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
