Nurs614 Exam 2 Bronchospasm/laryngospasm

Front 1

What is bronchospasm?

Back 1

Reversible narrowing of the medium and small airways due to smooth muscle contraction

Front 2

What are the s/s of bronchospasm?

Back 2

Audible wheezing during exhalation
Decreased Pulmonary Compliance
Decreased Tidal Volume
End-tidal CO2 may be absent
Increased Peak Inspiratory Pressure (PIP)

Front 3

To treat mild bronchospasm, hand ventilate with?

Back 3

100% oxygen

Front 4

How do you manipulate level of anesthesia to treat mild bronchospasm?

Back 4

Increase anesthetic depth -
Volatile Agent (Sevoflurane/Halothane are great bronchodilators);
This includes IV anesthetics like ketamine/propofol.

Front 5

How much IV lidocaine is used to tx mild bronchospasm?

Back 5

1.5 mg/kg

Front 6

How are beta agonist used to tx mild bronchospasm?

Back 6

Administer Beta Agonist via MDI - Albuterol, Atrovent via ETT (4-8 puffs)

Front 7

What are things that can mimic s/s bronchospasm (a differential diagnosis may rule them out)?

Back 7

Kinked ETT
Right main stem intubation
ETT touching carina
Obstructed ETT

Front 8

When is Epi used to tx severe bronchospasm

Back 8

Epinephrine is usually a later choice or if the bronchospasm is caused by an allergic rxn and it is accompanied by anaphylaxis.

Front 9

When Epi used is to tx severe bronchospasm, what is the IV bolus dose?

Back 9

Epi 0.5-1 mcg/kg IV

Front 10

When Epi is used to tx severe bronchospasm, what is the SQ dose?

Back 10

0.1-0.5 ml of 1:1000 Epi

Front 11

When Epi is used to tx severe bronchospasm, what is the infusion dose?

Back 11

4-8 mcg/min (0.05-1.0 mcg/kg/min);
Concentration is usually 1mg/250ml;
Titrate to desired effect

Front 12

How is Terbutaline used to treat severe bronchospasm?

Back 12

It is given:
IV - 0.01 mg/kg or
SQ - 0.25 mg q20 min or
neb - 0.1 mg/kg

Front 13

How much Ephedrine is used to tx severe bronchospasm and how does its effectiveness compared to other drugs?

Back 13

Ephedrine 5 mg IV
It is readily available but not as effective as other drugs (used for this purpose)

Front 14

How is Aminophylline used to treat severe bronchospasm?

Back 14

5-6 mg/kg over 20-30 min or
0.4-0.9 mg/kg/hr continuous infusion

Front 15

What is the mechanism of action of Aminophylline in the treatment of severe bronchospasm?

Back 15

Increases level of cAMP which causes bronchodilation

Front 16

How is Isoproterenol used to tx severe bronchospasm?

Back 16

By infusion at 0.5-1.0 mcg/min.
(It is rarely used).

Front 17

How is diphenhyramine used to tx severe bronchospasm?

Back 17

1 mg/kg IV
(It reduce H1 effects).

Front 18

H2 actions can cause severe bronchospasms, name 2 H2 blockers & their doses, used in its treatment

Back 18

H2 antagonists
Ranitidine, 1 mg/kg IV
Cimetidine 4 mg/kg IV

Front 19

What is the Methylprednisolone dose used to tx severe bronchospasm?

Back 19

1-2 mg/kg IV

Front 20

How is Hydrocortisone used to tx severe bronchospasm?

Back 20

It is given:
5-10 mg/kg IV (up to 1gm) for initial dose, then 2.5 mg/kg q 6 hr for 24 hr.

Front 21

The goal of induction is to prevent airway irritation (thus bronchospasm). In this respect, what is the induction drug of choice?

Back 21

Propofol - it reduces the laryngeal and cough reflexes better than pentothal and etomidate.

Front 22

How does lidocaine help to prevent bronchospasms?

Back 22

It blunts airway reflexes
Dose is 0.5-1.5 mg/kg IV prior to intubation or
LTA with 4% lidocaine.

Front 23

Which inhalation agent best prevents bronchospasm during intubation?

Back 23

Sevoflurane - give after induction before intubation to deepen the anesthetic level.

Front 24

To reduce bronchospasm during emergence,how do you manipulate the level of anesthesia?

Back 24

Extubate under deep anesthesia (yes, deepen the anesthetic at the end of the case, the patient emerges on a mask)

Front 25

How can beta2 agonist & ipratropium be used to reduce bronchospasm during emergence?

Back 25

IF there are no contraindications to mask anesthesia, can give beta2 agonist & ipratropium before emergence.

Front 26

How can lidocaine be used to reduce bronchospasm during emergence?

Back 26

Give 1.5mg/kg up front. (Be careful with concomitant use of opioid and be cognizant of when lidocaine is given in relationship to wake-up time needed)

Front 27

What are the causes of laryngospams?

Back 27

Secretions;
Blood (blood touching vocal cords cause them to snap shut!)

Front 28

What are the clinical manifestations of laryngospams?

Back 28

Stridor
Hypoxemia
Tachypnea
Tachycardia
Retractions
No airflow despite ventilatory efforts
Inability to phonate

Front 29

Ways to prevent laryngospasm:

Back 29

Minimize airway manipulation during Stage 2 Recovery;
Extubate either deeply anesthetized or fully awake;
Clear all secretions from the airway;
Consider Topical/IV Local Anesthetics

Front 30

Positive pressure ventilation is used to treat bronchospasms. CPAP with bag/mask can be used. How much pressure is used and how does it work?

Back 30

25-30 cm Hg
CPAP may break laryngospasm by lowering the pressure gradient across the obstructed segment --> the pneumatically resetting of the pharyngeal and laryngeal muscles

Front 31

What is laryngospasm?

Back 31

A forceful involuntary spasm of the laryngeal musculature caused by sensory stimulation of the SLN

Front 32

How much succinycholine is used to treat laryngospasm?

Back 32

Adult requires usually only 20 mg IV or 4mg/kg IM,
Pediatric 0.1-0.3 mg/kg IV or 0.2-0.6 mg/kg IM

Front 33

What causes negative pressure pulmonary edema?

Back 33

It is caused by the large negative intrathoracic pressure generated by a pt struggling during laryngospasm
(breathing against closed vocal cords).
It is most common in young AA males.