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Y3/4--5 respiratory > Breathlessness prep for sim > Flashcards

Breathlessness prep for sim Flashcards

1
Q

what are you looking for in A in a breathless patient

A

signs of obstruction - stridor or choking
intervene with airway manoeuvres or adjunct if necessary

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2
Q

what are you looking for in B in a breathless patient

A

RR , resp effort , SPo2
breath sounds - wheeze and crackles
administer oxygen if needed and vent support

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3
Q

what are you looking for in C in a breathless patient

A

pulse, BP, crt , JVP , cyanosis, cold peripheries, ABG/VBG , IV fluids and meds

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4
Q

what are you looking for in D andE in a breathless patient

A

AVPU or GCS temp, pedal oedema, calf swelling and trauma

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5
Q

what investigations might you consider in a patient with breathlessness

A

if abnromal HR - ecg
suspected pe - ctpa - fluid pre and post - creatiine
abnromal chest exam

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6
Q

system causes of breathlessness

A

respiratory
cardiovascular
others

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7
Q

sudden onset breathlessness

A

PE
anaphylaxis
ACS
pneumothorax

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8
Q

gradual onset breathlessness

A

infection
pulmonary oedema
pleural effusion

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9
Q

pathophysiology behind asthma

A

bronchial hypersensitivity and inflammation leading to reversible bronchoconstriction causing recurrent sx cough, wheeze, chest tightness and dyspnoea

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10
Q

how do we dx asthma

A

obstructive spirometry with positive bronchodilator reversibility - ratio less than 70
peak flow readings over 2-4 weeks with 20% variability
FeNO level of over40ppb in adults anad 35 in children 5-16

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11
Q

management of severe asthma attack

A

A-E - target sats 94-98
oxygen driver nebulised bronchodilator therapy - salbut 5mg and ipratropium 0.5mg
repeat doses 15-30min intervals
ocntinuous if no repsonse
give pred 30mg )D for 5 days or IV hydrocortisone 100mg 6hrly
magenesium sulphate 2g IV over 20mins - senior
procalcitonin to guide abx

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12
Q

life threatening asthma features

A

hypoxia
hypercapnia
altered consciousness
ABG showing fall in ph
hypotnesion
silent chest
confusion
PEFR less than 33%

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13
Q

follow up long term mx after asthma attack

A

early follow up with GP post discharge
identify and avoid triggers
optimise preventative treatment
self management plan

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14
Q

pathophysiology of COPD

A

chronic infalmmation leads to strctural lung changes - destruction of alveoli, mucus hypersecretion.
airflow obstruction and air trapping
impaired gas exchange

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15
Q

features of COPD

A

cough
sputum
dyspnoea
reduced exercise tolerance
sometimes fever
auscultation - reduced air entry , wheeze and rhonchi

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16
Q

how do you stage COPD

A

based off FEVI1

17
Q

exacerbation of COPD management

A

A-E - retainer 88-92 , 94-98 CO2 retention
nebulised bronchodilator therapy - salbutamol 5mg + ipratropium bromide 0.5mg
systemic corticosteriods 30mg OD 5 days
consider abx - microguide
if acidotic, NIV and earyl escalation

18
Q

long term mx of copd

A

stop smoking
inhaler therapy
pulmonary rehab

19
Q

Pulmonary embolism risk factors

A

DVT
malignancy
recent surgery
recent immobility
thrombotic disorders
preg
recent trauma or lower limb fracture
recent MI
increasing age
FH of VTE
COCP or HRT
recent long travel

20
Q

how might PE present

A

pleuritc chest pain, breathlessness, collapse, haemoptysis , dvt
hypoxic, tachyp, hypotensive, tachyc,raised JVP

21
Q

ix for pe

A

a-e
o2
iv fluid boluses
vbg
dvt
ecg
wells
d-dimer
troponin, CXR - rule out pnuemothora
CTPA
analgesia

22
Q

management of PE

A

DOAC or LMWH
thrombolyssi for masive pe
senior

23
Q

what is pulmonary oedema

A

excess fluid in pulmonary intersittium. this eventually fills with alveoli and leads to poor gas exchange. its usually caused by poor cardiac pump function, leading to increased pressure in the pulmonary vasculature.

24
Q

acute flash pulmonary oedema caused by

A

MI , arotic dissection, PE or arrhtyhmia

25
Q

sub-acute pulmonary oedema may be caused by

A

sepsis, thyroid storm, renal failure or myocarditis

26
Q

chronic pulmonary oedema caused by

A

HTN, anaemia, cardiomyopathy or valvular pathology

27
Q

acute pulmonary oedema presents as

A

breathlessness, pale and sweaty, chest pain, frothy sputum

28
Q

chronic pulmoanry oedema presents as

A

delirium , functional decline, fatigue,cough, SOB , reduced exercise tolerance , leg swelling

29
Q

what to do in acute pulmonary oedema

A

sit pt up
high flow O2
bilateral crackles and sweaty
get iv access blood gas and bloods
fever is generally absent
look for sacral and peripheral oedema too
ECG to look for underlying causes
cxr

IV loop diuretics
nitrates
opiods with resp distress
consider NIV
seniors
weight pt and montior input and output

Y3/4--5 respiratory (21 decks)

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