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Respiratory Therapy - Lindsey Jones/Clinical Simulations

Terms in this set (1320)

Anaphylactic-from exposure to foreign substance or chemicals(bee sting, snake, insect, drugs, cleaning chemicals)
-release of histamine which dilates blood vessels(hypotension)
-deadliest shock
signs:
-rash, facial swelling, inflammation of internal tissues
Treatment:
-give fluids
-Epi

Cardiogenic-BP failure due to damage and dysfunction of the heart. Insufficient blood flow to key body organs.
-Often happens prior, during, or after MI(where significant injury and death of tissue occurred)
-ECG reveals elevated S-T segments & pronounced Q waves
-Administration of fluids is rarely helpful
Short-term Treatment:
-Dobutamine(Dobutrex)
-Dopamine
-Epi
-Levosimendan
-Milrione
-Norepinephrine
Long-term Treatment:
-depends on cause of shock
-possible CABG
-cardiac catheterization & angioplasty or stent placement
Other:
-continous heart monitoring
-O2 therapy
-Ongoing fluid administration
-Intra-aortic balloon pump
-pacemaker

Septic-loss in BP due to widespread infection of the body. Doesn't respond to any treatment. The most common cause is indwelling catheters like PICC line, IV lines. Such devices should be discontinued if septic shock suspected esp if inflammation or redness noted around the site.
Treatment:
-give O2
-fluid administration
-CPR
-Corticosteroids if refractory vasopressor-dependent shock
-Drotrecogin alpha if severely ill (APACHE II >25)
-management of blood sugar
-appropriate antibiotic therapy
-Surgery if source is internal
-removal, debridement, drainage of focal infection site

Hypovolemic-loss of BP due to lack of blood volume/fluid, occurs over short period, massive cuts, lacerations, loss of limbs.
-associated with physical trauma
-massive burns can cause massive blood/fluid loss
Treatment:
-administration of fluids
-IV fluid (Dextran)
-Blood transfusion
-Blood expanding agents (Plasmenogen)

Neurogenic shock-loss of BP due to brain damage
-caused by physical traumata head where CNS is affected, SCI, neurological pathology
-signs: bradycardia
Treatment:
-fluids
-Dopamine(Intropin)-increases cardiac contractility
-Vasopressin
-Atropine(esp if brady present)
-refractory hypoxemia, cyanosis
-poor lung compliance & gas exchange (rising plateau pressure)
-labored breathing
-hypercapnia with advancing profound hypoxemia
-pH <7.25
-PF ratio <300=ALI
-PF <200=ARDS
-CXR shows diffuse alveolar infiltrates
-elevated PCWP

caused by:
-sepsis
-near-drowning
-long-term pan
-aspiration of gastric contents or foreign substances(gasoline/kerosene)
-major trauma

inhalation of oropharyngeal, gastric, foreign substances into lungs
findings:
-scattered coarse and medium rales
-febrile conditions
-consolidation on CXR
-hypercapnia and hypoxemia

Aspiration of gastric contents can cause pneumonia called aspiration pneumonitis.
Tube feeding aspiration-most tube feeding is artificially colored. If ETT/NT sx reveals colored sputum that matches the color of tube feeding material then its likely because of aspiration of gastric contents. In this case, tube feeding must be stopped immediately and airway should be protected.
-Oral/pharyngeal secretion aspiration can cause bacterial pan
-foreign body aspiration can cause acute respiratory emergency

collapsing of alveoli so gas-exchange is interrupted, possibly causing respiratory failure
-signs: fine crackles, trachea deviated towards atelectasis if severe, low-grade fever, decreased lung volume or inspiratory capacity
Treatment:
-IS(aka SMI therapy)-to prevent post-operative complications
-Ambulation prompts deep breathing, pain control may be used
-IPPB if pt has not fully emerged from sedation
-NIPPV to reduce atelectasis
-on MV, use of PEEP may be used to decrease atelectasis