Breathless pt Flashcards
What is dobutamine?
Used in cardiogenic shock + HF
Stimulates Beta receptors in heart
Indications for NIV in the COPD patient
pH <7.35
pCO2 >6.5
RR >23
1 hour medical therapy first
When is NIV not indicated?
Asthma/ pneumonia
Refer to ICU
What are the options for O2 delivery + how much do they deliver?
Nasal cannula 24-30% Venturi: Blue = 24% White = 28% Yellow = 35% Red = 40% Green = 60% Non-rebreathe = 85-90% NIV (CPAP + BIPAP) Invasive ventilation = 100%
What is cricothyroidotomy?
Using scalpel to insert airway through membrane between cricoid + thyroid cartilage
What investigation is required before NIV?
CXR due to risk of pneumothorax
Management of spontaneous pneumothorax - how to begin stratifying?
Are they:
>50 y/o + significant smoking Hx?
Evidence of underlying disease?
Yes = secondary No = primary
How to managed primary pneumothorax?
> 2cm or breathless = aspirate with 16-18G cannula
If successful, discharge with review in OPD in 2-4 weeks
If unsuccessful, chest drain 8-14F + admit
<2cm = discharge with OPD review
How to manage secondary pneumothorax?
> 2cm or breathless = chest drain 8-14F + admit
1-2cm = aspirate with 16-18G cannula
If successful, admit + give high flow O2 + observe for 24hrs
If unsuccessful, chest drain
<1cm = admit + give high flow O2 + observe for 24hrs
What are the types of respiratory failure?
1 = hypoxic 2 = hypercapnic
Causes of type 1 resp failure
COPD Pneumonia Pulmonary oedema Pulmonary fibrosis Asthma Pneumothorax PE Pulmonary HTN ARDS Cyanotic congenital heart disease
Causes of type 2 resp failure
COPD Severe asthma Drug OD Myasthenia gravis Head + neck injuries ARDS
Diagnosis + management of resp failure
ABG, CXR, FBC
Spirometry
Oxygen +/- ventilation
Complications of respiratory failure (by system)
Pulmonary = PE, fibrosis
CV = cor pulmonale, hypotension, reduced output, pericarditis, MI
GI = haemorrhage, ileus, distention, pneumoperitoneum
HAP
Management of open pneumothorax
3 sided dressing
Chest tube
Surgery
