Misc Pulm Disorders (Test 2)

Carbon Monoxide (CO)

A colorless, odorless gas that occurs as a by-product of fuel combustion

What systems are most effected by CO

CNS
Heart

Carboxyhemoglobin

Carbon monoxide bound with hemoglobin

Why is CO prone to poisoning

x200 affinity to hemoglobin

What is the half-life of COHb

•Room Air = 4-6 hours
•100% O2 = 90 min
•Hyperbaric O2 = 20 min

What is the normal level of COHb?

•Normal < 2%
•Smokers can be up to 10%

At what level of COHb causes headaches?

10%

At what level of COHb causes death?

50%

What is the most common death associated with CO

Suicide by Car Exhaust

Where do most deaths occur with CO poisoning

Garages

What is the presentation of CO poisoning

•Most common: Headache
•May present with flu-like symptoms
•Pulse ox is normal
•Classic cherry red skin is rare
•Late Findings = AMS + Papilledema

What confirms CO poisoning

•Elevated venous carboxyhemoglobin (>3-4% in nonsmokers / > 10% in smokers)

How do we treat CO posoning?

• 100% O2
• Hyperbaric Chambers
• Treating other inhalants

Who needs more aggressive treatment with CO poisoning

Children
Pregnant
Elders

When do we use the hyperbaric chamber for CO

COHb > 40%
CNS Impairment
EKG Ischemic Changes

Foreign Body Aspiration

Inhalation of objects causing airway obstruction.

Where do distal foreign body aspiration tend to go

Right Bronchi

What is the most common aspirated object

Food

What conditions are at risk for lower foreign body aspiration

• Atelectasis
• Pneumonia
• Absecess

What is the presentation of upper airway foreign body

• Sudden Onset Aphonia and Respiratory Distress
• Stridor Drooling
• Cyanosis, LOC, and Cardiac Arrest if Untreated

What is the presentation of lower airway foreign body

• Respiratory Disress
Decreased lung sounds, focal wheeze, and pneumonia signs

What is the CXR finding for lower foreign body

Unilateral hyperinflation

How do manage upper foreign body

•Heimlich Maneuver
•Back Strikes (Infants)

How do manage lower foreign body

•Consults with pulm, otolaryngologist, or surg

Anaphylaxis

Life threatening allergic reaction caused by IgE triggering mast cells and basophils

What occurs during anaphylaxis

•Vasodilation (Hypotension)
•Vascular Permeability
•Bronchospasm and Edema
•Increased mucus

What are the most common agents for anaphylaxis

Food
Meds
Stings
IV Contrast
Latex

What is the history of anaphylaxis

•Within 30 minutes of exposure (The quicker, the worse)
•Cough, Hoarseness, and Thorat Tightness will Precede Obstruction
•Lightheaded / Syncope
•SOB
•Non-specific GI

What is the exam of anaphylaxis?

•Impending Doom
•Erythema, Edema, and Pruritus
•Hives
•Angioedema
•Stridor and Drooling
•Chest Pain and Palpitations
•Sensation of Airway Closing with Wheeze
•Tachypnea, Tachycardia, Hypotensive
•Distension and Vomiting

How do we manage anaphylaxis

•High Flow O2
•Cardiac Monitor
•IV Access
•IM Epinephrine
•0.9 NS Wide Open
•Nebulized epi = angioedema
•Vasopressor Drip= Refractory Hypotension
•May require intubation

What are some adjunctive therapy for anaphylaxis?

•Histamine 1 Blocker (Diphenhydramine) x 5 days
•Histamine 2 Blocker (Famotidine) x 5 days
•Steroids (Methylprednisolone) x 5 days
•Prescribe Epi-Pen for discharge