Breathless pt

Question 1

What is dobutamine?

Answer 1

Used in cardiogenic shock + HF

Stimulates Beta receptors in heart

Question 2

Indications for NIV in the COPD patient

Answer 2

pH <7.35
pCO2 >6.5
RR >23
1 hour medical therapy first

Question 3

When is NIV not indicated?

Answer 3

Asthma/ pneumonia

Refer to ICU

Question 4

What are the options for O2 delivery + how much do they deliver?

Answer 4

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%

Question 5

What is cricothyroidotomy?

Answer 5

Using scalpel to insert airway through membrane between cricoid + thyroid cartilage

Question 6

What investigation is required before NIV?

Answer 6

CXR due to risk of pneumothorax

Question 7

Management of spontaneous pneumothorax - how to begin stratifying?

Answer 7

Are they:
>50 y/o + significant smoking Hx?
Evidence of underlying disease?

Yes = secondary 
No = primary

Question 8

How to managed primary pneumothorax?

Answer 8

> 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

Question 9

How to manage secondary pneumothorax?

Answer 9

> 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

Question 10

What are the types of respiratory failure?

Answer 10

1 = hypoxic 
2 = hypercapnic

Question 11

Causes of type 1 resp failure

Answer 11

COPD 
Pneumonia 
Pulmonary oedema 
Pulmonary fibrosis
Asthma 
Pneumothorax 
PE 
Pulmonary HTN 
ARDS
Cyanotic congenital heart disease

Question 12

Causes of type 2 resp failure

Answer 12

COPD
Severe asthma 
Drug OD 
Myasthenia gravis 
Head + neck injuries 
ARDS

Question 13

Diagnosis + management of resp failure

Answer 13

ABG, CXR, FBC
Spirometry
Oxygen +/- ventilation

Question 14

Complications of respiratory failure (by system)

Answer 14

Pulmonary = PE, fibrosis
CV = cor pulmonale, hypotension, reduced output, pericarditis, MI
GI = haemorrhage, ileus, distention, pneumoperitoneum
HAP

Question 15

Management of open pneumothorax

Answer 15

3 sided dressing
Chest tube
Surgery

Question 16

Management of hemothorax

Answer 16

Restore blood volyme
Chest tube
Thoracotomy if >1500ml blood loss

Question 17

Management of flail chest

Answer 17

O2 + fluid therapy + pain control

Positive pressure ventilation

Question 18

What is flail chest?

Answer 18

Free floating segment of chest wall due to >2 rib fractures

Question 19

O/E + investigation results for flail chest

Answer 19

Paradoxical movement of flail segment
Palpable crepitus of ribs
Decreased air entry on affected side
Respiratory acidosis

Question 20

What findings are seen on an aortic tear due to chest trauma?

Answer 20

Chest pain, SOB, hoarseness
Decreased femoral pulses, differential arm BP
Sudden high speed deceleration

Question 21

Urgent + other causes of respiratory SOB

Answer 21

Urgent: airway obstruction, epiglottitis, abscess, pneumothorax, pulmonary oedema, PE, pneumonia, COPD exacerbation
Other: pleural effusion, chronic disease

Question 22

Urgent + other causes of cardiac SOB

Answer 22

Urgent: CHF, MI, valvular disease, tamponade, arrhythmias
Other: chronic HF, angina

Question 23

Urgent + other causes of metabolic SOB

Answer 23

Urgent: metabolic acidosis, CO inhalation
Other: anemia

Question 24

Urgent + other causes of neuromuscular SOB

Answer 24

Urgent: myasthenia gravis, diaphragmatic paralysis
Other: CNS lesion