Emergency Care In The Streets: Chapter 26 Respiratory Emergencies

Front 1

angioedema

Back 1

An allergic reaction that may cause severe swelling of the tongue and lips.

Hint 1

26.6-7

Front 2

What are usually consider the dividers between the upper and lower airway?

Back 2

The larynx (voicebox) and glottis.

Hint 2

26.7

Front 3

arytenoid cartilages

Back 3

Visable when intubating, two pearly white lumps at the distal end of each vocal cord.

Hint 3

26.7

Front 4

piriform fossa

Back 4

Hollow pockets on the lateral side of the glottic opening.

Hint 4

26.49

Front 5

What is the space between the thyroid and cricoid cartilages?

Back 5

Cricothyroid membrane potential site for a cricothyrotomy

Hint 5

26.8

Front 6

Typical dead space is-

Back 6

1mL per pound space outside of ventilation, air in tubes.

Hint 6

26,8

Front 7

The trachea is about __ to ___ long and expands from the level of the _______________ to the point of bifurcation or _______ at the level of the the _____________(~nipple level),

Back 7

10 to 13cm
sixth cervical vertebra
or carnia
fifth thoracic vertebra

Hint 7

26.8

Front 8

atelectasis

Back 8

Collaspe of the alveolar air spaces of the lungs.

Hint 8

26.48

Front 9

Pulmonary circulation

Back 9

Begins as blood leaves the rt ventricles via the pulmonary artery. The pulmonary capillary bed brings red blood cells very close to the terminal bronchioles. There is more perfusion to the bases of the lungs than to the apices. After picking up oxygen, the blood returns to the left atrium via pulmonary veins.

Hint 9

26.11

Front 10

What type of breathers are we usually?

Back 10

Negative-pressure breathers (air suckers) as oppose to positive-pressure.

Hint 10

26.12

Front 11

Exhalation

Back 11

Usually a passive process with asthma, reactive airway disease, or COPD the pt may need to use the abdominal muscles to push air out, exhalation is no longer a passive process.

Hint 11

26.13

Front 12

Difficulty in exhalation usually indicates _______________________.

Back 12

obstructive pulmonary disease.

Hint 12

26.13

Front 13

Difficult in inhalation may indicate ______________________.

Back 13

upper airway obstruction.

Hint 13

26.13

Front 14

Hering-Breuer reflex

Back 14

Receptors that stop you when taking too deep a breath causing you to cough.

Hint 14

26.14

Front 15

Respiration

Back 15

The process by which oxygen is taken into the body, distributed to the cells, and used by the cells to make energy.

Hint 15

26.14

Front 16

Neurologic signs of hypoxia

Back 16

Early signs are anxeity, late signs are confusion, lethargy, and coma. Also sz and cardiac arrest.

Hint 16

26.15

Front 17

Cadiovascular status with hypoxia

Back 17

Early on it will just cause tachycardia while late on it cause bradycardia.

Hint 17

26.15

Front 18

Soft tissue retraction

Back 18

The rigid bones don't move but the soft tissue is pulled around the bones, during inhalation.

Hint 18

26.16

Front 19

Bony retraction

Back 19

Most common in children, on inhalation the sternum or rubs may pull or retract, causing a visible deformity with each breath.

Hint 19

26.16

Front 20

orthopnea

Back 20

Severe dyspnea experienced when recumbent and relieved by sitting or standing up.

Hint 20

26.49

Front 21

stidor

Back 21

A harsh, high-pitch sound heard on inhalation, indicates narrowing, usually as a result of swelling (laryngeal edema).

Hint 21

26.17

Front 22

Nasal flaring

Back 22

The nostrils are pulled wide open on inhalation.

Hint 22

26.17

Front 23

Pulsus paradoxus

Back 23

Profound intrathoracic pressure changes causing the peripheral pulses to weaken, or disappear during inspiration.
Rather rare.

Hint 23

26.17

Front 24

Auditory respiration

Back 24

As a general rule, any respiratory noises that you can hear without a stethoscope are abnormal noises.

Hint 24

26.17

Front 25

Tracheal tugging

Back 25

The thyroid cartilage is pulled upward and the area just above the sternum notch is sucked inward with inhalation.

Hint 25

26.17

Front 26

Quiet tachypnea should prompt you to consider ...

Back 26

shock.

Hint 26

26.17

Front 27

The patient with tachypnea who has crystal-clear breath sounds may have...

Back 27

hyperventilation syndrome but may also be breathing fast because of acidosis.

Hint 27

26.17

Front 28

Paradoxical respiratory motion

Back 28

The epigastrum is pulled in with inhalation while the abdomen pushes out, creating a seesaw appearance as the two move in opposite directions.

Hint 28

26.17

Front 29

What is a healthy level for hemoglobin?

Back 29

12 to 14g/dL

Hint 29

26.17

Front 30

paroxysmal nocturnal dyspnea

Back 30

Dyspnea that comes on suddenly in the middle of the night is an ominous sign. It may signal left heart failure, worsening of COPD, or both. It occurs because of accumulation of fluid in the alveoli or pooling of secretions in the bronchi during sleep.

Hint 30

26.18

Front 31

JVD may indicate

Back 31

Often normal, however it may implicate cardiac failure as the source of pt's dyspnea. May also indicate high pressure in the thorax, which keeps blood from draining out of the head and neck. Cardiac tamponade, pneumothrax, heart failure, and COPD can all cause JVD.

Hint 31

26.19

Front 32

hepatojugular reflux

Back 32

If you gently press on the liver, and blood further engorge the jugular vein. Ominous sign of right heart failure. When the right ventricle is not pumping effectively, blood backs up, making it difficult for the jugular veins and large reservoirs of blood in the liver to drain into the thorax.

Hint 32

26.20

Front 33

Tracheal deviation often times occurs _________________.

Back 33

behind the sternum

Consider feels the trachea above the suprasternal notch.

Hint 33

26.20

Front 34

What may it mean if you can understand what a pt is saying while you are listening to their lung sounds?

Back 34

It may mean consolidation from pneumonia or atelectasis.

Hint 34

26.22

Front 35

adventitious breath sounds

Back 35

The extra noises that you may hear on top of the breath sounds.

Hint 35

26.22

Front 36

crackles

Back 36

Discontinuous sounds are the instantaneous pops, snaps, and clicks.

Hint 36

26.22

Front 37

rhochus

Back 37

Also called rales, is a low wheeze or death rattle.

Hint 37

26.22

Front 38

What do you want to question about a cough?

Back 38

Productive or non productive?
If productive, is the mucus different (chronic), what color is it?

Hint 38

26.23

Front 39

What is normal peak flow?

Back 39

From 350 to 700 L/min

<150 L/min is bad

Hint 39

26.25

Front 40

When a pt is snoring

Back 40

Take away any pillow behind their head and reposition their airway.

Hint 40

26.26

Front 41

croup

Back 41

Viral infection of area around glottis. Most common children between 6 months and 3 years of age. Most commonly occurs in the middle of the night when air gets cool (in spring and fall). Child has classic seal-bark cough. May be distressing but is not typically fatal. Also called laryngotracheobronchitis. Do not manipulate the airway.

Hint 41

26.27

Front 42

Epiglottis

Back 42

Severe, rapidly progressive infection of the epiglottis and surrounding tissues that may be fatal because of sudden respiratory obstruction. Pts may present at any and at any time of the year. Pts typically drool, have a fever, hoarse voice, and purposefully hyperextension. Do not manipulate the airway.

Hint 42

26.27

Front 43

Peritonsillar abscess

Back 43

Uncommon in children, more common in young adults. Abscess forms behind pharyngeal tonsil on one side. Pt has a fever and sore throat. May be mistaken for epiglottis until you look in throat and see lateral abscess. Do not manipulate airway.

Hint 43

26.27

Front 44

Retropharyngeal abscess

Back 44

Most common in children, in whom infection from retropharyngeal lymph nodes can flourish. May also be caused by direct trauma to pharynx. Patient may have fever and sudden stridor. May be mistaken for epiglottis until laryngoscope examination reveals huge retropharyngeal pus sack instead of a cherry-red epiglottis. Do not manipulate the airway.

Hint 44

26.27

Front 45

Diphtheria

Back 45

Causative bacterium attacks and kills layer of epithelial tissue, creating pseudomembrane that is often seen in tonsillar area. Membrane along with swelling can obstruct upper airway. Part of immunization. Do not manipulate the airway.

Hint 45

26.27

Front 46

Enormous tonsils

Back 46

Palatine tonsils can swell excessively resulting in fever, difficulty swallowing, and sore throat. Tonsils can grow to golf ball size in some individuals. Severely swollen tonsils rarely compromise the airway but can cause snoring or stridor. Do not manipulate the airway.

Hint 46

26.27

Front 47

asthma

Back 47

Means "panting" in greek. Increase reactivity of the airway to a variety of stimuli causing widwpread reversible narrowing of the airways, or bronchospasm.

Hint 47

26.28

Front 48

What is the asthma triad

Back 48

The three primary components of asthma, and the corresponding treatments. 1) Airway edema, tx with corticosteroids, 2) Bronchospasm, tx with bronchodilator, 3) Increase mucous production, tx with water and expectorants.

Hint 48

26.28

Front 49

Status asthmaticus

Back 49

A severe, prolonged asthmatic attack that cannot be broken with conventional tx.

Hint 49

26.29

Front 50

COPD comprises at least two distinct clinical entities:

Back 50

emphysema and chronic bronchitis.

Hint 50

26.29

Front 51

Emphysema

Back 51

A chronic weakening and destruction of the walls of the terminal bronchioles and alveoli. Most common cause is cigarette smoking.

Hint 51

26.29

Front 52

Causes of wheezing

Back 52

Not all is asthma, other reasons include acute left heart failure, smoke inhalation, chronic bronchitis, and acute pulmonary embolism or obstruction.

Hint 52

26.30

Front 53

Chronic bronchitis

Back 53

As sputum production most days of the month for 3 or more months out of the year for more than 2 years. Excessive mucous production in the bronchial tree, which is nearly always accompanied by a chronic or recurrent productive cough. Often related to heavy cigarette smoking.

Hint 53

26.30

Front 54

hypoxic drive

Back 54

A situation in which a person's stimulus to breathe comes from a fall in PaO2 rather than the normal stimulus, a rise in PaCO2.

Hint 54

26.49

Front 55

The classic presentation of TB

Back 55

Turberculosis includes sudden weight loss, night sweats, fever, and cough with blood-tinged sputum. Put a NRB on pt to contain cough, and wear a N95 mask.

Hint 55

26.32

Front 56

_______ side heart failure is often a cause of pulmonary edema.

Back 56

Left

Hint 56

26.35

Front 57

When applying CPAP watch respiratory rate for...

Back 57

the success of CPAP. If the rate increase, the therapy is likely to fail, however if the rate decrease, then then the therapy is likely to succeed.

Hint 57

26.44