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DU PA Resp Em/airwy

Duke PA Respiratory Emergencies and Airway management

Feeling of difficult, labored or uncomfortable breathing Dyspnea
Rapid physical exam for respiratory distress Oropharynx, neck, cardiac, chest exam, pulmonary, skin
What do you look for in the oropharynx in the setting of respiratory distress Appearance of uvula, foreign body
What do you look for in the neck exam in the setting of respiratory distress Tracheal deviation, distended neck veins, stridor
What do you look for in the cardiac exam in the setting of respiratory distress Rate and rhythm
What do you look for in the chest exam in the setting of respiratory distress Equal rise, trauma
What do you look for in the pulmonary exam in the setting of respiratory distress Rales, crackles, wheezing, equal breath sounds
What do you look for in the skin exam in the setting of respiratory distress Color, temperature, diaphoresis
Arbitrarily defined as a Pao2<60mmHg, correlates with O2 sat 90% Hypoxia
Segmental fracture of 3 or more adjacent ribs in two or more places of each individual rib, results in paradoxical respiration Flail chest
Tall lanky guy who smokes, with sudden onset of dyspnea, what is it Tension pneumothorax
Chest pain worse on breathing in, leaning forward, and on palpation Pleuritic chest pain
Accumulation of fluid in alveoli resulting in impaired gas exchanged and subsequent hypoxia Pulmonary edema
Characterized by inflamed airway tissue and excessive mucus production COPD
COPD treatment Steroids, use of NIPPV:CPAP or BiPAP, careful use of O2 (goal of PaO2 at least 60mmHg), broad spectrum antibiotics
History: pleuritic chest pain, dyspnea (may be intermittent), cough, hemoptysis, anxiety. Physical findings: tachypnea, tachycardia, fever, hypotension, signs of DVT. What is it Pulmonary embolism
Do you get a d-dimer on patients who you have a high suspicion or low suspicion for pulmonary embolism Low
Cornerstone of treatment for pulmonary embolism LMWH, heparin, coumadin
Biggest reason to perform the Sellick maneuver To prevent aspiration
flail chest: indicators for early intubation include persistent arterial Po2<80, shock, age>65, severe head injury, comorbid pulmonary disease
what should be done immediately for the patient with a tension pneumo 14-16 ga catheter should be inserted into anterior chest wall (2nd intercostal space at midclavicular line)
what is the definitive treatment for a tension pneumo inflation of affected lung with evacuation of pleural air via a chest tube
who is at risk for aspiration pneumonia nursing home patients, alcoholics, patients on sedatives, narcotics users, patients with GERD
what are some causes of non-cardiogenic pulmonary edema drug overdose, sepsis, pulmonary contusion
treatment for pulmonary edema 100% O2, noninvasive positive pressure vent CPAP or BiPAP (consider intubation for obtunded patients), NTG, morphine, diuretics (Lasix), foley (for the lasix you just gave), treat underlying cause
what are the two phases of asthma acute bronchoconstriction, sub-acute airway inflammation and mucous plugging
what are some ominous signs of impending respiratory failure in someone with asthma a quiet chest, agitation or confusion
what are red flags in an asthma patient fever, productive cough, immunosuppression, elderly or very young
asthma treatment supplemental oxygen, beta agonist (albuterol/smooth muscle relaxation), anticholinergic (atrovent/decreased mucuous production), epinephrine(if impending resp failure), steroids (treat late phase and prevent rebound)
characterized by inflamed airway tissue and excessive mucus production. coughing on most days for 3 month in 2 consecutive years COPD
alveoli loose ability to stretch and thus become weak, and break resulting in inability of the lung to exchange CO2 and O2 emphysema
what is the treatment goal of COPD PaO2 of at least 60mmHg
what are some hypercoagulable states (in PE) malignancy, pregnancy, postpartum, estrogen use, genetic mutations, Pro C/S deficiency
risk factors for pulmonary embolism hyper-coagulable state, vascular injury, venous stasis
bed rest > __ hours can lead to venous stasis and put the patient at risk for PE 48
gold standard for the diagnosis of PE pulmonary angiography
causes of cardiogenic pulmonary edema h/o CHF or ESRD, new onset arrhythmia, medication noncompliance, dietary indiscretion
pulmonary edema: ancillary tests Pulse Ox, blood gas, BNP, chemistry, cardiac markers, EKG; Urine/Serum, toxicology screen
Pulmonary embolism: ancillary imaging tests Doppler US; CT (may miss small peripheral PE); V/Q scan; pulmonary angiography
Pulmonary embolism: tx Anticoagulation (cornerstone of tx; LMWH, hep, warfarin); thrombolysis (for pts in extremes); embolectomy (rare); IVC filter (recurrent DVT/PE pt on anticoag)
miller laryngoscope blade straight; Lifts epiglottis directly
macintosh laryngoscope blade curved; Lifts valecula (indirectly lifting epiglottis)
ET tube sizes M 8.0-8.5; F 7.0-7.5; infants/kids: estimate by diameter of pinky finger
LEMON Look externally; Evaluate 3-3-2; Mallampati; Obstruction; Neck mobility
BURP Backward, Upward, Rightward, Pressure on thyroid cartilage (studies don't support benefit of either maneuver)
Created by: bwyche
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