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Sam: Emergency Medicine > Respiratory Emergencies - SD > Flashcards

Respiratory Emergencies - SD Flashcards

(73 cards)

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1
Q

what vital sign is always the “right” answer?

A

Oxygen

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2
Q

Current steroid use or recent withdrawal from oral steroids, comorbid conditions, serious psychiatric illness, illicit drug use, and low socioeconomic class are risk factors for what disease?

A

Asthma

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3
Q

Which is illicit drug is very risk risky for asthma sufferers?

A

Crack cocaine

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4
Q

What are some questions you should get in your HPI when treating an asthmatic?

A
  1. Measures of home peak flow meter
  2. Recent illness/fever/cough
  3. Exposure to triggers
  4. Recent increase in use of rescue medications
  5. Duration of current exacerbation
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5
Q

According to Frank, what are some key questions to ask in your HPI?

A
  1. Have you ever been intubated?
  2. Are you taking steroids?
  3. Is that what your asthma feels like?
  4. Are you getting tired?
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6
Q

What are some “red flags” you might see on physical exam of someone who is profoundly SOB?

A

Respiratory distress, tachypnea/tachycardia/low SaO2 stats, unable to speak full sentences, audible wheezing, accessory muscle use, mental status change

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7
Q

Prior intubations, previous ICU admissions for asthma, recent or frequent emergency department visits for asthma exacerbations, hospitalizations or ED visits in the last month, use of 2 or more albuterol inhalers in the last month, use of air conditioning are all risk factors for?

A

Death from Asthma

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8
Q

What do we want to keep patient’s SaO2 levels above?

A

95%

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9
Q

When someone comes in for an asthma exacerbation, what 2 (maybe 3) things do we want to do (or monitor) right away?

A

Pulse ox monitoring, IV, +/- cardiac monitoring

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10
Q

What is a very simple thing you can ask your patient to do to help them breathe?

A

Sit patient up

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11
Q

What is our inhaled Beta2 agonist?

A

Albuterol

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12
Q

How quickly does albuterol work?

A

5 minutes

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13
Q

What drug acts by relaxing bronchial smooth muscle, decreasing histamine release, inhibiting microvascular leakage into airways, and increases mucociliary clearance?

A

Albuterol

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14
Q

What two side effects are typically seen after administration of albuterol?

A

Tachycardia and tremor

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15
Q

Which drug is a beta 2 receptor agonist with some beta 1 activity?

A

Levalbuterol

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16
Q

Steroids ________ recovery and ______ recurrence.

A

speed, reduce

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17
Q

When administering steroids, is onset faster PO or IV?

A

They are equal in onset

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18
Q

Which class of drugs works by inhibiting airway inflammation, reverse beta-receptor down-regulation, block leukotriene synthesis, and inhibit cytokine production and adhesion protein activation?

A

Steroids

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19
Q

_________ corticosteroids have no role in acute exacerbation

A

Inhaled

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20
Q

What drug is considered the standard of care for severe asthma exacerbations?

A

Epinephrine

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21
Q

true or false

IM route is superior to SC route when administering epinephrine

A

True

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22
Q

Which drug is a selective beta2-agonist that act directly on beta2-receptors, relaxing bronchial smooth muscle, relieving bronchospasm, and reducing airway resistance?

A

Terbutaline

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23
Q

Terbutaline serves as an alternative to epinephrine - whats the benefit to terbutaline?

A

less cardiac side effects

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24
Q

Which medication effects as a bronchodilator are mild, and toxicity is common?

A

Theophyline

*not commonly used anymore

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25
Efficacy of this drug is controversial, but it relaxes smooth muscle and there is essentially no risk when administering it. What is it?
Magnesium sulfate
26
Which element is about 25% as dense as room air?
Helium
27
Heliox-driven nubulizer treatments should have more or less albuterol?
More -- typically double the amount
28
What are some warning signs of a severe asthma exacerbation?
PFM less than 100-80L/min PA02 less than 60mmHg PCO2 greater than 45 mmHg Pulsus paradoxus greater than 20 mmHg Also, mental status change, cardiac arrhythmias, and pneumothorax
29
What is a severe, prolonged asthma attack which cannot be broken by usual treatment?
Status asthmaticus
30
Should we wait until the last possible second to intubate someone?
No -- the decision to intubate is best done semi-electively before the crisis of respiratory arrest
31
What are some criteria for admitting a patient with an asthma exacerbation?
1. Changes in mental status | 2. Failure of post-treatment PFM to increase by more than 15% above initial value, or if absolute PFM is
32
When discharging a patient for an asthma exacerbation, what two things must we educate on?
Reinforce importance of PFM Educate patient and family on triggers, proper use of meds and when to call for help
33
What the hell do you do if your tanking asthmatic is pregnant?
You do everything exactly the same
34
What are the four asthma take home points?
1. lots of nebs 2. Steroids, terbutaline, epinephrine 3. Silent chest, not your friend 4. Document re-examinations
35
Weight loss, dyspnea on exertion, cough only in AM, barrel chest, and tachypnea are things seen on physical exam in what patients?
COPD
36
Is wheezing or ronchi typically found in a COPD patient?
Depends -- some do
37
Enlarged accessory muscles, clubbing of fingers, pursed lips, and prolonged expiratory phase should make you think of?
COPD
38
What are the three steps to managing a COPD patient?
Step 1: medication therapy and supplemental oxygen Step 2: positive pressure ventilation Step 3: intubation
39
What bronchodilator do we typically use for COPD patients?
Ipratroprium
40
When should we begin treating with corticosteroids for COPD patients?
Corticosteroid therapy should be started immediately for all but mild exacerbations
41
How do we feel about inhaled corticosteroids?
Great for preventative care not great for emergent care
42
What are advantages to NIPPV?
Decrease the need for intubation, reduce hospital stay, and reduce mortality in patients with severe exacerbations
43
What actions should we take if a patient exhibits the following: Changes in mental status, increased respiratory distress with cyanosis, acute deterioration or exhaustion
Intubate and mechanically ventilate immediately!
44
How do NIPPV's work?
Improve gas exchange and decrease hypoxia by reducing the work of breathing
45
When should we prescribe antibiotics during a COPD exacerbation?
Controversial -- some recommend antibiotic therapy for patient with pneumonia, increased sputum production, fever, and worsening dyspnea
46
What antibiotics do we typically prescribe if we are going to prescribe abx for a COPD exacerbation?
Macrolides and Flouroquinolones
47
Why can't we give COPD patients "too much" oxygen?
It can cause respiratory depression and respiratory arrest
48
What is alpha1-antitrypsin deficiency syndrome?
Congenital lack of primary lung antiprotease (alpha1-antitrypsin) leading to increased protease tissue destruction and emphysema in adults
49
What is alpha1-antitrypsin's primary function?
Protect the lungs from protease-mediated tissue destruction
50
What are the three take home points for COPD?
1. Give as much oxygen as they need 2. Steroids and lots of nebs 3. Try to avoid intubation at all costs
51
Who is the classic pneumothorax patient?
Max
52
How does a pneumothorax present?
Abrupt pleuritic chest pain +/- dyspnea Often tachy, tachypneic, and have decreased breath sounds
53
What part of the lung do pneumothorax occur most frequently?
Apex
54
What is the most common treatment for pneumothorax
Nothing and repeat chest x-ray in 24 hours
55
If treatment for pneumothorax is urgent, what should we do?
Chest tube
56
If treatment for pneumothorax is emergent, what should we do?
Needle decompression
57
Pneumothorax caused by trauma, how do we treat?
Typically either emergent needle decompression or chest tube placement
58
What are our four take home points for a pneumothorax?
1. Remember the classic patient for spontaneous pneumo 2. Needle early if any concern for tension 3. In this case....size matters 4. Know your landmarks for needle thorascotomy and chest tube
59
What life-threatening condition is often missed initially?
Pulmonary embolism
60
What is the classic triad for PE?
Pleuritic chest pain, dyspnea, and hemoptysis
61
What is the most common presenting complaint for a PE?
dyspnea
62
What might you hear on auscultation when assessing for a PE?
pleural friction rub, S3, S4 gallop
63
Tell me 6 risk factors for PE
1. Recent long distance travel 2. Recent surgery 3. Recent immobilization 4. Hemoptysis 5. History of clotting disorder 6. History of cancer
64
What is the first step in testing for a PE?
You MUST determine pretest probability
65
What is the second step in testing for a PE? Third step?
Second step -- testing if indicated Third step -- imaging if indicated
66
What are three scoring system we can use to assess likelihood of a PE?
Wells score, Canadian PE score, Geneva PE score, PERC rule
67
Loaded card -- 8 parts to the PERC rule for PE
1. Age less than 50 2. Heart rate less than 100 3. Oxygen saturation on room air greater than 94% 4. NO prior hisotry of DVT?PE 5. No recent trauma or surgery 6. No hemoptysis 7. No exogenous estrogen 8. No clinical signs suggesting DVT?
68
If you determine your patient is high risk do you do "testing"?
No -- go straight to imaging
69
What are the take home points from PE's?
1. DDimer is not a pregnancy test 2. Pretest probability + decision rules = testing or no testing 3. Anything but low risk = imaging study
70
The mortality rate for pneumonia if left untreated is ________ percent.
thirty
71
Cough, SOB, fever, malaise, vomiting, pleuritic CP, chills/sweats think of?
Pneumonia
72
What are common pathogens for pneumonia?
Haemophilus influenzae Klebsiella Staphylococus Legionella
73
When should we consider admitting a patient for pneumonia?
VS unstable Bilateral pneumonia Significant comorbidities Immune compromised Eldery

Sam: Emergency Medicine (12 decks)

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