Respiratory Emergencies and Thoracic Trauma Flashcards

Question

metabolic alkalosis with respiratory compensation

Answer 1

ph high or normalizing PaCO2 high HCO3 high

Answer 2

deep vein thrombosis or other material that dislodged and traveled to pulmonary vasculature and is obstructing pulmonary bloodflow

Answer 3

blood fat amniotic fluid air

Answer 4

migrates from other part of body, usually R side of heart, pelvis, or DVT in legs

Answer 5

24-48 hours after long bone fx petechiae of chest and axilla

Answer 6

shortly after delivery

Answer 7

usually d/t inadvertent air injection in IV or with dive injuries

Answer 8

``` previous DVT surgery last 4 weeks estrogen use active, metastatic CA recent travel w/ immobility IV drug use age smoking hypercoagulable state ```

Answer 9

Pulmonary Embolism Rule-out Criteria decrease pre-test probability to acceptable level so no further testing required

Answer 10

``` no hormone use <50 yo no DVT/PE hx no coughing blood no LE swelling unilaterally SpO2 > 94% HR < 100 no surgery/trauma last 28 days ``` no previous DVT = negative result

Answer 11

``` sx DVT = 3 PE likely = 3 HR > 100 = 1.5 immobilization of 3 days = 1.5 surgery last 28 days = 1.5 previous PE/DT = 1.5 hempotysis = 1 malignancy w/ tx last 6 mo or palliative = 1 ``` score <= 4 can r/o with dimer previous DVT = positive result

Answer 12

``` sudden sob tachypnea, tachycardia cough w/ poss. hemoptysis diaphoresis, syncope, fever crackles accentuated S2 JVD, hypotension elevated ESR, dimer new RBBB, peaked P waves, depressed T waves ```

Answer 13

``` supp. O2 anticoags fibrinolytics/thrombolytics IV fluids vasopressors w/ hypotension ```

Answer 14

viral inflammation of upper airways most common cause of antibiotic misuse

Answer 15

consider influenza can look like simple URI in first few days and is often associated w/ simple URI

Answer 16

dry, hacking, non productive cough progressing to productive cough > 5 days exacerbated at night, w/ deep inspiration, talking, laughing pleuritic cp fever unlikely

Answer 17

OTC or Rx cough meds humidification bronchodilators corticosteroids

Answer 18

viral infection, usually RSV, producing copious nasal secretions clinical syndrome in children < 2 yo

Answer 19

upper resp prodrome followed by increased resp effort lower resp inflammation w/ wheezing/crackles self-limiting - distress peaks 5-7 days wheezing may last week+

Answer 20

- URI w/ dyspnea, cough - poor feeding, cranky, decreased alertness - tachypnea, apnea in infants - grunting, nasal flaring, retractions, cyanosis - wheezing

Answer 21

suction nares supp. o2 bronchodilators admission of RR > 70

Answer 22

viral slower onset, more comment in winter bacterial rapid onset

Answer 23

streptococcus pneumoniae

Answer 24

aerobic gram-negative

Answer 25

RSV, influenza, parainfluenza

Answer 26

``` fever pleuritic chest pain productive cough tachypnea, tachycardia decreased breath sounds pleural friction rub hyporesonance, increased remitus ```

Answer 27

hx ICU admission leukopenia alcohol abuse asplenia

Answer 28

stable, healthy can be sent home with abx, bronchodilators, oral hydration admitted: abx, O2, IV fluids, bronchodilators, maybe CPAP, BiPAP, intubation

Answer 29

burns to respiratory tract from fire in confined space or smoke exposure

Answer 30

consider inhaled toxin exposure 2ndary to burning objects damage to cilia makes it difficult to clear secretions

Answer 31

``` hoarse voice stridor wheezing facial burns, singed nasal hair carbonaceous sputum ```

Answer 32

airway | coboxyhemoglobin

Answer 33

O2 airway poss. intubation

Answer 34

chronic reactive airway disease with airway hyperreactivity, inflammation, and reversible airflow obstruction

Answer 35

can be life threatening status asthmaticus is a severe, refractory asthma attack

Answer 36

``` environmental URI exercise meds food additives, sulfites, tetrazine menses GERD cold, dry air (seasonal changes) ```

Answer 37

``` chest tightness cough WOB hyperresonance to percussion crackles prolonged expiratory time respiratory alkalosis (early) respiratory acidosis (late) exp wheeze (early), insp wheeze (late) decreased lower breath sounds hypoxia pulsus paradoxus ```

Answer 38

PEFR | objective measure of airflow

Answer 39

``` sit upright, legs dangling inhale fully, seal mouthpiece exhale fully note measurement repeat 3 times and record best ```

Answer 40

70-90% of predicted value or personal best: use inhalers < 70%: seek medical attention 40-60%: moderate exacerbation < 40%: severe exacerbation

Answer 41

relax smooth muscles of bronchioles, producing bronchodilation tachycardia is side effect

Answer 42

epi, racemic epi albuterol salmeterol levalbuterol

Answer 43

inhibits contraction of bronchial smooth muscle and limits mucus secretions side effects: dry mouth, pupil dilation, increased HR, blurred vision

Answer 44

ipratropium

Answer 45

anti-inflammatory and immunosuppressant effects, which: - reduce airway inflammation - inhibit mucus production - decrease airway swelling and hyperactivity

Answer 46

inhaled: - dexamethasone - beclomethasone - triamcinolone oral: prednisone IV: methylprednisone

Answer 47

inhibits smooth muscle contraction decreases release of histamine inhibits acetylcholine release

Answer 48

drug suspended in liquid propellant use of space recommended

Answer 49

increase vaporization of particles and increase lung penetration while decreasing loss of med in air or mouth 85% of meds delivered compared to 15% always with MDI

Answer 50

alternative for people who cannot use MDI

Answer 51

preferred if unable to sit upright or too sick for MDIs and spacers best delivery method upright to allow for deep ventilation and maximal diaphragmatic movement if HR increases > 20bpm, stop

Answer 52

``` avoid triggers hypoallergenic bedding air purifiers wash linens q week in hot water carpet removal pets outside inside with air conditioning during early morning and midday meds as directed stop smoking pretreat before exercise ```

Answer 53

preventable, treatable disease characterized by progressive airflow limitation abnormal inflammation response that is not fully recoverable

Answer 54

chronic bronchitis | enphysema

Answer 55

cough and sputum production for at least 3 months during 2 consecutive years

Answer 56

alveoli destruction

Answer 57

``` "blue bloater" productive cough stocky onset 40-50 yo normal RR hypoxemia increased PaO2 cyanosis polycythemia cor pulmonale peripheral edema risk for PE enlarged HR ```

Answer 58

``` "pink puffer" cough uncommon thin onset 50-70yo tachypnea PaO2 normal or slightly low PaCO2 low or normal until end barrel chest accessory muscles tripod position pursed-lip breathing hyporesonance lung over inflation and low diaphragm ```

Answer 59

``` CPAP, BiPaP bronchodilators high folwer IV fluids monitor arrhythmias IV corticosteroids abx prn ```

Answer 60

``` immunize avoid exposures to URIs small, frequent meals for max chest excursion adequate hydrations for moist secretions stop smoking ```

Answer 61

CPAP | BiPAP

Answer 62

constant, mild airflow at single set pressure to keep airway open requires tight fitting mask

Answer 63

time-cycle airflow w/ two levels of pressure lower pressure inhaling higher pressure exhaling requires tight fitting mask

Answer 64

``` hemodynamically stable normal mental state spontaneously breathing tolerate mask, sit upright handle secretions sx resp distress ```

Answer 65

- improves pulm fxn and gas exchange - decreases inspiratory threshold pressure - decreases venous return to heart - limits workload - increases functional residual capacity - may affect CO

Answer 66

decrease venous return to heart which could decrease CO in dehydrated patient barotrauma aspiration if vomiting

Answer 67

accumulation of fluid in extravascular spaces of lungs

Answer 68

cardiogenic: high pulmonary capillary pressure noncardiogenic: pulmonary capillary permeability

Answer 69

``` ARDS renal failure (fluid overload) submersion injury head trauma, szs rapid re-expansion of lung (scuba) high altitude toxic gas inhalation OD ```

Answer 70

``` sob tachypnea, tachycardia anxiety, agitation sensation of suffocation cough, crackles, wheeze diaphoresis pink, frothy sputum ```

Answer 71

``` high-flow IV, careful fluids CPAP/BiPAP intubation w/ low tidal volumes supportive treatment ```

Answer 72

form of noncardiogenic pulmonary edema inflammatory syndrome characterized by diffuse alveolar injury in which increased permeability of alveolar=capillary barrier allows protein-rich fluid to pass into alveoli, resulting in severe hypoxemia.

Answer 73

refractory to high concentrations of oxygen associated with loss of surfactant, alveolar collapse, and decreased lung compliance

Answer 74

``` aspiration of gastric contents PNA toxic inhalation pulm contusion submersion injury ```

Answer 75

``` sepsis multiple trauma massive transfusion severe pancreatitis OD burns DIC shock ```

Answer 76

``` dyspnea, tachypnea, cysnosis tachycardia anxiety, restless, agitated accessory muscle use fever or hypothermia ```

Answer 77

CXR | bronchoscopy with lavage

Answer 78

intubate, PEEP low tidal volumes careful fluids ICU

Answer 79

acute renal failure hypo/er glycemia MODS VAP

Answer 80

abnormal collection of fluid in pleural space not a disease

Answer 81

``` HF nephrotic syndrome malnutrition PNA infected wound lung abscess tumor fibrosis trauma infection ```

Answer 82

``` dyspnea cough CP dullness to percussion decreased breath sounds pleural friction rub decreased chest expansion on affected side ```

Answer 83

needle thoracentesis or chest tube if large and compromising respirations

Answer 84

blockage in airway

Answer 85

large obstructions: complete obstruction with lack of coughing, airway sounds or airway movement smaller obstructions: hoarseness and aphonia

Answer 86

large obstruction: complete airway obstruction with lack of coughing, airway sounds, airway movement smaller obstructions: wheezing similar to asthma

Answer 87

cough, unilateral wheeze, unilateral breath sound decrease 80-90% aspirated objects are in bronchi adults: usually R bronchus peds: R or L equally

Answer 88

``` heimlich CPR direct visualization largyncoscope with Magill forceps endoscope for partial/bronchial ```

Answer 89

accumulation of air in pleural space causing partial or complete collapse of lung as air accumulates with increasing pressure

Answer 90

penetrating wound allowing air to enter thorax and loss of normal negative intrathoracic pressure

Answer 91

no trauma young, thin, tall males or in smokers with pulm disease

Answer 92

blunt trauma

Answer 93

penetrating trauma

Answer 94

``` sudden pleuritic CP dyspnea, tachypnea cough decreased BS hyperresonance ```

Answer 95

``` CP dyspnea, tachypnea cough decreased BS hyperresonance ```

Answer 96

``` visible chest wound resp distress sucking sound asymmetrical chest expansion bubbling of blood around wound subcutaneous emphysema ```

Answer 97

high Fowler monitor, pain control chest tube at 5 or 6th ICS mid axillary

Answer 98

high Fowler monitor, pain control oxygen if small enough chest tube if larger

Answer 99

ABCs 3 sided occlusive dressing chest tube

Answer 100

air enters pleural space during inspiration and can't escape during exhalation

Answer 101

life threatening pressure shifts mediastinum and collapses opposite lung, decreasing cardiac output

Answer 102

accumulation of blood in pleural space, usually accompanied by pneumothorax

Answer 103

massive hemothorax can accumulate more than 1500 ml blood in chest cavity

Answer 104

blunt, penetrating trauma | mechanical ventilation

Answer 105

blunt, penetrating trauma

Answer 106

``` severe resp distress decreased CO hyperresonance distant heart sounds JVD, deviated trachea ```

Answer 107

``` resp distress pain on inspiration asymmetric chest wall movement hypovolemic shock decreased breath sounds dull percussion ```

Answer 108

needle decompression | immediate chest tube

Answer 109

ABCs, fluids, blood chest tube emergent surgery with large accumulations

Answer 110

fluid: decreased air: decreased

Answer 111

fluid: absent air: decreased

Answer 112

fluid: hyperesonance air: hyperresonance

Answer 113

fluid: dull ache on affected side air: sharp pain, maybe radiating to shoulder on affected side

Answer 114

fluid: near top of fluid line air: not present over air

Answer 115

``` injury to: lungs aortic arch vertebra column suclavian artery, vein ``` rare - needs significant force

Answer 116

splenic injury (L) hepatic injury (R)

Answer 117

carilaginous ribs not easily fractured but may have significant trauma consider abuse

Answer 118

lack pulmonary reserves to compensate for rib fractures

Answer 119

diaphragmatic tears, liver or splenic injuries and associated bleeding with low rib fractures cardiac or vascular damage from sternal fractures

Answer 120

monitor resp status restrict activity pain admission for geriatrics

Answer 121

2 or more adjacent fractured ribs in 2 or more locations or detachment of sternum

Answer 122

life threatening impaired ventilation caused by loss of bellows effect (less negative intrapleural pressure to expand lungs) and associated with pulm contusion dead space and atelectasis

Answer 123

``` paradoxical chest movement cp resp distress hemo/pneumothorax subcutaneous emphysema bony crepitus increased resp effort decreased tidal volume impaired cough hypoxia ```

Answer 124

mechanical ventilation with PEEP chest tube if hemo/pneumothorax correct hypovolemia surgery

Answer 125

injury of lung resulting in edema and blood collection in lung parenchyma

Answer 126

severe blunt trauma high-velocity missile trauma significant barotrauma

Answer 127

``` resp distress chest pain chest wall bruising cough, hemoptysis decreased breath sounds crackles, wheezes other chest injuries ```

Answer 128

high flow intubation or CPAP/BiPAP careful fluids pain

Answer 129

abdominal contents herniate into chest and compress lungs, heart, aorta, vena cava

Answer 130

penetrating or blunt trauma

Answer 131

L because liver protects R side

Answer 132

dyspnea, orthopnea dysphagia bs in chest abd pain radiate to L shoulder (kehr sign) decreased breath sounds undigested food/fecal matter in chest tube

Answer 133

``` FAST exam CXR will show: -elevated L diaphragm -herniation of bowel into chest -NG or OG tube coiled in chest ```

Answer 134

ABC NG/OG tube emergent surgical repair

Answer 135

initial output >1500 ml continued output >200 ml/hr

Answer 136

lung re-expanded or obstruction in system

Answer 137

large air leak on patient or drainage system

Answer 138

clamp, clean, reconnect | assess, provider

Answer 139

pressure dressing, occlusive | assess, provider

Answer 140

significant blood loss | blood < 4-6 hrs

Answer 141

readily available no risk of rxn fresh, warm, whole blood

Answer 142

risk of enteric contamination ruptured diaphragm lower chest injury penetrating trauma

Respiratory Emergencies and Thoracic Trauma Flashcards

1. Describe concepts related to the care of an ED patient experiencing a respiratory emergency 2. Describe various patient presentations related to respiratory emergencies 3. List interventions necessary for a patient presenting with a respiratory emergency (167 cards)