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Medical Emergencies. Respiratory Disorders. Topics. Noninfectious Disorders Infectious Disorders. Noninfectious Disorders. ARDS Obstructive Airway Diseases Cystic Fibrosis Pulmonary Embolism Pickwickian syndrome Myasthenia Gravis Guillain-Barre Syndrome. Infectious Disorders.

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Medical emergencies l.jpg

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, S&S 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


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