Air Travel/Misc

Question 1

What are the important oxygen (RA) and TLCO cut offs in restrictive lung disease ?

Answer 1

PaO2 <9.42 in room air. TLCO < 50%. If both present then in flight oxygen 2L/min. If one present then consider Hypoxia Challenge Test

Question 2

What is the cut off MRC dyspnoea score, 6MWT threshold and resting O2 saturation in obstructive disease?

Answer 2

Resting SpO2 < 95% in air
MRC 3 or above warrants further testing
6MWT or SWT cut off of <84% to consider HCT or in-flight oxygen

Question 3

What result on HCT suggests in-flight oxygen would be needed?

Answer 3

PaO2 <6.6kPa or SpO2 <85%.
Oxygen should be titrated to maintain levels above this
If CO2 rise >1kPa at this level or pH 7.35 then air travel may be contraindicated

Question 4

Which contraindications does the BTS list for air travel?

Answer 4

Active pneumothorax with ongoing air leak
Within 7 days of resolution of spontaneous pneumothorax
Massive haemoptysis
Active infectious TB
Usual oxygen requirements at sea level >4L/min

Question 5

What is the correct agent and dose for the reversal of midazolam induced complications at bronchoscopy?

Answer 5

Flumazenil
Recommended initial dose 200 mcg IV over 15 minutes
If hypoxic should increase the O2 supplied and the procedure should be stopped until control gained

Question 6

In a patient with sarcodoisis, what is the best test to determine if TB infection is present?

Answer 6

IGRA. Patients with sarcoidosis have tuberculin anergy, meaning that the skin prick test is unlikey to be positive. IGRA is not affected by sarcoidosis.

Question 7

What is the correct initial treatment for anaphylaxis?

Answer 7

IM adrenaline. The correct dose is 0.5ml of 1:1000 dilution

Question 8

What is the risk of major bleeding in flexible bronchoscopy (no transbronchial biopsy)?
What is the risk of minor bleeding?

Answer 8

0.26% chance of major bleeding as per BTS, the risk doubles if transbronchial biopsy is performed

Question 9

What is Westermark sign? What is the associated condition?

Answer 9

CXR feature of focal oligaemia (often peripheral hyperlucency). It happens when there is oligaemia distal to a pulmonary embolus. Vascular collapse occurs distal to the thrombus. Associated with PE

Question 10

What does the BTS recommend as the maximum safe dose of lidocaine for bronchoscopy?

Answer 10

15.4mg/kg. Although toxicity can develop from doses as low as 9.6mg/kg

Question 11

What is the time cut-off post VTE where warfarin can be stopped for bronchoscopy without bridging?

Answer 11

3 months

If >3months since PE then considered lower risk thus warfarin can be stopped without bridging