Respiratory Emergencies 2 Flashcards
(52 cards)
1
Q
Tx for High Altitude Cerebral Edema
4 things
A
- Oxygen
- Descent/Evacuation
- Dexamethasone
-
Loop Diuretics
- Furosemide
- Bumetanide
2
Q
What is the most lethal of the high altitude illnesses?
A
High Altitude Pulmonary Edema
3
Q
Which condition?
- Dry cough, progresses to productive cough
- Decreased exercise performance / increased recovery time from exercise
- Rales - increased after exercise
- Increasing dyspnea
- Coma, death
A
High Altitude Pulmonary Edema
4
Q
High Altitude Pulmonary Edema
- Is due to high ___ ___ _____ & development of pulmonary HTN
A
pulmonary microvascular pressures
5
Q
Tx for High Altitude Pulmonary Edema
- Recognition
- Immediate descent is tx of choice
- Oxygen, may take up to ___ hours to resolve HAPE
- ____ every 8 hours
A
- 72 hours
- Nifedipine
6
Q
What is the most common reason for admission in Medicare pts?
A
CHF
7
Q
Most common cause of CHF?
A
LV dysfunction
8
Q
4 cardiac issues associated w/ CHF?
A
- Aortic stenosis
- Hypertension
- A. fib
- Coronary artery disease
9
Q
Signs / Sxs of what?
- Hypoxemia
- HTN
- Tachycardia
- Dyspnea
- Weight gein
- Rales
A
CHF
10
Q
Sxs of left or right CHF?
- Dyspnea
- Fatigue
- Cough
- PND
- Orthopnea
A
Left
11
Q
Sxs of left or right CHF?
- Peripheral edema
- JVD
- RUQ pain
A
Right
12
Q
Testing for CHF (5)
A
- CBC (anemia)
- Chemistries (electrolytes / renal function)
- Cardiac enzymes
- Pro-BNP (released by ventricular myocardium in response to stretching) >200 suggests CHF
- EKG
(PECCC)
13
Q
Chest x-ray for CHF has high or low sensitivity?
- Dilated upper lobe vessels
- Cardiomegaly
- Interstitial edema
- Enlarged pulmonary artery
- Pleural effusions
- Kerley B lines
A
Low
14
Q
What has a higher sensitivity / specificity compared to CXR for diagnosing CHF?
A
US of lung will show B lines
15
Q
CHF
What dx test is used to evaluate LV and valvular functions, tamponade, VSD?
A
Echocardiography
16
Q
3rd leading cause of death of hospitalized pts in the US
A
PE
17
Q
Most common cause of non-surgical maternal deathin peripartum period is what?
A
PE
18
Q
PE occurs when proximal portion of ______ breaks off and travels to lung
Most commonly due to ___ or _____ veins, but can result from any vain (except intracranial veins)
A
- venous thrombosis
- pelvic or deep lower extremity
19
Q
Virchow’s Triad of PE
A
- Venous stasis
- Vessel wall inflammation
- Hypercoagulability
20
Q
Risk Factors of PEs
(moist camels)
A
- Malignancy
- Obesity
- Immobilization
- Surgery
- Trauma
- CHF
- Age >40
- Mobility (lack of)
- Estrogen excess
- Long bone fx
- Smoker
21
Q
Triad of sxs of PE
A
- Pleuritic CP
- SOB
Hemoptysis
22
Q
Wells Score is used for what?
A
Risk Assessment of PE
23
Q
Besides Wells Score, what are 2 other Risk Assessment tools for PE?
A
- Simplified Revised Geneva Score
- PERC Criteria
24
Q
If all answers are “yes” for PERC criteria the risk of PE is _____.
A
Less than 2%
25
Is "Experiences Clinical Gestalt" better or worse at assessing risk of PE compared to the tools?
Just as well
26
**3 CXR signs for PE**
| (CXR is normal 1/3 of the time)
* **Hampton's Hump** (triangular pleural based infiltrate w/ apex pointed toward hilum)
* **Westermark's sign** (dilate pulmonary vessels proximal to embolus w/ sharply demarcated cutoff)
* **Fleischner sign** (distended central pulmonary artery)
27
What is the diagnostic test of choice for PE? Why?
**CT scan**
* Good at identifying central clots, but can miss small peripheral clots
* Also identifies other possible causes
* Iodine infusion required
28
What is seen on electrocardiography if pt has large clot (PE) (likely central) w/ poor prognosis?
RV enlargment & RV dysfunction
29
What US is used to evaluate primarily the lower extremities from groin distally?
Venous Compression US
30
What test cannot be used to exclude / diagnose PE?
ABG
31
**ABG**
* PAO2 =?
* PaO2 =?
* **PAO2** = partial pressure of oxygen in alveolus
* **PaO2** = partial pressure of oxygen in artery
32
* What test for PE measures fibrin degradation products?
* Is detectable within __ hour(s) of thrombus formation
* Has high negative predictive value, but poor positive predictive value
* D Dimer
* 1
33
Value is increased with:
* Cancer
* Inflammation
* Infection
* Aging \>70
* Recent surgery
* trauma
* MI
* pregnancy
* arterial thrombosis
* acute CVA
* Superficial phlebitis
* RA
* Liver disease
D dimer
34
Value decreased with:
* Warfarin
* Sxs \<5 days
* Small clot burden
35
What blood tests can be elevated w/ PE?
Pro-BNP
Troponin
36
* What is the most common EKG finding for PE?
* Followed by what?
* What EKG finding represents right heart strain and is seen in only 20% of cases?
* Sinus Tachycardia
* T wave inversions
* S1Q3T3
37
Tx for PE?
* Heparin, must monitor PTT
* Coumadin, must monitor PT/INR
* Lovenox
* Rivaroxaban (Factor Xa inhibitor)
* Vena caval filter if problem or contraindications to anticoagualation
38
3 indications for Thrombolytic Tx of PE?
* Massive PE (hemodynamically unstable)
* Massive ileofemoral DVT
* Large DVT w/ significant vascular compromise
39
Contraindications for Thrombolytic Tx of PEs
* Major bleeding within 6 months
* Intracranial or intraspinal surgery / trauma within 2 months
* Surgery within 10 days
* Pericarditis/Endocarditis
* Uncontrolled HTN
* Pregnancy
* Suspected aneurysm
## Footnote
**(MISPUPS)**
40
3 Thrombolytic Agents
* Streptokinase (highly antigenic)
* Urokinase
* Alteplase
41
2 mechanical treatments for PE
* **Embolectomy** (for massive PEs if pt has contraindications to fibrinolysis/unstable after fibrinolysis)
* **Catheter directed thrombolysis** (Alteplase infused over 4 hours)
42
* Chronic/reversible inflammatory disorder affecting 10% of adults and 30% of children
Asthma
43
Pathophysiology triad of asthma
* Airway inflammation
* Obstruction to airflow
* Bronchial hyper-responsiveness
44
Clinical triad of asthma
* Dsypnea
* Wheezing
* Cough
45
Chronic / Irreversible Disorder
**COPD**
* Chronic Bronchitis
* Emphysema
46
**Chronic Bronchitis or Emphysema?**
* Presence of chronic productive cough for 3 months in 2 successive years
* Clinical dx
Chronic Bronchitis
47
**Chronic Bronchitis or Emphysema?**
* Destruction of bronchioles and alveoli
* Pathologic dx
Emphysema
48
Most common risk factor (90%) for COPD?
**Tobacco use**
(only 15% of tobacco smokers develop COPD)
49
Besides smoking, what are 4 other risk factors for COPD?
* Occupational exposures
* Environmental exposures (air pollution)
* Alpha 1 antitrypsin deficiency
* IVDA
50
**What is used to assess COPD and is patient dependent?**
* Measures severity of airway restriction
* Should be compared to pt's baseline
* Can be used to monitor response to therapy
* Use guidelines if age/height table not available
FEV1
51
3 tx goals of COPD
* Reverse airflow obstruction
* Provide adequate oxygenation
* Relieve inflammation
52
