Breathlessness Flashcards
Describe a moderate asthma attack
PEFR 50-75% expected
mild chest discomfort/tightness
normal speech
no other features
Describe a severe asthma attack
PEFR 33 - 50% RR >25, Pulse >110 Cant talk in complete sentences accessory muscle use O2 Sats <92%
Describe a life threatening asthma attack
PEFR <33% Poor respiratory effort - exhaustion altered consciousness Hypotension, cardiac arrhythmias Cyanosis silent chest!
SABA dosage in acute asthma
Salbutamol - 5mg, Neb
Repeat every 20 - 30 mins
Dosage of Ipratropium bromide
0.5mg, Neb, every 4 hours
What steroid treatment in acute asthma?
Prednisolone, 40-50mg, PO
OR
Hydrocortisone 100mg IV
Given in hospital, and a 7 day course post-discharge
Options for intensifying treatment in acute asthma? if regular bronchodilators do not work
IV Magnesium sulphate - 1 - 1.2mg IV
IV Aminophylline
IV salbutamol
Principals of management for exacerbation of COPD
Intensify bronchodilator therapy (^ dose/frequency)
Oral steroids - 30mg Prednisolone, 7-14 days
Abx if appropriate
O2 therapy
Abx of choice for exacerbation of COPD?
Amoxicillin, 500mg TDS
Alternatives - Doxycycline, clarithromycin
Explain the CURB 65 scoring system
C = confusion U = urea >7mmol/L R = RR >30 B = SBP <90 65 = age 65+
0-1 = manage in primary care, 2 = moderate mortality, hospital. 3+ = high mortality, hospital
Abx of choice for each severity of pneumonia, as guided by CURB 65
0 - 1 = Amoxicillin (or Doxy, or Clarith)
2 = Amoxicillin + Clarithromycin
3+ = Co-Amoxiclav (or Cefuroxime + Clarith)
Causative organisms of CAP
Most often - cause not found
Strep Pneumoniae
Staph A
Mycoplasma
H. Influenzae
Treatment for Pneumocystis Jirovecii in immunocompromised patient
Co-trimoxazole
Presenting features of pneumothorax
Sudden onset chest pain, SoB, tachycardia
Pulsus paradoxus
Hyperresonant chest, reduced breath sounds
Deviation of trachea away from collapse
Describe purpose of Well’s score
Indicates likelihood and risk for DVT/PE
> 4 points, PE likely
<4 points, PE unlikely
What is PERC - Pulmonary Embolism Rule Out criteria?
Checklist of 8 questions.
If all 8 are negative - no further testing required, however if 1 positive, test for PE
Order of investigations for PE?
1st - CTPA - can have interim anticoagulation
- V/Q perfusion scan
Not much value to either D-dimer or Chest x-ray
Management of PE?
Anticoagulation with LMWH / Heparin (if renal function impaired)
Aim for oral switch once INR stable at 2+
Treatment and dosages for acute Pulmonary Oedema
L - Loop diuretics - Furosemide 40mg IV M - morphine, 5-10mg IV N - nitrates, 800mcg, 2 puffs O - oxygen, high flow NRBM P - positioning, sat upright
Pneumonic for management of exacerbation of COPD
COSI CAR
CO - controlled Oxygen (venturi - titrate to sats of 88-92%)
S - salbutamol nebs - 5mg, B2B
I - ipratropium bromide - 500mcg neb
C - corticosteroids - 30mg Pred PO, or 200mg Hydrocortisone IV
A - Abx / Aminophylline
R - respiratory support - BiPAP
Indications for CPAP vs BiPAP
CPAP - type I respiratory failure - forces O2 in
BiPAP - type II respiratory failure - forces O2 in, forces CO2 out
Primary vs Secondary pneumothorax?
Primary = no underlying lung disease, <50yrs, no smoking history
Secondary = underlying lung disease, >50yrs, smoking history
Management of primary pneumothorax
If <2cm, asymptomatic - observe/ discharge
If >2cm, or symptomatic - needle decompression
If this fails –> chest drain
Management of secondary pneumothorax
If >50yrs, OR >2cm, or SoB - chest drain
If 1-2cm - aspiration
All patients should be admitted for 24hrs
If <1cm - give O2, observe
Avoid scuba diving permanently
