Medical Emergencies

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Medical Emergencies

• Respiratory Disorders

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Topics

• Noninfectious Disorders
• Infectious Disorders

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Noninfectious Disorders

• ARDS
• Obstructive Airway Diseases
• Cystic Fibrosis
• Pulmonary Embolism
• Pickwickian syndrome
• Myasthenia Gravis
• Guillain-Barre Syndrome

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Infectious Disorders

• Pleurisy
• Pneumonia
• Legionnaires Disease
• Tuberculosis

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Adult Respiratory Distress Syndrome

• AKA Noncardiogenic pulmonary edema
• Increased membrane permeability
• Complication rather than cause
• Trauma
• Infection (Sepsis)
• Drug OD
• Aspiration

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ARDS Pathophysiology

• Increased permeability
• Pulmonary edema
• Surfactant destruction
• Atelectasis
• Decreased compliance
• Hypoxemia

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ARDS Management

• High concentrations of oxygen
• PEEP
• CPAP
• ECG Monitoring
• Treat underlying cause

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Obstructive Airway Disease

• Asthma
• Chronic bronchitis
• Emphysema

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Asthma

• Reactive Airway Disease
• Often triggered by
• Cold temperature
• Respiratory Infections
• Vigorous exercise
• Emotional Stress

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Asthma Pathophysiology

• Bronchial smooth muscle contraction
• Increased mucus production
• Bronchial plugging
• Relative dehydration
• Alveolar hypoventilation
• Ventilation Perfusion Mismatch
• CO2 retention
• Air Trapping

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Asthma Management

• Vigilant Assessment
• High concentrations of oxygen
• B2 Agonists (Albuterol, Terbutaline)
• Anticholinergics (Ipratropium)
• IV Fluid (rehydration)
• ECG Monitoring

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Chronic Bronchitis Pathophysiology

• Prolonged exposure to irritants
• Excessive mucus secretion
• Airway obstruction and restriction
• Increased resistance
• Hypercapnia - pulmonary vasoconstriction - V/Q
  mismatch
• Pulmonary hypertension
• Right ventricular hypertrophy
• Cor Pulmonale

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Emphysema Pathophysiology

• Destruction of alveoli
• Decreased elasticity recoil
• Air Trapping
• Hyperinflation
• Increased expiration difficulty
• Saturation usually normal
• Increased WOB
• Thin appearance

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COPD Assessment

• Chronic condition acute episode (exacerbation)
• Typically dyspnea, SS of hypoxemia
• Use of accessory muscles
• Increased expiratory effort
• Tachycardia, AMS, Cyanosis
• Wheezing, Rhonchi

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COPD Management

• Oxygen dictated by level of distress
• TRUE HYPOXIC DRIVE RARE
• Bronchodilators (albuterol, terbutaline)
• IV Fluids (titrate to level of dehydration)
• Anticholinergics as dictated by protocol
• ECG Monitor

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Cystic Fibrosis (CF)

• Inherited disorder
• Increased mucus production
• Mucus plugs
• Presentation similar to Chronic Bronchitis
• Management also similar

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Pulmonary Embolism (PE)

• Occlusion of a pulmonary artery by a clot
• Contributing factors
• Venostasis
• Surgery or trauma
• Oral contraceptives
• Pregnancy
• DVT
• A-Fib

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Pulmonary Embolism

• Severity related to size
• Rapid onset
• Dyspnea, cough, hemoptysis, JVD
• Pleuritic chest pain
• Localized wheezing
• Consider when no other cardio-respiratory
  diagnosis make fit.

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PE Management

• High concentration oxygen
• IV
• Aspirin
• Thrombolytics

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Pickwickian Syndrome

• Extreme obesity
• Form of sleep apnea
• Treat symptomatically

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Myasthenia Gravis

• Gradual onset of muscle weakness
• Face and throat
• Respiratory weakness - paralysis
• Inability to process mucus
• Treat symptomatically
• Watch for aspiration

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Gullain-Barre Syndrome

• Autoimmune disease leading to gradual
  de-myelination
• Progressive tingling and weakness
• Moves from extremities in
• May lead to respiratory paralysis
• Treat symptomatically

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Pleurisy

• Inflammation of the pleura
• Commonly associated with other respiratory
  disease
• Effusion or dry
• Caused by friction rub
• Sharp, sudden and intermittent chest pain with
  related dyspnea
• Possibly referred to shoulder
• May ? or ? with respiration

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Pneumonia

• Inflammation of the bronchioles and alveoli
• Bacterial, viral or fungal
• Aspiration
• Commonly associated with other diseases
• May lead to VQ Mismatch and hypoxemia
• May have crackles

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Legionnaires Disease

• Acute bacterial infection with symptoms similar
  to pneumonia
• Fever, anorexia, weakness, malaise, chills, N/V
• Treat symptomatically

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Tuberculosis

• Infectious airborne bacterial disease
• Often causes fibrosis of lung
• Tubercles Walling Off Effort
• Early, latent and reactivation periods
• Leads to VQ mismatch and hypoxemia
• Treat symptomatically
• Reduce exposure