Acute Resp Flashcards
Features of T1RF?
Hypoxia from ventilation perfusion mismatch.
Focal
Features of T2RF?
Hypoxia and Hypercapnia
Global
T1RF causes?
Acute asthma, atalectasis, pulmonary oedema, pneumonia, pneumothorax, PE, ARDS
T1RF managment?
CPAP as increased airway recruitment (ventilation)
T2RF causes?
COPD!!
Acute severe asthma, upper airway obstructions, neuropathies e.g. GBS, MND, Drugs e.g. opiates
T2RF management?
BIPAP
What is normal intrapleural pressure?
-5 to -8cmH2O
types of pneumothorax?
Primary: young healthy and unlikely to have disease
Secondary: older, lung disease, smoking, CF patients
Management of primary pneumothorax?
> 2cm or SOB = Needle aspiration
If not discharge and observe
If not successful = chest drain
Succesful = Observation + O2
RFs for primary pneumothorax?
Men more than women, smoking, marfans or marinoid habitus
What are the features of Tension pneumothorax?
Lung compression = severe dyspnoea, tracheal deviation (away), silent chest, hyperresonance and reduced expansion on lesioned side
Mediastinal shift = hypotension and tachycardia
Where for needle aspiration?
2 ICS MCL
orange or grey
Secondary pneumothorax management?
> 2cm or SOB = chest drain
1-2cm = needle aspiration. If not successful then Chest drain
When to suspect acute massive PE?
Collapse, central crushing pain, severe dyspnoea
When to suspect acute submassive and small PE?
Pleuritic chest pain, haemoptysis and dyspnoea
When to suspect chronic PE?
Exertional dyspnoea
What would PE show on ECG?
S1Q3T3 pattern
RAD
RBBB
Sinus tachycardia
What can PE show on CXR?
Westermarks sign
RFs for PE mneumonic?
CT S’il vous plait
C for PE?
Cancer, chemo, cardiac failure, COPD, factor C deficiency
T for PE?
Trauma, time (age), thrombocytosis
S for PE?
Stasis, surgery, factor S deficiency
V for PE?
Varicose veins, Virchows triad, Factor V leiden
P for PE?
Pill (OCP), pregnancy, puerperium, previous VTE, polcythaemia, paraprotein deposition
VTE prevention technique?
Mechanical = anti-embolic stockings Pharamcological = LMWH
How to investigate PE?
Wells (4 is cut off for CTPA vs D-dimer)
PE SCORE
Previous DVT or PE
Evidence of DVT
Stasis Cancer Opinion is PE Rate Raised >100 Exsanguination (haemoptysis
Stable Management for PE?
Haemodynamically stabble (SBP <90mmHg)
Yes = Resp support and anticoaguation ( Fondaparinux/heparin for 5 days and warfarin for 3 months. Start DOAC)
Unstable Management for PE?
Resp support
1st line: thombolysis (alteplase or streptokinase)
2nd line: embolectomy
Description of ARDS?
Non-cardiogenic pulmonary oedema
ARDS causes?
Drugs, ventilation, nearly drowning, severe bruns, sepsis, pneumonia and transfusion reactions.
COVID-19`
Common in critically ill (ITU)
Pathology of ARDS?
Severe inflammation so alveolar oedema so alveolar collapse
Berlin criteria for ARDS?
ARDS Alternative cause (cardiogenics pulmonary oedema) Rapid onset <1 week Dyspnoea Similar on CXR
Investigation for ARDS?
ABG, CXR/CT, ECHO, COVID SWAB
