Acute breathlessness

Question 1

Features of moderate asthma

Answer 1

Increasing symptoms
PEF >50-75% best
No features of acute severe

Question 2

Features of acute severe asthma

Answer 2

PEF 33-50%
RR >25
HR >110
Inability to complete sentences in 1 breath

Question 3

Life threatening asthma

Answer 3

PEF <33%
SpO2 <92%
PaO2 <8kPa 
Normal PaCO2 
Silent chest
Cyanosis
Poor respiratory effort
Arrhytmia 
Exhaustion 
Altered consciousness level 
Hypotension

Question 4

Near fatal asthma

Answer 4

Raised PaCO2 +/or requiring mechanical ventilation with raised inflation pressures

Question 5

Med doses for asthma

Answer 5

Salbutamol 5mg
Ipatroprium 500mcg (0.5mg)
Prednisolone PO 40-50mg or hydrocortisone IV 100mg

Question 6

When to discharge asthmatic patients

Answer 6

If PEF >75% within 1hr of initial tx
Stable on discharge meds for 24hrs
*need inhaler technique checking prior to d/c
Peak flow >75% with <25% diurnal variation

Question 7

Follow up for asthmatics

Answer 7

GP appointment in 2d

Resp clinic in 4wks - follow up for 1yr

Question 8

What is pulmonary oedema

Answer 8

Accumulation of fluid in parenchyma and air spaces of the lungs. Commonly due to HF or fluid overload

Question 9

Signs/sx of pulmonary oedema

Answer 9

SOB
Pink frothy sputum 
Tachypnoea, low sats, raised JVP 
Coarse crackles 
Wheeze - 'cardiac asthma'

Question 10

WET-WARM HF patients

Answer 10

Pulmonary oedema with no hypoperfusion of organs

Question 11

WET-COLD HF patients

Answer 11

Pulmonary oedema with hypo perfusion

Question 12

Why does acute heart failure occur?

Answer 12

LV unable to empty properly
Congestion in pulmonary or systemic circulation
Increased hydrostatic pressure in pulmonary vasculature

Question 13

Signs of acute heart failure

Answer 13

Basal crackles
Oedema
Dull percussion at lung bases
Raised JVP 
Hepatomegaly 
Gallop rhythm 
Murmur

Question 14

What is the leading cause of AHF in absence of CCF?

Answer 14

MI

Question 15

BNP findings in AHF

Answer 15

Sensitive but not specific

AHF unlikely if BNP <100 or NT-proBNP <300

Question 16

CXR findings in AHF

Answer 16

A - alveolar oedema (perihilar or bat wing opacification)
B - Kerley B lines (interstitial oedema)
C - cardiomegaly
D - dilated upper lobe vessels
E - effusions (blunted costophrenic angles with meniscus)

Question 17

CHAMP conditions

Answer 17

Conditions which may precipitate AHF
ACS
Hypertensive crisis
Arrhythmias
Mechanical problems e.g. valve dysfunction
Pulmonary embolism

Question 18

Treating AHF

Answer 18

ABCDE
Oxygen - may need CPAP, BiPAP, NIV 
Loop diuretics - IV furosemide 
Nitrates - do not use if SBP <90 or AS 
If cold - ?vasopressors + inotropes

Question 19

Signs of a massive PE

Answer 19

R heart strain - hypotension, raised JVP, HF

Question 20

Signs of a PE

Answer 20

SOB
Pleuritic chest pain
Haemoptysis
Cough 
Collapse
Tachycardia 
Hypertension 
Cyanosis
Raised JVP 
Pyrexia 
*look for signs of a DVT