Breathlessness Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

Definition of sepsis

A

Infection + adverse host reaction (organ failure, SOFA >=2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Quick assessment of organ f(x) for sepsis

A

Lungs: O2 sats

Heart: MAP

Liver: Bilirubin

Haem: Platelets

Kidneys: Creatinine

CNS: GCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Differential for wheeze

A

Asthma

COPD

Heart failure

Anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differential for stridor

A

Epiglottitis

Anaphylaxis

Trauma

Foreign body/tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differntial for reduced air entry + clear chest

A

Pneumothorax

Pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differential for crepitations

A

Pneumonia

Pulmonary oedema

Bronchiectasis

Pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differential for SOB + clear chest

A

PE

DKA

Pneumocystis jirovecii pneumonia

CNS causes

Anaemia

Drugs e.g. salicylates

Hyperventilation (e.g. panic attack)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs and symptoms of anaphylaxis

A

Itching, urticaria

Angioedema

D+V

Wheeze, laryngeal obstruction

Tachycardia, hypotension (SHOCK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mimics of anaphylaxis

A

Carcinoid

Phaeochromocytoma

Systemic mastocytosis

Hereditary angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acute management of anaphylaxis

A

Secure airway, ?intubate, 100% O2

adrenaline IM

chlorphenamine and hydrocortisone IV

Saline IV (titrate against blood pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Long-term management of anaphylaxis

A

Mast cell tryptase at 1-6h

Monitor 4-6h for biphasic reaction + safety net (more likely if happened before)

2-3d course of oral prednisolone TTO

Allergy clinic F/U if first episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adrenaline dose anaphylaxis

A

0.5mg (0.5ml of 1:1000) IM

Repeat every 5 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hydrocortisone dose anaphylaxis

A

200mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chlorphenamine dose anaphylaxis

A

10mg IV (of 1:1000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Features of severe asthma attack

A

PEF 33-50% of expected

Unable to complete sentences

RR >25

Pulse >110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Features of life-threatening asthma attack

A

PEF <33%

Feeble/absent respiratory effort

Cyanosis

Altered consciousness

Hypotension, arrhythmia

Normal/high PaCO2

PaO2 <8; sats <92%

17
Q

Management of acute asthma

A

Salbutamol nebuliser

Hydrocortisone/prednisolone

Fluids

If infx suspected, abx

If severe, ipratropium bromide

Reassess every 15min, incl. ECG/ABG

If unresponsive to therapy, magnesium sulfate (senior consultation)

If remains unresponsive, consider aminophylline (ICU)

18
Q

Salbutamol dose acute asthma

A

5mg nebulisedrepeated every 15-30min or 10mg/h continuously

19
Q

Steroid doses acute asthma

A

100mg IV hydrocortisone

OR

40-50 mg PO prednisolone

20
Q

Ipratropium bromide dose acute asthma

A

0.5mg/4-6h nebulised

21
Q

TTO for asthma

A

5-7d of 40-50mg oral prednisolone

GP f/u

Respiratory clinic f/u

22
Q

Management of acute exacerbation of COPD

A

Salbutamol + ipratropium bromide

O2 > titrate to sats of 88-92%

Prednisolone

Antibioticsif infective

If unresponsive, consider aminophylline/NIV (not intubation unless haemodynamically unstable/unable to protect airway)

23
Q

Steroid dose acute COPD

A

30mg PO prednisolone (7-14d)

24
Q

Nebuliser doses COPD

A

5mg/4h salbutamol

0.5mg/4-6h ipratropium

25
Q

Causes of pneumothorax

A

Idiopathic: Young, tall, thin

Secondary: Significant smoking Hx, age >50, underlying lung disease e.g. asthma, COPD, infx, fibrosis

Traumatic: incl iatrogenic

CTD: E.g. Ehlers-Danlos, Marfan’s

26
Q

Presentation of pneumothorax

A

Asymptomatic

Pleuritic chest pain

Dyspnoea

Reduced expansion/breath sounds

Hyper-resonance

Sudden deterioration in COPD/asthma/ventilated patients

27
Q

Indictions for chest drain in pneumothorax

A

SOB and/or size >2cm

Atempt aspiration first in 1ry pneumothorax

28
Q

Management of tension pneumothorax

A

Large-bore (orange/grey) cannula in midlavicular line, 2nd intercostal space

Consider finger thoracostomy if suspicion of pus/blood (e.g. trauma)

29
Q

Risk factors for PE

A

Immobilisation (flights, illness)

Surgery (esp pelvis/legs)

Pregnancy, OCP, HRT

Coagulopathy, previous DVT/PE

Malignancy, inflammation

30
Q

Presentation of PE

A

Tachycardia, gallop rhythm, loud P2, raised JVP, RV heave

SOB, pleuritic chest pain, haemoptysis, pleural rub

RV strain, RBBB, S1Q3T3, tachycardia

31
Q

Management of PE

A

Morphine + metoclopramide 10mg

Oxygen

C: Dalteparin 200U/kg OR fondaprinux 7.5mg

Alteplase 10mg over 1-2 min if haemodynamic instability

Consider IR/ITU referral

Dobutamine if BP remains low

32
Q

qSOFA score for sepsis

A

RR >=22

SBP <100

GCS <15

33
Q

Wells scoring for PE

A

Clinical signs and symptoms of DVT

PE is #1 diagnosis OR equally likely

Heart rate > 100

Immobilization at least 3 days OR surgery in the previous 4 weeks

Previous, objectively diagnosed PE or DVT

Hemoptysis

Malignancy w/ treatment within 6 months or palliative

34
Q

Indication for CXR in acute asthma attack

A

Life-threatening (NOT SEVERE! i.e. PEF <33%)

Suspected pneumothorax, pneumomediastinum

Suspected consolidation