ARF Flashcards

Question

Exasperation of COPD: Increased d______. Increased cough; increased sputum purulence and increased sputum v______. U_____ a____ symptoms (eg, colds and sore throats). Increased wheeze and chest tightness. Malaise. Reduced exercise tolerance. Increased f______. Marked respiratory distress with dyspnoea and tachypnoea, acute c_______, increased c_____, peripheral o______. Respiratory failure - may develop and may require non-invasive ventilation (NIV)

Answer 1

Exasperation of COPD: Increased dyspnoea. Increased cough; increased sputum purulence and increased sputum volume. Upper airway symptoms (eg, colds and sore throats). Increased wheeze and chest tightness. Malaise. Reduced exercise tolerance. Increased fatigue. Marked respiratory distress with dyspnoea and tachypnoea, acute confusion, increased cyanosis, peripheral oedema. Respiratory failure - may develop and may require non-invasive ventilation (NIV)

Answer 2

``` NICE Guideline treatment of COPD Antibiotics Oxygen therapy Physiotherapy Nebulised Bronchodilators IV theophyline NIV (Non-Invasive Ventilation) ```

Answer 3

COPD: Onset in later life Symptoms slowly progressive Long smoking history ``` ASTHMA Onset early in life Symptoms vary day to day Symptoms worse at night/morning Allergy, rhinitis, and/or eczema Family history of Asthma ```

Answer 4

Asthma definition: Chronic inflammatory disorder of the airway. Airflow obstruction and increased resistance Bronchoconstriction, airway oedema and mucus production Air trapping, prolong exhalation, V/Q mismatch, shunt

Answer 5

Signs and Symptoms: ``` Wheezy Chest tightness Unable to talk in full sentences Hypoxic – decreased SpO2 Cough Hyperventilating Dyspnoea – SoB Peak airway flow is < 75% ```

Answer 6

Moderate Asthma: Increasing symptoms PEF >50-75% best or predicted No features of acute severe asthma

Answer 7

Severe Asthma: One of - PEF 33-50% best or predicted RR greater than 25/min and HR greater than 110/min Inability to complete sentences in one breath

Answer 8

``` Life-threatening Asthma Severe asthma plus one of - PEF less than 33% SPO2 less than 92% PaO2 less than 8kPa Silent chest Cyanosis poor respiratory effort Arrhythmia Exhaustion/ altered conscious level ```

Answer 9

Near-fatal Asthma | Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Answer 10

‘Pneumonia is an infection of the lung tissue. When a person has pneumonia the air sacs in their lungs become filled with microorganisms, fluid and inflammatory cells

Answer 11

Signs and symptoms of Pneumonia: ``` Temperature Cough Sputum WCC normal range 4.0-11.0 Spo2 ```

Answer 12

Airway: Look for signs of airway obstruction, Treat as medical emergency if obstructed Give high flow oxygen (15l non-rebreather) Tgt O2 = 94-98% , 88 -92% at risk of hypercapnea (COPD) (Resus, 2019)

Answer 13

Breathing: Look listen feel for signs of respiratory distress. Count respiratory rate (12-20 is normal) Assess depth, rhythm and symmetry Look for chest deformity - raised Jugular venous pulse (JVP) Record inspired oxygen concentration and monitor SpO2 Listen to the patient’s breath sounds a short distance from face Percuss chest (hyper resonance or dullness) Auscultate the chest Check tracheal position Feel the chest wall to detect surgical emphysema or crepitus

Answer 14

Respiratory distress is: | sweating, central cyanosis, use of the accessory muscles of respiration, and abdominal breathing.

Answer 15

Breathing sounds Rattling airway noises indicate the presence of airway secretions, usually caused by the inability of the patient to cough sufficiently or to take a deep breath. Stridor or wheeze suggests partial, but significant, airway obstruction.

Answer 16

Breathing: Breathing Assessment: Look listen feel for signs of respiratory distress. Count respiratory rate (12-20 is normal) Assess depth, rhythm and symmetry Look for chest deformity - raised Jugular venous pulse (JVP) Record inspired oxygen concentration and monitor SpO2 Listen to the patient’s breath sounds a short distance from face Percuss chest (hyper resonance or dullness) Auscultate the chest Check tracheal position Feel the chest wall to detect surgical emphysema or crepitus Consider NIV (non-invasive ventilation)

Answer 17

The specific treatment of respiratory disorders depends upon the cause. Nevertheless, all critically ill patients should be given oxygen. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their blood oxygen tensions are allowed to decrease. In this group, aim for a lower than normal PaO2 and oxygen saturation. Give oxygen via a Venturi 28% mask (4 L min-1) or a 24% Venturi mask (4 L min-1) initially and reassess. Aim for target SpO2 range of 88–92% in most COPD patients, but evaluate the target for each patient based on the patient’s arterial blood gas measurements during previous exacerbations (if available). Some patients with chronic lung disease carry an oxygen alert card (that documents their target saturation) and their own appropriate Venturi mask.