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Medical Emergencies

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

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  1. Medical Emergencies Respiratory Disorders

  2. Topics • Noninfectious Disorders • Infectious Disorders

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

  4. Infectious Disorders • Pleurisy • Pneumonia • Legionnaires’ Disease • Tuberculosis

  5. Adult Respiratory Distress Syndrome • AKA Noncardiogenic pulmonary edema • Increased membrane permeability • Complication rather than cause • Trauma • Infection (Sepsis) • Drug OD • Aspiration

  6. ARDS Pathophysiology • Increased permeability • Pulmonary edema • Surfactant destruction • Atelectasis • Decreased compliance • Hypoxemia

  7. ARDS Management • High concentrations of oxygen • PEEP • CPAP • ECG Monitoring • Treat underlying cause

  8. Obstructive Airway Disease • Asthma • Chronic bronchitis • Emphysema

  9. Asthma • Reactive Airway Disease • Often triggered by: • Cold temperature • Respiratory Infections • Vigorous exercise • Emotional Stress

  10. Asthma Pathophysiology • Bronchial smooth muscle contraction • Increased mucus production • Bronchial ‘plugging’ • Relative dehydration • Alveolar hypoventilation • Ventilation Perfusion Mismatch • CO2 retention • Air ‘Trapping’

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

  12. 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

  13. Emphysema Pathophysiology • Destruction of alveoli • Decreased elasticity “recoil” • Air Trapping • Hyperinflation • Increased expiration difficulty • Saturation usually normal • Increased WOB • Thin appearance

  14. 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

  15. 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

  16. Cystic Fibrosis (CF) • Inherited disorder • Increased mucus production • Mucus plugs • Presentation similar to Chronic Bronchitis • Management also similar

  17. Pulmonary Embolism (PE) • Occlusion of a pulmonary artery by a clot • Contributing factors • Venostasis • Surgery or trauma • Oral contraceptives • Pregnancy • DVT • A-Fib

  18. 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.

  19. PE Management • High concentration oxygen • IV • Aspirin • Thrombolytics

  20. Pickwickian Syndrome • Extreme obesity • Form of sleep apnea • Treat symptomatically

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

  22. 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

  23. 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

  24. 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

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

  26. 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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