Acute Resp Flashcards
Differentiate type 1 and type 2 respiratory failure. Which is focal and which is global?
Type 1: hypoxia. Focal. V/Q (ventilation/ perfusion) mismatch
Type 2: Hypoxia and hypercapnia, global, alveolar hypoventilation.
Give 7 causes of Type 1 respiratory failure.
Give 5 causes of Type 2 respiratory failure.
Type 1:
- Acute asthma
- Atalectassis
- ARDS
- Pneumonia
- Pneumothorax
- Pulmonary oedema
- PE
Type 2:
- Acute severe asthma
- COPD
- Upper airway obstruction
- Neuropathies: GBS, MND
- Drugs (opiates)
Give 3 risk factors for pneumothorax
- Male
- Smoking
- Marfanoid habitus (not strictly those with Marfan’s)
Give 2 classifications of pneumothorax.
What type would be expected in a young person? What would be the cause?
- Traumatic vs spontaneous
- Primary vs secondary. Primary usually young healthy person. Due to pleural blebs or pleural adhesions forming.
Give 3 signs of lung compression in tension pneumothorax.
Give 2 signs of mediastinal shift in tension pneumothorax.
Lung compression:
- Severe dyspnoea
- Tracheal deviation away from lesion
- Silent chest, hyperresonance, reduced expansion on lesioned side.
Mediastinal shift
- Hypotension
- Tachycardia
Tension pneumothorax is a one way valve, the pneumothorax only gets larger.
What is the immediate management for a tension pneumothorax
- Wide bore cannula inserted into 2nd Intercostal space, mid-clavicular line. Orange or grey cannula.
Place just above 3rd rib to avoid neuromuscular bundle of 2nd rib.
Outline the treatment for primary and secondary pneumothorax
Primary:
- If no SOB or <2cm: discharge
- > 2cm/ SOB: Needle aspirate then observe with O2
- If unsuccessful chest drain.
Secondary:
- If no SOB or <1cm: observe with O2
- 1-cm: Needle aspirate and observe. If unsuccessful chest drain.
- > 2cm or SOB: Chest drain.
What is the mnemonic for patients at risk of PE?
What investigation is needed for a suspected PE?
CT S’il Vous Plait- here are the trickier examples.
- Cancer/ factor C deficiency
- Trauma
- Factor S deficiency
- Virchow’s triad, Factor V Leiden
- Pregnancy
Investigation is a CTPA.
Which scoring system is used to investigate a PE?
What are the score dependent investigations to be carried out after?
Well’s score:
- > /= 4, CTPA, high risk
- <4: D-dimer, low risk
Give 3 signs of an acute massive PE: sudden complete occlusion of pulmonary artery.
Give 3 ECG changes of an acute massive PE
- Collapse
- Central crushing chest pain
- Severe dyspnoea
- S1Q3T3 pattern: indicative of RV strain. Prominent S Wave in lead I. Q wave and inverted T wave in lead III
- RAD- right axis deviation
- RBBB
Give 3 signs of acute small PE: sudden incomplete occlusion of pulmonary artery.
Give 1 ECG change of an acute small PE
- Pleuritic chest pain
- Haemoptysis
- Dyspnoea
- Sinus tachycardia
Give 1 sign of chronic PE: chronic occlusion of pulmonary vasculature.
Give 1 CXR finding with a high predictive value for PE, even though it only occurs in 10% of cases.
- Exertional dyspnoea.
- Westermark sign. Shows translucent region distal to occluded pulmonary artery.
In the prevention of PE, give 1 mechanical and 1 pharmacological prevention step.
- Mechanical: thrombosis-embolic deterrent stockings.
- Pharmacological: Low molecular weight heparin- tinzaparin.
“TEDs and Tinz”
What is the key question for the management of PE? What are the conclusions of a positive or negative answer?
Is patient haemodynamically stable- SBP >90. Worried about low blood pressure
Yes: Sub-acute/ chronic PE
No: Massive PE
Give the 2 management steps and 2 medications for a sub-acute/ chronic PE (haemodynamically stable)
- Respiratory support
- Anticoagulation
Anticoagulants:
- Fondaparinux/ Heparin for 5 days
- Warfarin for 3 months
