Breathlessness Flashcards
What is Bronchiectasis defined as?
A permanent dilatation of bronchi due to destruction of muscular components of the bronchial wall
What is the most common risk factor associated with Bronchiectasis? What are other risk factors?
Cystic fibrosis
Immunodeficiency, recurrent infections, A1AT, primary cilliary dyskinesia, IBD
What are the two most common symptoms in Bronchiectasis?
Cough (98% of patients)
Sputum (66% of patients)
On auscultation of lungs in a patient with Bronchiectasis, what may be heard?
- Crackles
- High pitched inspiratory wheeze
- Ronchi (low pitched rattling, sounds like snoring)
On CXR of a patient with Bronchiectasis, what may be found?
Characteristic volume loss, tram lines, tubular / ovoid opacities
What might be visualised on High Resolution CT in a patient with Bronchiectasis?
Dilatation of bronchi
What is the most common and second most common organism cultured from sputum of a patient with Bronchiectasis?
Haemophilus influenza (most common) Pseudomonas aeruginosa
Bronchiectasis commonly co-exists with which upper respiratory tract diseases?
Chronic rhinitis
Sinusitis
In patients with Type 1 Respiratory Failure, what is commonly seen with O2/CO2 levels?
Hypoxia, with Hypocapnia / Normocapnia
In patients with Type 2 Respiratory Failure, what is commonly seen with O2/CO2 levels?
Hypoxia, with Hypercapnia
Pregnancy is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory alkalosis
Pulmonary embolism is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory alkalosis
Anxiety / hyperventilation is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory alkalosis
COPD is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory acidosis
Benzodiazepine / opiate overdose is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory acidosis
Obesity hypoventilation syndrome is commonly associated with which? Respiratory acidosis or alkalosis?
Respiratory acidosis
Give examples of neuromuscular disorders which can cause Respiratory Acidosis (Type 2 Respiratory Failure)
Duchenne Muscular Dystrophy Motorneurone Disease Cervical Cord Lesions Myasthenia Gravis Guillin-Barre Syndrome Diaphragmatic Paralysis
What are the oxygen saturation targets for acutely ill patients who are not at risk of hypercapnia?
94-98%
What are the oxygen saturation targets for patients at risk of hypercapnia?
88-92%
For patients to benefit from LTOT, how long should they be on oxygen for per day?
15 hours / day
What patient parameters should be assessed for LTOT?
FEV < 30% Cyanosis Polycythaemia Peripheral Oedema Raised JVP O2 Sats < 92% on room air
How should pO2 be measured from ABGs for assessment of LTOT? What level of pO2 should it be before LTOT is offered?
ABGs should be measured on 2 occasions at least 2 weeks apart
pO2 should be < 7.3 - Offer LTOT
If pO2 from 7.3 - 8 - Offer LTOT if they have polycythaemia, peripheral oedema or pulmonary hypertension
What is the name of technique used to safely insert a Chest drain?
Seldinger’s technique under ultrasound guidance
What are the borders of the triangle of safety when inserting a chest drain?
Base border of axilla (superior border)
Lateral border of the Lattisimus Dorsi (medial border)
Lateral border of Pectoralis Major (lateral border)
Fifth intercostal space (inferior border)
In what groups of patients with no evidence of hypoxaemia should you NOT give oxygen therapy to? 5 examples
- Myocardial Infarction patients
- Stroke patients
- Anaemia patients
- Obstetric emergency patients
- Anxiety related hyperventilation patients
What is the only indication for Hyperbaric Oxygen chambers?
Carbon monoxide poisoning
What is the mechanism of Hyperbaric Oxygen Chambers?
High atmospheric pressures increase the amount of oxygen dissolved in blood
What is the indication for Mechanical Ventilation?
Only used in ITU or theatres. Not suitable for all patients with chronic respiratory disease
What are the indications for the Nasal Cannulae?
In patients with Minimal Acute Respiratory Distress
In patients with LTOT
What are the indications for the Simple Face Mask?
In patients with Minimal Acute Respiratory Distress
In patients with LTOT
What are the indications for the Venturi Mask?
When the exact FiO2 delivered is important, for example patients at risk of hypercapnia / hypoxia
What are the indications for the Non-Rebreathe mask?
Patients who are spontaneously breathing and require the highest possible FiO2 (severe pneumonia, pulmonary oedema, shock, trauma, CO poisoning)
What is CPAP? How is it different to BiPAP? What kinds of patients might be suitable for CPAP
CPAP: Continuous Positive Airway Pressure
Different to BiPAP because it is only set to a single pressure
Best used for Sleep Apnoea patients and those at risk of TYPE ONE Respiratory Failure
What is BiPAP? How is it different to CPAP? What kinds of patients might be suitable for BiPAP?
BiPAP: Bilevel Positive Airway Pressure
Different to CPAP because it can be set at two pressures
Best used for Sleep Apnoea, heart failure, lung disorders and neuromuscular disorders and those at risk of TYPE TWO Respiratory Failure
ACUTE RESPIRATORY DISTRESS SYNDROME
- What is it?
- What are causes of ARDS?
- What are features of it?
- What may you see on CXR?
- What is the management?
- Caused by increased permeability of alveolar capillaries, causing fluid overload
- infection, i.e. Sepsis, pneumonia, Pancreatitis, Massive blood transfusion, Trauma, Cardiopulmonary bypass
- Increased RR, decreased O2 sats, SOB, widespread bilateral lung crackles
- Ground-glass appearance on CXR
- ITU management, oxygen, ventilation, treat underlying cause i.e. ABX, organ support i.e. vasopressors, proning, muscle relaxants
PLEURAL EFFUSION
- What are the two types?
- How can you differentiate between them?
- What are causes of Exudative pleural effusions?
- What is the MOST common exudative cause?
- What are causes of Transudative pleural effusions?
- What is the MOST common transudative cause?
- Meig’s syndrome is a triad of what?
- What are features on examination of a Pleural Effusion?
- What is some imaging modalities for a Pleural Effusion?
- What is the initial management of a Pleural Effusion?11. What are the indications for a chest drain when treating Pleural Effusion?
- How might you treat recurrent pleural effusions?
- What are indications from pleural aspiration there may be an empyema?
- What tool is used to assess if a patient has an Exudative or Transudative effusion?
- Discuss through it
- Exudative + Transudative
- Exudative, >30g/L protein, Transudative <30g/L
- Infective (pneumonia, TB), connective tissue disorders, malignancy, PE, pancreatitis, dressler’s, yellow nail syndrome
- INFECTION
- Heart failure, hypothyroidism, hypoalbuminaemia, meig’s syndrome
- HEART FAILURE
- Benign ovarian tumour, ascities, pleural effusion
- Reduced breath sounds, dullness to percussion, reduced chest expansion, trachial deviation
- US Chest, PA CXR, Contrast CT
- Pleural aspiration with 21G needle, followed by sending fluid off for pH, protein, LDH, cytology, glucose
- If purulent, or if clear with pH <7.2
- Recurrent pleural aspirations, pleurodesis, indwelling catheter
- If pH<7.2, low glucose, high LDH
- Light’s criteria
- Pleural fluid protein / serum protein >0.5
Pleural fluid LDH / serum LDH >0.6 then LIKELY EXUDATIVE
