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Acute Respiratory failure, Status asthmaticus, Acute Respiratory Distress…
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Status asthmaticus
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Patient management
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If intubated, low PEEP to keep bronchioles open so that exhalation can occur (leads to less air trapping). high PEEP should be avoided
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Assessment
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PEFR (peak expiratory flow rate) usually <40% normal values based on gender, age and height
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Pharm
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Corticosteroids
Systemic used to treat status asthmaticus, anti inflammatory effects decrease edema, decrease mucous production and potentiate B2 agonist
Bronchodilators
Short acting anticholinergics (inhibit bronchoconstriction) when used with B2 have a synergistic effect
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Common causes
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Triggers (allergens, exercise, environmental)
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Dx
ABGs: normal to low PaCO2, initially, later increased with decreased O2
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Chest tubes
3 chambers
Suction: amount ordered by provider, wall suction set to at least 80, ordered suction set on collection chamber
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Drainage: monitor for amount, color consistency, and any odor
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Pneumonia
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treatment
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aspiration: stop NG feedings, may place NG tube to decompress stomach, may feed with duodenal tube
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what is it
acute inflammation of the lung parenchyma that is caused by an infections agent that can lead to alveolar consolidation
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Pulmonary Embolism
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S/S
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Cough with pink, frothy sputum
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Pleuritic chest pain (sudden, sharp)
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Treatment
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Oral anticoagulants
Factor Xa inhibitors = rivaroxaban (xarelto), apixaban (eliquis)
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Dx
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D-dimer: strong negative predictive value only (if normal, no clot) (elevated means theres a clot somewhere) (not specific) (screening tool)
EKG: not specific, sinus tachycardia, T wave inversion
CTPA (computed tomography pulmonary angiography): current standard of care for DX (CT with contract to see where it is)
ABG: low PaO2, low PaCO2, high pH
V/Q scan: must be combine with assessment and other fundings. Used if patient can't have contrast (bad if they can't stay still)
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what is it
A clot that occurs in the body and travels through the venous circulation to the pulmonary circulation
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Fractured Ribs
Sternal fractures
Unstable
surgical fixation, ETT, and mech vent
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Hemothorax
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S/S
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400 ml signs of shock, diminished or absent breath sounds on side on hemothorax
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Thoracic trauma
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Who gets them
Usually serous in elderly, obese, and patients with cardiac or pulmonary disease
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Flail chest
S/S
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Hypotension, tachycardia, and hemoptysis may also be present
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Sucking chest wound
What is it
special type of open pneumothorax where air is sucked into the thoracic cavity through the chest wall instead of into the lungs during inspiration
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