cerebral blood flow increases-->brain enlarges-->vasogenic edema

27

Acute mountain sickness treatment

1. Discontinue ascent
2. Oxygen
3. Acetazolamide
4. ASA, Tylenol, Motrin
5. Dexamethasone

28

Acute mountain sickness prevention

1. Gradual onset
2. Avoid overexertion
3. Avoid alcohol
4. High carb meal
5. Acetazolamide
6. Dexamethasone

29

High Altitude Cerebral Edema sx's

1.AMS
2. Neurologic sx's: CN 3 & 6 Palsy- Eye is down and out

30

What is the most lethal high altitude illness

High Altitude Pulmonary Edema

31

High Altitude Pulmonary Edema etiology

Pulmonary HTN

32

High Altitude Pulmonary Edema sx's

1. Dry cough-->productive cough
2. Increasing dyspnea
3. Coma, death

33

What is the treatment of choice in High Altitude Pulmonary Edema

1. Immediate descent
2. Nifedipine
3. Oxygen

34

What is the MC reason for admission in medicare pt's?

CHF

35

What BNP value is suggestive of CHF?

200

36

EKG findings in CHF

LV hypertrophy

37

What imaging has both the highest sensitivity and specificity in CHF?

US

38

CXR findings in CHF

1. Cardiomegaly
2. Enlarged pulmonary artery
3. Pleural effusions
4. Kerley B lines

39

US findings in CHF

B lines

40

What does an echo evaluate in CHF?

1. LV and valvular function
2. Tamponade
3. VSD

41

Pharmacologic treatment in CHF

1. NTG-Reduce preload and BP
2. Diuretic (Lasix)
3. Morphine sulfate- Reduces preload
4. Dobutamine-adjunct to NTG, use in hypotensive pt's

42

What medications do you want to avoid in CHF?

1. CCB
2. NSAIDs
3. Anti-arrhythmias

43

Virchows triad

1. Venous stasis
2. Vessel wall inflammation/injury
3. Hypercoagulability

44

PE risk factors: MOIST CAMEL

M-Malginancy
O-Obesity
I-Immobilizations
S-Surgery
T-Trauma

C-CHF
A-Age: 40+
M- Mobility (lack of)
E-Estrogen excess
L-Long bone fx
S-Smoker

45

Triad of sx's in PE

1. Pleuritic CP
2. Dyspnea
3. Hemoptysis

46

CXR findings in PE

1. Hampton's Hump
2. Westermark's sign
3. Fleischner sign

47

What is considered by most to the dx test of choice in PE

CT scan

48

What echo findings indicated a poor prognosis in PE

RV enlargement + RV dysfunction= large clot

49

MC EKG finding in PE

Sinus tachycardia
Followed by T wave inversion

50

"Classic" EKG findings in PE

S1Q3T3

51

Anticoagulation treatment in PE

1. Heparin
2. Coumadin
3. Lovenox
4. Rivaroxaban (Xeralto)- factor Xa inhibitor

52

Indications for thrombotic treatment in PE

Massive PE
Hemodynamically unstable

53

Asthma pathophysiology triad

1. Airway inflammation
2. Obstruction to airflow
3. Bronchial hyperresponsiveness

54

Asthma clinical triad

1. Dyspnea
2. Wheezing
3. Cough

55

COPD definition

Chronic irreversible disorder

56

Define Chronic Bronchitis

1. Presence of chronic productive cough for 3 months in 2 successive years
2. Clinical diagnosis

57

Define Emphysema

1. Destruction of bronchioles and alveoli
2. Pathologic diagnosis

58

What does FEV1 measure?

Severity of pt's airway restriction

59

What are the treatment goals in COPD?

1. Reverse airflow obstruction
2. Provide adequate oxygenation
3. Relieve inflammation

60

What is the cornerstone of therapy in Asthma/COPD?

1. Beta Agonist: Albuterol
2. Corticosteroids (high-dose): Prednisone, Methylprednisolone, Dexamethasone

61

Role of Epinephrine in COPD?

Acts as a bronchodilator
NOT beta selective

62

What location of the airway does Ipratropium Bromide (anti-cholinergic) primarily work at?

Large central area

63

What is Magnesium Sulfate reserved for?

Severe exacerbations

64

What is Heiolx reserved for?

Severe reactions in pediatrics

65

BiPAP indications

1. Cooperative patient
2. Dyspnea (moderate to severe)
3. Tachypnea (>24 breaths per minute)
4. Increased work of breathing
5. Hypoxemia

66

BiPAP contraindications

1. Need for emergent intubation
2. Cardiac or respiratory arrest
3. Inability to protect airway or clear secretions
4. Decreased LOC
5. Facial trauma or deformity
6. Recent esophageal surgery

67

What age groups does FB aspiration MCly occur in?

< 1 year and >75 years of age

68

Adult risk factors in FB aspirations?

1. Altered level of consciousness
2. Impaired swallowing mechanism
3. Stroke related dysphagia
4. Alzheimer’s dementia
5. Parkinson’s disease

69

Where is the MC location for FB? What's significant about this location?

Thoracic inlet
-Site of anatomical change from skeletal to smooth muscle
-Cricopharyngeus muscle