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Flashcards in Pulmonary Emergencies Deck (98)
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1

Causes of Upper Airway Obstruction

Foreign body
Tongue
Swelling/edema

2

Upper Airway Obstruction Etiology

Foreign body
Retropharyngeal abscess
Angioedema
Head and neck trauma
Swelling/edema from inhalation injuries
Epiglottitis
Croup
Tonsillitis
Peritonsillar abscess
Ludwig's angina

3

Types of Foreign Body Obstruction

Incomplete
Complete

4

Where does the retropharyngeal space extend from and go to?

Base of the skull to the tracheal bifurcation

5

Etiology of Retropharyngeal Abscess in Children

Lymph node that drains the head and neck

6

Etiology of Retropharyngeal Abscess in Adults

Penetrating trauma
Infection in the mouth/teeth
Lymph nodes that drain the head and neck

7

Signs and Symptoms of a Retropharyngeal Abscess

Fever
Dysphagia
Neck pain
Limitation of cervical motion
Cervical lymphadenopathy
Sore throat
Poor oral intake
Muffled voice
Respiratory distress
Stridor (children)
Inflammatory torticollis

8

Work Up of Retropharyngeal Abscess

Lateral soft tissue X-ray of the neck during inspiration
CT scan of the neck: "gold standard"

9

Treatment of Retropharyngeal Abscesses

Immediate ENT consult
Surgical I&D
IV hydration
IV antibiotics

10

Antibiotics for a Retropharyngeal Abscess

Clindamycin
Ampicillin-sulbactam (Unasyn)

11

Complications of a Retropharyngeal Abscess

Extension of infection into mediastinum
Pleural or pericardial effusion
Upper airway asphyxia
Sudden Rupture: aspiration pneumonia or widespread infection

12

Define Angioedema

Subdermal or submucosal swelling

13

Describe the Swelling in Angioedema

Diffuse
Non-pitting

14

Assessment of Angioedema

Rapid assessment of airway
Close monitoring

15

What areas of the body does angioedema generally affect?

Face
Lips
Mouth
Throat
Larynx
Extremities
Genitalia
Bowel

16

Etiology of Angioedema

Mast cell mediated
Bradykinin mediated

17

What medications does mast cell mediated angioedema respond to?

Epinephrine
Glucocorticoids
Antihistamines

18

What conditions or medications does bradykinin mediated angioedema occur secondary to?

ACE-inhibitors
Hereditary angioedema

19

Treatment of Allergic Angioedema

Intubation if signs of respiratory distress
Epinephrine (0.3 mg IM)
Glucocorticoids
Diphenhydramine (25-50 mg IV)

20

Treatment of ACE Inhibitor Induced Angioedema

Intubation if signs of respiratory distress
Discontinue offending drug
If severe or no improvement in 24 hours: antihistamines, glucocorticoids, C1 inhibitor therapy

21

Treatment of Hereditary Angioedema

Intubation if signs of respiratory distress
C1 inhibitor if available
Bradykinin receptor antagonist

22

Define Anaphylaxis

Acute, potentially lethal, multi system syndrome from the sudden release of mast cells and basophils into the circulation

23

Presentation of Anaphylaxis

Sudden onset urticaria
Angioedema
Flushing
Pruritus
Hypotension

24

Treatment of Anaphylaxis

Epinephrine

25

Airway Management in Anaphylaxis

Immediate assessment for wheezing, stridor, and difficulty breathing
Intubation if marked stridor or respiratory arrest

26

Treatment of Anaphylaxis

Assess airway
IM epinephrine
O2 via nonrebreather (patent airway)
2 large bore IVs
NS rapid bolus via IV (1-2L)
Consider: albuterol nebulizer, H1 blocker, H2 blocker, methylprednisolone

27

Usually Medications Given in Anaphylaxis

Epinephrine
H1 blocker: diphenhydramine
H2 blocker: ranitidine
Glucocorticoid: solu-medrol
Albuterol nebulizer
Possible vasopressors

28

Possible Assessment Findings in Head and Neck Trauma

Gurgling
Snoring
Stridor
Wheezing

29

Define Gurgling

Pooling of liquids in the oral cavity or hypopharynx

30

Define Snoring

Partial airway obstruction at the pharyngeal level from the tongue