5 - General Respiratory and Respiratory Emergencies Flashcards
What is the MRC dyspnea score?
What is the WHO performance status?
How do you take a respiratory history? (importance of occupation history)
- PC: dyspnea, chest pain, wheeze, cough, sputum, haemoptysis
- HPC: see image
- PMHx: asthma, COPD, DVT, previous lung infections, surgery, CVS illness, cancer, childhood infections
- DHx and allergies: inc adherance
- FHx: resp and cardo disease, cancer, CF
- SHx: smoking, alcohol, occupational history (birds), travel, immobility, pets, asbestos exposure, ADLs, performance status
- Systems review
- ICE
- Summarise
What are the 6 respiratory features to ask about in a respiratory history?
- Dyspnea
- Chest pain
- Wheeze
- Cough
- Sputum
- Haemoptysis
ALSO CHECK ABOUT FEVER AND WEIGHT LOSS
How do you perform a respiratory examination?
- General inspection
- Hands
- Face
- Neck
- Chest inspection
- Chest expansion
- Chest percussion
- Chest auscultation
- Vocal resonance
- Complete exam
What are some tests you should offer to do at the end of a respiratory exam?
- Check oxygen saturations and temperature
- Sputum sample
- Peak flow assessment PEFR
- Chest X-ray
- ABG
- CVS exam
What are some bedside and special tests in chest medicine?
Bedside:
- Sputum sample
- PEFR
- Pulse oximetry
- ABG
- Spirometry
Special: lung function tests, CXR, CTPA, bronchoalveolar lavage, lung biopsy, rigid bronchoscopy
What is stridor and what does this mean?
Inspiratory sound due to partial obstruction of the upper aiways
Within lumen: foreign body, tumour
Within wall: oedema from anaphylaxis, tumour
Extrinsic: goitre, lymphadenopathy
What do each of the following coughs indicate?
- Loud brassy cough
- Bovine cough
- Barking cough
- Chronic cough
- Dry chronic cough
- Pressure on trachea e.g tumour
- Laryngeal nerve palsy
- Croup
- Pertussis, TB, asthma
- Acid irritation from GORD or ACEi
What are some causes of haemoptysis and how should you manage a patient in hospital with this?
- IVI
- CXR
- Blood gases
- FBC
- INR/APTT
- Cross match
- IV morphine
What are some causes of dyspnea?
- Lung disease e.g asthma
- Cardiac disease e.g heart failure
- Anatomical e.g diseases of chest wall, muscles, pleura
- Shock
What are some causes of the following breath sounds:
- Bronchial breathing
- Diminished breath sounds
- Crackles
- Pleural rub
What are some signs of respiratory distress?
- Tachypnea
- Nasal flaring
- Tracheal tug (pulling of thyroid cartilage to sternum on inspiration)
- Use of accessory muscles
- Intercostal and subcostal recession
- Pulsus paradoxus
What are the causes of Kussmaul respiration and Cheyne-Stokes breathing?
Kussmaul: deep sighing breaths in severe metabolic acidosis to blow off CO2. DKA, Alcoholic ketoacidosis, renal impairment
Cheyne-Stokes: breathing gets deeper and deeper and then shallower in cycles. Due to brainstem lesions or compression (e.g strok)
What should you send a sputum sample for and what do the following sputum colours indicate?
- Black specks
- Yellow/green
- Pink frothy
- Red
- Clear
Send for gram stain, culture, cytology
- Smoking
- Infection
- Pulmonary oedema
- Haemoptysis (TB, malignancy, PE)
- Saliva
How do you report on a chest x-ray?
- Name and Age of patient
- Date and Time taken
- Type of x-ray e.g erect or mobile, AP or PA
- Quality of film (RIP)
- ABCDE using zones and cardiothoracic ration
- Say what you see e.g blunting of costophrenic angle which could mean pleural effusions
What is vital capacity, forced vital capacity (FVC), and forced expiratory volume (FEV1)?
VC is not forced
How do FEV1 and FVC values change in obstrutive and restrictive lung disease?
What are the causes of hypoxia (low PaO2)?
- Hypoventilation
- Diffusion impairment
- Shunt
- V/Q mismatch
What happens to the pH, PaCO2 and HCO3- when there is metabolic acidosis/alkalosis and respiratory acidosis/alkalosis?
What are some causes of respiratory acidosis?
- Alveolar hypoventilation e.g COPD
- Hypoventilayion e.g neuromuscular disease
What is the A-a gradient and what can it be used for?
PAO2 - PaO2
where (arterial) PAO2 = PIO2 - PaCO2/0.8
Gradient should be <2kPa in the young and <4kPa in elderly.
If >4kPa this implies lung pathology
What is the AA gradient for this case and what is the conclusion from the gradient?
What is the AA gradient for this case and what is the conclusion?
What are the signs and symptoms of anaphylaxis?
- Pruitis
- Urticaria
- Angiooedema
- Hoarseness progressing to stridor and bronchial obstruction
- Wheeze and chest tightness from bronchospasm
When can someone be discharged after an anaphylactic reaction?
Need referral to allergy clinic and an interim adrenaline auto injector before discharge
What is the emergency management for anaphylaxis?
- Remove trigger
- Maintain airway and 100% O2
- Lie flat and fluid resuscitation
- IM 0.5mg adrenaline
- IV chlorphenamine 10mg
- Measure serum tryptase
- Treat bronchospasm with NEB salbutamol
- Treat laryngeal oedema with NEB adrenaline
How do you rate the severity of an asthma attack?