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