Acute Dyspnea, Exacerbations And Conditions Flashcards
What are some symptoms of an acute asthma exacerbation?
SOB
Chest pain/tightness
Cough
Short sentences
What are some signs of an acute asthma exacerbation?
Tachycardia
Inc resp rate
Use of accessory muscles
Wheeze
Hyper-resonance
What type of wheeze is typically heard with an acute asthma exacerbation?
Polymorphic wheeze (wheeze is different depending on degree of narrowing in different places
When is a monophonic wheeze typically heard?
Cancer
Foreign bodies
Why do you get hyper-resonance with an acute asthma exacerbation?
Unable to fully empty lungs since patient is too breathless (expiratory phase shortens)
What investigations would you request for a patient with an acute asthma exacerbation and why?
FBC (elevated WCC for infection)
U+Es (check K+ levels)
Obs (Sats)
Peak flow
ABG
What imaging would you want for a patient with an acute asthma exacerbation and why?
Evidence of infection (can cause exacerbation)
?pneumothorax
Why is it important to assess for a low potassium (K+) when managing an acute asthma exacerbation?
Nebulised salbutamol internalises K+ into cells leading to reduce serum K+ (hypokalaemia)
How do you treat an asthma exacerbation?
Nebulised salbutamol (back to back until stable need to monitor heart and K+)
Controlled oxygen therapy
Magnesium infusion
Drip (ventolin and then aminophylline if required)
What type of IV medication is ventolin?
its IV salbutamol a B2 agonist
What needs to be monitored when giving ventolin?
K+
Heart rate
What is the function of aminophyline?
An anti-inflammatory + bronchodilator
What are the side effects of aminophyline?
Why do you have to be careful with dosing?
SE: seizures, arrhythmias
Has a narrow therapeutic window (if already takin theophylline’s patient doesn’t require loading)
What are the 3 severities of asthma?
Mild
Moderate
Severe
For mild asthma, what are the most likely results you will see for:
-O2 levels
-CO2 levels
-pH levels
Why is this the case?
O2 - normal
CO2 - reduced
pH - normal
Will by hyperventilating to keep oxygen normal which is what leads to the carbon dioxide levels being reduced, CO2 levels not reduced enough to cause a pH change
For moderate asthma, what are the most likely results you will see for:
-O2 levels
-CO2 levels
-pH levels
Why is this the case?
O2 - reduced
CO2 - very reduced
pH - Alkalotic
Patient hyperventilating to try and increase oxygen levels, patients CO2 is very low due to this leading to the blood becoming very alkalotic
For severe asthma, what are the most likely results you will see for:
-O2 levels
-CO2 levels
-pH levels
Why is this the case?
O2 - reduced
CO2 - increased
pH - acidotic
Patient has become exhausted from hyperventilating so their respiratory effort is failing. This has lead to their CO2 levels rising leading to an acidotic blood pH
What are the accessory muscles to respiration?
Sternocleidomastoid
Scalenes
Serratus anterior
Rectus abdominis
Intercostals
Pec major and minor
What are some symptoms of a patient having a COPD exacerbation?
SOB
Increased production/change in character of sputum
Reduced exercise tolerance
Short sentences
What are some signs of a patient having a COPD exacerbation?
Pursed lip breathing (PEEP)
Accessory muscle use
Cyanosis
Tachycardia
Why do COPD patients use pursed lip breathing?
To achieve PEEP (positive end expiratory pressure)
They doo this to keep the airways inflated for as long as possible
What are some investigations you would do for a patient having a COPD exacerbation?
FBC
Peak flow
ABG
Why would you do an ABG for a patient with COPD?
To asses wether they are a CO2 retainer
This can be seen by compensated respiratory acidosis (so an increased HCO3-)
What imaging would you do for a patient with a COPD exacerbation?
What are you looking for?
CXR
Signs of infection
?Pneumothorax
How do you manage a patient with a COPD exacerbation?
Controlled oxygen therapy
Nebulised salbutamol + ipratropium bromide
Nebulised atrovent
Non invasive ventilation
ITU if required
Pallliative care if required
What is atrovent, how does it work?
Anti Muscarinic medication (M3)
Prevents bronchoconstriction by binding to M3 blocking the receptors leading to bronchodilation
How does a patient typically present with a pneumothorax?
SOB
Chest pain
Hyper-resonant chest
Tracheal deviation away from the pneumothorax
Reduced chest expansion and breath sounds on affected side
Cyanosis
Distended neck veins
What investigations/imaging would you do for a patient with a ?pneumothorax?
ERECT CXR
ABG
How would you manage a low risk pneumothorax?
Pleural Vent Ambulatory device. (Catheter put in plural space in outpatient)
Conservatively (activity modification)
How would you manage a high risk pneumothorax?
Immediate needle decompression with a large bore cannula (venflon)
Then definitive management involves chest drain insertion
Where is a chest drain inserted for a patient with a high risk pneumothorax?
Triangle of safety above the rib
What are the borders of the triangle of safety?
5th intercostal space
Lateral edge of pec major
Lateral edge of Latissimus dorsi
What are the complications of chest drains?
Air leakage around drain
Subcutaneous emphysema
Where is the immediate needle decompression inserted with a tension pneumothorax?
2nd intercostal space in the mid clavicular line
What is the pathophysiology of a tension pneumothorax?
1 way valve allows air to fill into pleural space but cant leave
This builds up putting pressure on the mediastinal structures and vessels which can lead to cardio-respiratory arrest
The pressure can push the trachea to the other side
What is the management for a patietn with acute Haemoptysis?
Oxygen
Resus if necessary
Bronchoscopy to find cause + CT chest
Surgical fix if necessary
Dual ET tubing
What is the main rare emergency with Haemoptysis?
Aspergilloma
How does a dual ET tube work when managing a patient with acute Haemoptysis?
Blood can be sucked from 1 lung and the other tube can ventilate the other lung
What is the main cause of Haemothorax?
Vessel connecting 2 pleural surfaces ruptures when the pleural surfaces seperate
How is haemothorax managed?
Thoracic surgery if patient is young
If patient is old the blood can tamponade the rupture so leave
