Acute Resp - MedEd Flashcards
Causes of Type 1 respiratory failure
PE Pneumothorax Lung collapse/lobar collapse Acute asthma Atelectasis Pulmonary oedema Pneumonia ARDS
Causes of type 2 resp failure
COPD Acute SEVERE asthma Upper airway obstruction Drugs Neuro conditions e.g. GBS, MND
Pneumothorax classifications and causes
Primary
-in young thin tall people e.g. with EDS, Marfan’s
Secondary
-underlying lung pathology
Traumatic/Iatrogenic
Tension pneumothorax - symptoms and signs
SYMPTOMS
Severe dyspnoea
Pleuritic chest pain
Tachycardia (as the air presses on collapsible IVC so impacts circulation)
SIGNS Tracheal deviation AWAY from tension pneumothorax Hyperresonance (lots of air) Silent chest because no airflow Reduced expansion Hypotension (due to pressing on IVC)
Management of tension pneumothorax
- Grey/orange wide bore cannula - second intercostal space, MCL, just above third rib to avoid neurovascular bundle
Management of primary pneumothorax
PRIMARY
If less than 2cm OR symptomatic
- needle aspiration (sterile cannulation essentially at 2nd ICS, MCL)
(if unsuccessful, chest drain, if successful give oxygen and observe, if none of the above then pt can go home for OPD review)
Management of secondary pneumothorax
SECONDARY
If secondary and less than 2cm OR symptomatic
- chest drain in axila (lateral edge of pec major, anterior edge of lat dorsi, below base of axilla and above 5th ICS)
If between 1-2cm but not symptomatic
- needle aspiration
If under 1cm and not symptomatic,
- observe and give oxygen
Five Ps of PLEURITIC chest pain
Pneumonia Pneumothorax Pleural effusion Pericarditis PE
Classifications of PE
Acute massive
Acute submassive / small
Chronic
Symptoms of acute massive PE
Collapse (hypotension)
Central crushing chest pain
Severe dyspnoea
ECG signs of massive PE
s1q3t3
Big S wave in lead 1 (indicates rightwards shift of heart)
Pathological Q wave in lead 3
Inverted T wave in lead 3
What does the S1Q3T3 mean? What can it lead to?
Right sided heart strain
Can lead to RBBB
What might an CXR
Westermark’s sign
Symptoms of acute submassive PE
Pleuritic chest pain
Haemoptysis
Dyspnoea
ECG signs of small PE
Sinus tachycardia
What is occluded in massive PE?
Pulmonary artery
What is a small PE?
Incomplete occlusion of pulmonary artery or an artery distal to that
What is a chronic PE?
Obstruction of pulmonary microvasculature that results from an undissolved clot previously
Symptoms of chronic PE
Exertional dyspnoea
Risk factors for PE
CT s’il vous plait
C: Cancer/chemo Cardiac failure COPD Factor C
T:
Trauma
Thrombocytosis
S:
Stasis
Surgery
Factor S deficiency
V
Varicose veins
Virchow’s triad
Factor V Leiden (hypercoagulable state)
P OCP Pregnancy Previous VTE Polycythaemia Paraprotein deposition Puerperium
What are paraproteins? Name an example of a deposition disorder
Monoclonal gammopathy i.e. ?antibodies (from b-cells)
Amyloidosis
VTE prophylaxis
TED stockings
LMWH
What does the Well’s score
Higher than 4 - CTPA
Lower than 4 - D-dimer
What are the things you look
PE Score
Previous DVT/PE (1.5)
Evidence of DVT (3)
Stasis Cancer Opinion is PE Rate raised Exsanguination (haemoptysis)
