Acute Resp - MedEd

Question 1

Causes of Type 1 respiratory failure

Answer 1

PE
Pneumothorax 
Lung collapse/lobar collapse 
Acute asthma
Atelectasis
Pulmonary oedema
Pneumonia
ARDS

Question 2

Causes of type 2 resp failure

Answer 2

COPD
Acute SEVERE asthma
Upper airway obstruction
Drugs
Neuro conditions e.g. GBS, MND

Question 3

Pneumothorax classifications and causes

Answer 3

Primary
-in young thin tall people e.g. with EDS, Marfan’s

Secondary
-underlying lung pathology

Traumatic/Iatrogenic

Question 4

Tension pneumothorax - symptoms and signs

Answer 4

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)

Question 5

Management of tension pneumothorax

Answer 5

1. Grey/orange wide bore cannula - second intercostal space, MCL, just above third rib to avoid neurovascular bundle

Question 6

Management of primary pneumothorax

Answer 6

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)

Question 7

Management of secondary pneumothorax

Answer 7

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

Question 8

Five Ps of PLEURITIC chest pain

Answer 8

Pneumonia
Pneumothorax
Pleural effusion
Pericarditis
PE

Question 9

Classifications of PE

Answer 9

Acute massive
Acute submassive / small
Chronic

Question 10

Symptoms of acute massive PE

Answer 10

Collapse (hypotension)
Central crushing chest pain
Severe dyspnoea

Question 11

ECG signs of massive PE

Answer 11

s1q3t3

Big S wave in lead 1 (indicates rightwards shift of heart)
Pathological Q wave in lead 3
Inverted T wave in lead 3

Question 12

What does the S1Q3T3 mean? What can it lead to?

Answer 12

Right sided heart strain

Can lead to RBBB

Question 13

What might an CXR

Answer 13

Westermark’s sign

Question 14

Symptoms of acute submassive PE

Answer 14

Pleuritic chest pain
Haemoptysis
Dyspnoea

Question 15

ECG signs of small PE

Answer 15

Sinus tachycardia

Question 16

What is occluded in massive PE?

Answer 16

Pulmonary artery

Question 17

What is a small PE?

Answer 17

Incomplete occlusion of pulmonary artery or an artery distal to that

Question 18

What is a chronic PE?

Answer 18

Obstruction of pulmonary microvasculature that results from an undissolved clot previously

Question 19

Symptoms of chronic PE

Answer 19

Exertional dyspnoea

Question 20

Risk factors for PE

Answer 20

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

Question 21

What are paraproteins? Name an example of a deposition disorder

Answer 21

Monoclonal gammopathy i.e. ?antibodies (from b-cells)

Amyloidosis

Question 22

VTE prophylaxis

Answer 22

TED stockings

LMWH

Question 23

What does the Well’s score

Answer 23

Higher than 4 - CTPA

Lower than 4 - D-dimer

Question 24

What are the things you look

Answer 24

PE Score

Previous DVT/PE (1.5)
Evidence of DVT (3)

Stasis
Cancer
Opinion is PE
Rate raised 
Exsanguination (haemoptysis)