CSE review for Respiratory
Croup - ANS-IG: Viral infection of the upper airway with a barking cough and often
stridor, low grade fever developed over 2-5 days, rhinorrhea, marked intercostal
retractions. X-ray shows pencil point of the upper airway.
DM: give racemic epi (if you have to give more than 1 be worried) and corticosteroids
Decadron (dexamethasone), along w/ cool aerosol mist. If no improvement with epi
suction and intubate. make sure to listen for a leak around the cuff before you extubate.
neonatal resuscitation - ANS-wipe baby off, put under radiant warmer, if grunting & HR
80 Initiate CPAP or neopuff if HR decreases to 60 or less initiate compressions and
100% FiO2
-NRP: 1 rescuer 30:2
2 rescuer 15:2
pulmonary edema - ANS-IG: sudden onset with orthopnea, pink frothy secretions,
enlarged heart, ST depress, bilateral fluffy infiltrates on x ray.
DM: give hyperinflation therapy, put in fowler's position. Thoracentesis for infiltrate and
fluid. Medication: Lasix, morphine, and digitalis.
Myocardial Ischemia/infarction - ANS-IG: chest pain and nausea, substernal squeezing
pain in left shoulder, shows elevated ST segment, ST depression T wave inversion on
EKG.
IG: Troponin 0.78 (elevated) (> 0.1), CK shows recent MI, pedal edema, character of
chest pain, peripheral pulses, CBC, electrolytes, ECG, if intubated evaluate CXR for
tube placement, elevation in cardiac enzymes
DM: give oxygen for hypoxemia 2L/M BP 80/40 give dopamine, digoxin, Levophed
(inotropic drug) to increase BP. Use Verapamil if BP is high . Sublingual nitroglycerin,
O2, aspirin, and morphine. (OMAN)
ultrasound to determine if mitral valve is blocked
PVC's ---> lidocaine or amiodarone
Guillian-Barre - ANS-IG: pt. comes in with acute weakness in legs, onset of difficulty
walking, reduced lower extremity strength, recent infection
,Test: Lumbar puncture if not diagnosed. positive if increase in protein within cerebral
spinal fluid
(Tx: plasmapheresis)
IG: ability to swallow, cough effort, sensory and motor function, level of consciousness,
and deep tendon reflexes.
--> closely monitor respiratory muscle strength
(VC,VT, MIP) VC < 1.0 intubate, MIP < -60- -70
DM: continue to monitor MIP and VC if not intubated, refer to physical therapy for
evaluation, pressure stockings
Cystic Fibrosis - ANS-IG: has elevated hemoglobin and hematocrit sweat chloride to
diagnose must be above 60(usually already diagnosed so wont need to do), tenacious
yellow-green sputum (infection), decreased BS, coarse crackles,
IG: Spirometry, sputum culture & sensitivity for infection, 6MWT, CXR (bronchiectasis
give antibiotics- ciprofloxacin)
DM: oral ciprofloxacin (antibiotic), increase frequency of airway clearance therapy.
hemoptysis present give epinephrine
ivacafort, cayston is medication for CF first being diagnosed
DM: Home care management: bronchodilator, pulmozyme, HFCWO, tobramycin,
pancreatic enzymes, For C.F. adult at college give DPI TOBI instead of Nebulizer.
neonate being delivered - ANS-pick intubation supplies if needed: size 2.5-3.5 ETT,
laryngoscope blades, bag to ventilate suction material, warmer, drying materials (if
suction material and tubes already gathered don't pick again) wipe off and warm under
radiant warmer first
-baby ends up having a pneumothorax on left, insert chest tube
otherwise suction, give surfactant, right after birth & 12 hours later if needed. If still
showing distress put on ventilator, PC/SIMV
Asthma - ANS-IG: Personal best PEF establish different zones, adherence to
medication regimen, nocturnal awakenings. Complete education on medications and
yellow zone. Add inhaled steroid (Flovent) for persistent yellow zone.
, DM: Asthma exacerbation: albuterol multiple treatments and IV methylprednisone if no
improvement with albuterol
DM: if exercise induced use albuterol 2 puffs prior to exercise. seasonal allergies
Singulair and budesonide/formoterol (Symbicort) complete allergen testing, vacuum,
wash sheets, change filters
COPD - ANS-IG: Diffuse crackles & wheezing, bronchospasm, progressive dyspnea,
SOB,
ABG: 50-50 club PaCO2 & PaO2- normal pH, hyperinflation
DM: first give: 24-28% (1-2L) O2
IG: FEV1 Pre and post 12-15% difference, Lung volumes, DLCO, O2 titration during
exercise, 6MWT, CXR, PFT (not acute) , for infection do sputum C&S, chemistry panel,
ECG if pedal edema present
DM: Acute infection/exacerbation/bronchospasm: give Albuterol or DuoNeb, then IV
methylprednisone or oral prednisone, oral ciprofloxacin (antibiotic) for infection, maintain
FiO2 at 0.28
1) LAMA (Spiriva, Spiriva Respimat, Incruse Ellipta)
2) LABA (Salmeterol, Formoterol, Arformoterol(Brovana))
3) LAMA/LABA (Spiolto Respimat, Anoro Ellipta)
-long term O2 therapy if needed
-yearly flu and pneumonia vaccinations
-pulmonary rehab referral
-have patient demonstrate proper use of meds
-smoking cessation if patient still smokes
Epiglottitis - ANS-Comes in drooling, emergency needs to go to the OR for intubation.
Order a lateral neck X ray (thumb sign), administer racemic epi.
initial neonate vent settings - ANS-PC/SIMV
Vt 4-5 mL/kg
RR 30-35
FIO2 40-60% (always use previous FiO2 or 0.10 above)
I-time .3-.6 (.4-.5-ideal)
PEEP 5
PIP 20-25
* always write down settings if Rate is decreased also decrease PIP
