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Questions and Answers
What are the symptoms at LEVEL I for Emphysema?
What are the symptoms at LEVEL I for Emphysema?
What is the main oxygen therapy for Emphysema?
What is the main oxygen therapy for Emphysema?
Low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal cannula.
What defines Chronic Bronchitis?
What defines Chronic Bronchitis?
What is often the primary test for Bronchiectasis?
What is often the primary test for Bronchiectasis?
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What therapy is indicated for OSA if obstructive?
What therapy is indicated for OSA if obstructive?
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The cessation of breathing during sleep is defined as Asthma.
The cessation of breathing during sleep is defined as Asthma.
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What can be watched for in patients with Status Asthmaticus?
What can be watched for in patients with Status Asthmaticus?
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What is a characteristic symptom of Myasthenia Gravis at LEVEL I?
What is a characteristic symptom of Myasthenia Gravis at LEVEL I?
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What is the important priority in treating a Drug Overdose?
What is the important priority in treating a Drug Overdose?
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What is an indicator of Chest Trauma?
What is an indicator of Chest Trauma?
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The usual treatment for a Hemothorax is the insertion of _____ tubes.
The usual treatment for a Hemothorax is the insertion of _____ tubes.
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What condition is monitored after Abdominal Surgery?
What condition is monitored after Abdominal Surgery?
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Pneumothorax requires chest tube placement for baseline improvement.
Pneumothorax requires chest tube placement for baseline improvement.
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What is the initial goal for incentive spirometry (IS) after surgery?
What is the initial goal for incentive spirometry (IS) after surgery?
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Which of the following can result in Acute Respiratory Distress Syndrome (ARDS)?
Which of the following can result in Acute Respiratory Distress Syndrome (ARDS)?
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What is an appropriate initial ventilator setting for a patient described as having ARDS?
What is an appropriate initial ventilator setting for a patient described as having ARDS?
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What type of surgery is performed to address cancer of the larynx?
What type of surgery is performed to address cancer of the larynx?
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Mechanical ventilation through the laryngectomy tube is not allowed.
Mechanical ventilation through the laryngectomy tube is not allowed.
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What is a common symptom in a patient with Guillain-Barre syndrome?
What is a common symptom in a patient with Guillain-Barre syndrome?
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What symptom may indicate a patient is in shock?
What symptom may indicate a patient is in shock?
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___ is a treatment that may involve administering diuretics for pulmonary edema.
___ is a treatment that may involve administering diuretics for pulmonary edema.
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What is the best diagnostic test for congenital heart defects?
What is the best diagnostic test for congenital heart defects?
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What is the presentation of a pre-term infant with SIDS?
What is the presentation of a pre-term infant with SIDS?
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Laryngotracheobronchitis is otherwise known as ___.
Laryngotracheobronchitis is otherwise known as ___.
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Croup is caused by bacterial infections.
Croup is caused by bacterial infections.
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What is Acute Epiglottitis?
What is Acute Epiglottitis?
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What are the common symptoms associated with Acute Epiglottitis in children aged 3 to 10 years? (Select all that apply)
What are the common symptoms associated with Acute Epiglottitis in children aged 3 to 10 years? (Select all that apply)
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Intubation is usually required immediately for Acute Epiglottitis.
Intubation is usually required immediately for Acute Epiglottitis.
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Which of the following are treatments for Bronchiolitis / RSV? (Select all that apply)
Which of the following are treatments for Bronchiolitis / RSV? (Select all that apply)
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What indicates the need for tracheostomy in case of Acute Epiglottitis? (Select all that apply)
What indicates the need for tracheostomy in case of Acute Epiglottitis? (Select all that apply)
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Cystic Fibrosis is an inherited disorder resulting in the mass production of ____ mucus in the lungs.
Cystic Fibrosis is an inherited disorder resulting in the mass production of ____ mucus in the lungs.
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Which test can show increased sweat chloride levels in Cystic Fibrosis?
Which test can show increased sweat chloride levels in Cystic Fibrosis?
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What is a common result from exposure to cold in potential hypothermia cases? (Select all that apply)
What is a common result from exposure to cold in potential hypothermia cases? (Select all that apply)
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Breath sounds may indicate respiratory distress in cases of burn trauma or carbon monoxide poisoning.
Breath sounds may indicate respiratory distress in cases of burn trauma or carbon monoxide poisoning.
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Which medication should be avoided in cases of kerosene ingestion? (Select all that apply)
Which medication should be avoided in cases of kerosene ingestion? (Select all that apply)
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What is the primary treatment for Foreign Body Aspiration in the lungs?
What is the primary treatment for Foreign Body Aspiration in the lungs?
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AIDS is a disease of the immune system that commonly results in ______ carinii pneumonia.
AIDS is a disease of the immune system that commonly results in ______ carinii pneumonia.
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What are common symptoms of Poison Inhalation/Ingestion? (Select all that apply)
What are common symptoms of Poison Inhalation/Ingestion? (Select all that apply)
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Chest x-rays are not useful in diagnosing conditions related to burn trauma.
Chest x-rays are not useful in diagnosing conditions related to burn trauma.
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How should activated charcoal be administered in case of poison ingestion?
How should activated charcoal be administered in case of poison ingestion?
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What is the associated condition with tachycardia?
What is the associated condition with tachycardia?
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What is the procedure associated with cold, clammy skin?
What is the procedure associated with cold, clammy skin?
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What treatment is indicated for suddenly short of breath?
What treatment is indicated for suddenly short of breath?
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What is a sign of a pneumothorax?
What is a sign of a pneumothorax?
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What pattern on X-ray is associated with respiratory distress syndrome?
What pattern on X-ray is associated with respiratory distress syndrome?
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What should be done for a patient with cyanosis?
What should be done for a patient with cyanosis?
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What is indicated for a patient who is lethargic and sleepy due to COPD O2 overdose?
What is indicated for a patient who is lethargic and sleepy due to COPD O2 overdose?
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What is the appropriate action for a patient showing signs of drug overdose?
What is the appropriate action for a patient showing signs of drug overdose?
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What treatment should be given for a severe asthma attack?
What treatment should be given for a severe asthma attack?
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Study Notes
Emphysema
- Characterized by destruction of alveoli, loss of elasticity, and symptoms such as cyanosis, barrel chest, and digital clubbing.
- Commonly associated with significant smoking history and occupational exposure.
- Diagnostic findings include flattened diaphragms on chest X-ray, polycythemia, and compensated respiratory acidosis in ABGs.
Chronic Bronchitis
- Defined by a productive cough occurring for 25% of the year for two consecutive years.
- Symptoms include dyspnea and purulent sputum production, often linked to smoking and frequent infections.
- PFT results reveal decreased airflow, especially in middle-sized airways.
Bronchiectasis
- Abnormal dilation of bronchi with productive cough, often containing blood; presents with digital clubbing and recurrent infections.
- Main diagnostic tool is a bronchogram showing a "tree in winter" pattern.
- Sputum culture typically indicates gram-negative bacteria.
Obstructive Sleep Apnea (OSA)
- Characterized by episodes of breathing cessation during sleep, often accompanied by snoring and daytime sleepiness.
- Diagnosed via polysomnography, revealing either obstructive or central sleep apnea mechanisms.
- Treatment options vary based on etiology, including CPAP for obstructive cases.
Asthma
- Involves bronchial constriction leading to wheezing, dyspnea, and coughing.
- Diagnostic findings may include respiratory acidosis on ABGs and hyperinflation on chest X-ray.
- Management strategies incorporate bronchodilators, oxygen therapy, and inhaled steroids.
Status Asthmaticus
- An acute exacerbation of asthma resistant to bronchodilators, characterized by severe dyspnea and wheezing.
- As it may deteriorate rapidly, interventions include intubation and mechanical ventilation if necessary.
Myasthenia Gravis
- Neuromuscular disorder causing muscle weakness, particularly ventilatory muscles; symptoms improve with rest and include ptosis and diplopia.
- The Tensilon Challenge Test is vital for diagnosis and assessing crisis events.
Drug Overdose
- Often presents with respiratory depression and requires immediate assessment of ventilatory drive.
- Treatment typically involves airway protection, intubation if needed, and narcotic reversal with Narcan for opioid overdoses.
Neuromuscular Conditions
- Include conditions like poliomyelitis and muscular dystrophy; may manifest as reduced respiratory volumes.
- Monitor vital functions and intervene with positive pressure if ventilatory failure occurs.
Head Trauma
- Assessment involves checking for signs of ICP and respiratory patterns.
- Management may require monitoring ICP and safeguarding ventilation strategies.
Chest Trauma
- Associated with pain, shallow breathing, and possible paradoxical movements if flail chest is present.
- Treatment emphasizes supporting ventilation and addressing complications like pneumothorax through chest tube insertion.
Hemothorax/Pneumothorax
- Signs include dyspnea, altered breath sounds, and changes observed on percussion.
- Management usually entails chest tube placement, particularly for tension pneumothorax.
Thoracic Surgery
- Requires careful monitoring of chest tube drainage and potential complications post-surgery.
- Utilize techniques that promote lung expansion, like incentive spirometry, especially after lobectomy or pneumonectomy.
Neck/Spinal Injury
- Presents with history of trauma and requires careful monitoring of ventilatory function.
- Intubation techniques must consider potential spinal damage; modified jaw thrust is preferred.
Abdominal Surgery
- Initial assessment should establish baselines for ventilatory function.
- Post-operative care may include incentive spirometry to enhance pulmonary recovery.
ARDS (Acute Respiratory Distress Syndrome)
- Characterized by decreased lung compliance and profound hypoxemia, often following significant lung insults.
- Requires meticulous management of ventilatory pressures and PEEP adjustments to optimize oxygenation while protecting hemodynamics.### Ventilation Strategies
- High ventilatory pressures may prompt consideration of alternate ventilation methods such as pressure control, high frequency, APRV, and inverse I:E ratios.
- For patients with ARDS on ventilation, start with a PEEP of at least 10 cm H2O and pressure control ventilation as initial settings.
Laryngectomy Overview
- Laryngectomy is performed to treat laryngeal cancer, with Level I involving surgical records indicating radical or simple procedures.
- Post-operative complications may include airway obstruction due to bleeding within hours after surgery.
Decision Making Post-Laryngectomy
- Monitor for complications such as blood clots in the laryngeal tube and be prepared for mechanical ventilation via the laryngectomy tube.
- Radical laryngectomy results in a permanent tracheostomy; simple laryngectomy requires tube replacement in 3 to 6 weeks.
- Prevent aspiration and delay oral ingestion for one week post-surgery.
Guillain-Barré Syndrome Information Gathering
- History may show recent influenza-like illness, with symptoms including muscle paralysis starting in legs and progressing.
- Pulmonary testing reveals decreased vital capacity and impending ventilatory failure; spinal tap indicates increased protein in spinal fluid.
Decision Making for Guillain-Barré
- Vigilantly monitor for ventilatory muscle deterioration; only initiate mechanical ventilation when VC falls below 1.0 L.
- Use anticoagulants and therapies like plasmapheresis and immunosuppressors to manage symptoms and prevent complications.
Shock Recognition
- Identify shock through signs of massive trauma or hypothermia; patients may appear cold and clammy, with tachycardia and hypotension.
- ABGs may show hypoxemia; hemodynamic values like CVP and cardiac output will be reduced.
Managing Shock
- Administer oxygen immediately upon suspicion of shock; appropriate fluid resuscitation may be necessary.
- Main treatment involves addressing the underlying cause of the shock.
Cardiac Surgery Overview
- Conduct thorough preoperative assessment including vital signs and family history, with spirometry to establish baseline function.
- ABGs are crucial for preoperative evaluations.
Decision Making for Cardiac Surgery
- Be prepared for immediate CPR if necessary; perform incentive spirometry hourly to enhance lung function post-surgery.
- Utilize ventilatory aids for unconscious patients, and remain vigilant for potential cardiac arrest.
Pulmonary Edema/CHF Information Gathering
- Look for historical indicators of CHF, presenting symptoms include tachycardia and pink frothy secretions.
- ABGs may reveal moderate to severe hypoxemia, with chest X-ray showing characteristic "Butterfly pattern."
Managing Pulmonary Edema/CHF
- Act immediately, administering 100% oxygen and diuretics; treat underlying cardiac issues if identified.
- Be ready for mechanical ventilation in case of ventilatory failure.
Myocardial Infarction/Arrhythmia Overview
- History showcases chest pain and signs of potential heart disease; tachycardia and nausea are common symptoms.
- ABGs demonstrate hypoxemia; elevated cardiac enzymes signal heart muscle damage.
Decision Making for Myocardial Infarction/Arrhythmia
- Provide emergency oxygen and address arrhythmias with appropriate medications, including defibrillation when necessary.
- Administer therapeutic levels of oxygen early upon presentation of signs.
Pulmonary Emboli Information Gathering
- Recent trauma or surgery history is critical; symptoms include chest pain and dyspnea, vital signs may show elevation.
- ABGs indicate persistent hypoxemia; a V/Q scan reveals mismatches in ventilation and perfusion.
Managing Pulmonary Emboli
- Initiate anticoagulant therapy and monitor coagulation parameters; administer 100% oxygen in emergencies.
- Mechanical ventilation may be required for severe cases.
Sudden Infant Death Syndrome (SIDS) Overview
- Infants may show signs of respiratory distress; common in pre-term births.
- Signs include cyanosis during feeding and abnormal APGAR scores.
Managing SIDS
- Promote lung maturity with surfactant therapy; use CPAP and oxygen supplementation.
- Mechanically ventilate as needed using SIMV mode for infants.
Congenital Heart Defects Information Gathering
- History may indicate pre-term birth with persistent cyanosis despite high FIO2.
- Echocardiogram serves as the definitive diagnostic tool for heart defects.
Managing Congenital Heart Defects
- Recognize and support until surgical intervention; maintain adequate PaO2.
- Mechanical ventilation is essential when signs of ventilatory failure emerge.
Neonatal Diaphragmatic Hernia Overview
- Presents with respiratory distress and mediastinal shift; absent breath sounds on the affected side.
- Chest X-ray typically shows displaced intestinal parts.
Decision Making for Diaphragmatic Hernia
- Surgical intervention is required; use low ventilatory pressures and avoid manual resuscitation if possible.
- Decompress the stomach and intestines with gastric tubes as needed.
Choanal Atresia Overview
- Infants may present with normal appearance but show cyanosis during feeding.
- Diagnosis confirmed by inability to pass a suction catheter through the nares.
Managing Choanal Atresia
- Care during feeding is critical; surgical correction is necessary; keep ventilatory pressure low.
Laryngotracheobronchitis (Croup) Overview
- Typically follows a recent cold; characterized by barking cough and stridor at rest in young children.
- Lateral neck X-ray may show subglottic swelling.
Decision Making for Laryngotracheobronchitis
- Priority is to administer oxygen and aerosolized racemic epinephrine.
- Intubation is warranted if severe respiratory distress is present.
Acute Epiglottitis Overview
- Rapid onset in children with drooling, hoarseness, and stridor; high fever is common.
- X-ray shows inflammation in the supraglottic region.
Managing Acute Epiglottitis
- Immediate airway establishment is critical; endotracheal intubation may be necessary in a surgical setting.
- Antibiotic therapy is essential, along with maintaining oxygen therapy until inflammation subsides.
Bronchiolitis/RSV Information Gathering
- Episodes of respiratory distress, wheezing, and recent illness in infants under 18 months are key indicators.
- Chest X-ray often shows hyperlucency and scattered infiltrates.
Managing Bronchiolitis/RSV
- Ribavirin treatment via SPAG unit is the primary intervention; ensure safe administration procedures are in place.
Cystic Fibrosis Overview
- Characterized by thick mucus production; family history and significant sputum output are notable signs.
- Chest X-ray resembles COPD, showing hyperinflation with a sweat test phenotype.
Managing Cystic Fibrosis
- Regular monitoring of lung function is essential; therapies should aim to manage secretions and treat infections.### Secretion Removal Therapies
- Primary treatment focuses on mobilizing and removing secretions.
- Common therapies include:
- PEP therapy devices
- Chest physiotherapy with postural drainage
- Hydration devices: heated aerosol or ultrasonic nebulization
- Vibration therapy
- Oxygen therapy as needed
- Antibiotic therapy when infection occurs, often includes Tobramycin and Pulmozyme (Dornase alpha).
Hypothermia
- Defined as significant body temperature drop due to cold exposure.
- Level I symptoms include lethargy, bradycardia, and unconsciousness.
- Level II: body temperature below 36°C.
- Level IV: lateral neck x-ray may show "thumb sign" or pencil point sign.
Management of Hypothermia
- Administer oxygen via heated aerosol at 40-100%.
- Maintain resuscitation efforts until normal body temperature.
- Monitor blood gas values, correcting for temperature discrepancies.
Burn Trauma / CO Poisoning
- Result from fire or smoke exposure, affecting airway and blood oxygenation.
- Level I focuses on history and visible signs like burns and "cherry-red" face.
- Level IV indicates COHb levels of 20% or higher.
Management of Burn Trauma / CO Poisoning
- Establish an artificial airway immediately if respiratory distress present.
- Initiate 100% oxygen for CO poisoning without waiting for COHb results.
- Continue oxygen therapy until COHb is below 10%.
Diabetes Management
- Diabetes failure leads to respiratory ketoacidosis, presenting with Kussmaul's respirations.
- Level I includes lethargy and significant alterations in respiratory patterns.
- Level IV indicates blood glucose > 160 mg/dL.
Decision Making in Diabetes
- Monitor for ventilatory failure and administer necessary electrolytes and fluids.
- Correct ketoacidosis as part of the treatment plan.
AIDS & Pneumonia
- AIDS results in pneumocystis carinii pneumonia; symptoms include weight loss and fever.
- Use aerosolized Pentamadine for treatment and implement universal precautions.
Foreign Body Aspiration
- Characterized by sudden onset cough, history of recent eating for adults.
- Classify as partial obstruction with soft cough or complete obstruction with no sounds.
Management of Foreign Body Aspiration
- Primary treatment is bronchoscopy to visualize and remove the foreign body.
Bronchopulmonary Dysplasia (BPD)
- Related to prolonged mechanical ventilation, common in newborns with a history of IRDS.
- Symptoms include wheezing and a chest x-ray showing chronic air trapping.
Treatment for BPD
- Utilize bronchodilator therapy and keep FIO2 low, aiming for PaO2 of 55-65 mmHg.
Transient Tachypnea - Type II RDS
- Occurs within 24-48 hours after birth, often in C-section deliveries.
- Initial signs include cyanosis and increased respiratory distress.
Management of Transient Tachypnea
- Supportive care for symptoms and oxygen therapy via oxyhood; CPAP for significant hypoxemia.
Infectious Pneumonia
- High pulse rate and fever signify bacterial pneumonia; low-grade temperature indicates viral pneumonia.
- Chest x-ray reveals lung consolidation and leukocyte changes depending on infection type.
Management of Infectious Pneumonia
- Sputum cultures to identify the causative agent and appropriate antibiotics; mechanical ventilation if required.
Pickwickian Syndrome
- Caused by obesity, characterized by obstructive sleep apnea.
- Diagnosis confirmed through polysomnography.
Treatment for Pickwickian Syndrome
- Use nasal nocturnal CPAP and support for weight loss.
Poison Inhalation/Ingestion
- Symptoms differ by poison type; petroleum and kerosene poisoning lead to CNS depression.
- Chest x-ray may show signs of pneumonitis or ARDS.
Decision Making in Poison Inhalation/Ingestion
- Gastric lavage for specific substances; do not induce vomiting for kerosene or corrosive materials.
- Administer activated charcoal for certain poisonings.
General Observations
- Cold, clammy skin may indicate myocardial infarction; immediate oxygen and ECG advised.
- Marked or severe symptoms require swift intervention.
- Anxiety and confusion often signal hypoxemia; address underlying causes promptly.
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Description
Test your knowledge on the symptoms and therapies related to emphysema, chronic bronchitis, and obstructive sleep apnea (OSA). This quiz covers key definitions and important tests for respiratory conditions. Explore the link between various respiratory diseases and their management.
