Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Guide to Essentials in Emergency Medicine > Chapter 3: Respiratory > Flashcards

Chapter 3: Respiratory Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What is Asthma and its pathophysio?

A

Chronic inflammatory disorder characterized by variable airway obstruction with recurrent or chronic wheeze/cough

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

DDx of wheeze?

A

1) CCF
2) GERD
3) Upper airway obstruction
4) Bronchiectasis
5) COPD

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

What are the aims of clinical assessment?

A

1) Determine the severity of the attack and rx accordingly
2) Identify pts with high risk of mortality
3) Establish the control of asthma in pt

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

Hx to ask in asthma attack?

A

1) Symptoms- SOB,wheeze, cough
2) Precipitating factors? Usual triggers?
3) Compliance and control
4) High-risk factors suggestive of decompensation

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

What to look out for in PE for acute asthma?

A

1) Mentation?(Agitated or drowsy?)
2) Ability to talk in phrases/sentences
3) Level of SOB and exertion
4) Wheeze/Silent chest?
5) Signs of resp distress?
6) RR (Increased or decreased?)
7) HR (120, Severe brady?)
8) Cyanosis?

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

what are the Risk factors of death from asthma?

A

1) Prior intubation/mech vent for asthma
2) Prior severe sudden exacerbation
3) Prior hosp>1 for asthma in the past 1 year
4) Use of systemic steroids
5) Poor socioeconomic status
6) Psychiatric problems
7) >3 Emed visits for asthma in the past year
8) Use of >2 canisters of B2 agonist inhalers per month

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

How do you determine asthma control?

A

1) Daytime symptoms
2) Nightime sypmtoms
3) Need for reliever?
4) Functional limitation in daily activities
4) Lung function via PEFR

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

Are there any invg for asthma?

A

not indicated as dx is purely clinical. H/r there are some special instances where invg can come into use

  • CXR: if pat is not responding to initial therapy to look for alternative ddx such as CCF, pneumothorax etc.
  • ABG: if patient is rapidly deteriorating
  • FBC: to look for infective ppt cause
  • U/E/Cr: to look for hypokalemia due to salbutamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mgmnt of asthma?

A

1) Supportive measures and ABC.
- monitoring, vital signs, IV access in serious cases
- indications of intubation: severe hypoxia, AMS, persistent hypercarbia, Pa02

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

Disposition and advice after resolution of asthmatic attack?

A

1) Check inhaler technique
2) Check control of asthma(ACT)
3) Advise pt to avoid ppt factors
4) Emphasize impt of compliance to therapy

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

What is CAP?

A

-Infiltrates on CXR and Altered breath sounds/local crep in patients who were not hospitalized/residents of long-term facility 14 days before symptom onset

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

What are common bact pathogens in CAP?

A
  • Strep pneumoniae
  • H. Influenzae
  • Atypicals: Mycoplasma and Legionella
  • Staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the presentation of HIV patients with pulm infection?

A
  • PCP(disproportionate hypoxemia with mild CXR abnormalities)
  • Pulmonary TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What hx to obtain in pneumonia?

A

1) Presenting Symp
- LRTI(fever, rigours, chills, sweats, new cough+-sputum, chest pain, SOB)
2) PMHX of factors which increase risk of mort
- Old age
- Alcoholism
- Active Malignancy
- Neuro Dz
- CCF
- DM
- Prev pneumonia
3) Prior Rx for current illness eg.prior antibiotics by GP

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

What to look out for in PE for CAP?

A

1) AMS
2) Signs of resp distress?
3) Signs of shock/dehydration
4) Crepitations
5) RR and HR

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

What invg to order for in CAP?

A

1) Bloods-FBC, U/E/Cr, Lactate, ABG(in mod-sev CAP), Blood cultures/sputum cultures
2) Radio: CXR
3) Others: CBG, ECG, Urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is CURB-65?

A

Confusion
Urea>=7
RR>30 breaths/min
BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the mgmnt of CAP?

A

1) Supportive measures-Monitor, vital signs, ABC, fluid resus
2) Anti-microbial therapy
- Hosp but not in ICU: Ceftriaxone +Clarithromycin
- Severe pneumonia: Augmentin +Azithromycin+Ceftazidime

19
Q

What are the types of pneumothorax(PTX)?

A

Primary: No lung pathology that predisposes to PTX
Secondary: Underlying lung is diseased

20
Q

What are the management principles of PTX dependant on?

A

1) Size of the PTX
2) Cinical state of patient
3) The disease state of the underlying lung

21
Q

What is the basis of initial mgmnt of a PTX?

A

1) ABC
2) Administer 100% O2 (the rate of resorption of PTX goes 4X the normal rate to 6% of vol of hemithorax a day if given high flow O2 therapy)

22
Q

What is the invg of choice for PTX?

A

CXR. Use inter-pleural distace (2cm) to determine size and severity of PTX.

23
Q

What is the definitive mgmnt of PTX?

A

If pt is unstable and hypotensive,( BP

24
Q

What is PTX advice?

A

1) No swimming/deep sea diving
2) No mountain climbing
3) No air travel for 6 weeks
4) No other strenuous physical activity for 4 weeks
5) to come back if worsening symp

25
Q

What is the relation between DVT and PE?

A

Leg DVT is found in 70% of pts with PE and 50% of those with DVT get PE. However PE is less likely if DVt is confined to calf veins

26
Q

What is Virchow’s triad and what are the RFs of PE?

A

1) Venous Stasis
- Prolonged immobility(recent travel), major surgery/trauma, advanced age, obesity
2) Endothelial damage-major surgery to legs/pelvis, thrombophlebitis, local trauma to legs
3) Hypercoagulability-Protein C/S def, Factor V Leiden mutation, APS, Anti-thrombin III def, OCP, Polycythemia, malignancy

27
Q

What clinical features are expected in PE?

A

Triad of:
Chest pain(pleuritic)
Tachypnoea(>20 breaths/min)
SOB

Hypercapnia is rare in PE but hypoxemia is a classical feature.
Orthopnea does not occur

28
Q

How does one classify patients based on pre-test probability of having PE?

A

If pt has classical triad of symptoms not explained by any other cause AND

1) radiographic signs of PE(Hampton’s hump and Fleischner sign)
2) High-risk factors based on Virchow triad
3) Signs of leg DVT(erythema, pain, swelling)
4) ECG signs of R heart strain and fainting

29
Q

What is the initial mgmnt of PE?

A

1) ABC and monitor vitals in P1 area
2) Give O2 via NRM but if indicated may need to intubate(however, know that intubation may further exacerbate the hypotension)
3) 2 large bore IV cannula and start fluid resus(if BP low, can start inotropes)
4) Give pain relief
5) Contact CTVS

30
Q

What invg do you order for PE?

A

1) Bloods
- FBC
- U/E/Cr
- ABG(reduced PaO2)
- D-Dimer ELISA test (if pre-test prob is low and D-dimer -ve can exclude PE but high pre-test prob and -ve D-dimer does not help)
- GXM 4-6 units
2) Radio
- CXR(Normal in 40%) Other findings are Hampton’s hump, Fleischner sign, Westermark sign, small pleural effusions)
- CTPA(Primary radio scan offered to evaluate PE and can help to look for ddx as well)
- Bedside U/S (look for R heart dilatation/reduced function)
3) Others
- ECG(most common is T wave inversion in anteroseptal and inf leads, S1Q3T3, R heart strain)

31
Q

What is the definitive mgmnt for PE?

A

If small PE: IV heparin 5000 U bolus/SC fraxiparine

If unstable PE: Urgent embolectomy/catheter directed thrombolysis

32
Q

What are the key features of making a dx of COPD?

A

1) Chronic cough
2) Chronic sputum production
3) SOB esp during exertion and infections
4) Exposure to smoke/occupational dusts etc.

33
Q

What is the GOLD Classification?

A

0: At risk (normal spirometry and chronic symptoms)
I: Mild (FEV1>80)
II: Mod(50

34
Q

How do you differentiate between asthma and COPD?

A

Asthma when there is complete broncho reversibility with bronchodilators and diurnal variation in peak flow of >20%

35
Q

History to ask in COPD?

A
  • Presenting symptoms: increased SOB, Cough, Purulent sputum from baseline, fever
  • PMHx: Prev intubations, prev NIV, no. of hosp/ED visits
  • Current meds and compliance
36
Q

What invg do you do for COPD?

A

Like asthma mostly clinical but invg can be used as adjuncts to guide/monitor response of mgmnt strategies

  • Bloods: FBC(look for leukocytosis), U/E/Cr if pt is septic and dehydrated, ABG(after 2 nebulizations in order to determine need for NIV)
  • Radio: CXR (Look for cause(pneumonia) or Cx(PTX)
  • Others: ECG(may see right heart strain, p pulmonale, MAT)
37
Q

What is the supportive mgmnt in COPD?

A
  • They should be placed in a monitored area with vitals signs.
  • ABC:
  • Airway secured via the necessary means: NIV/Intubation
  • Ventilatory settings should be low rate, low tidal volume and prolonged exp phase
  • Fluid resus should be judicious considering the fact that there is significant R heart issues in chronic COPD
38
Q

What is the definitive mgmnt in COPD?

A

Drug therapy:

  • Bronchodilators: B agonist(Salbutamol nebulized with ipratropium every 20mins for 1hr)
  • Steroids(Prednisolone PO 0.5-1mg/kg)
  • Antibiotics if there are signs of LRTI causing exacerbation of COPD: Augmentin/Azithromycin
39
Q

What advice do you give COPD patients on discharge?

A

1) Flu vaccination (age>65)
2) Stop smoking
3) Inhaler technique and importance of compliance

40
Q

What are the ddx of stridor in a child?

A
  • Epiglottitis
  • Croup
  • Foreign body aspiration
  • Angioedema
  • Retropharyngeal/peritonsillar abscess
  • Smoke inhalation
41
Q

What is the general supportive mgmnt of stridor?

A

1) Monitor at critical resus area with continuous vital signs monitoring
2) Airway management equipment ready with cricothyrotomy set
3) Administer supp O2 to maintain SpO2>95%
4) Establish peripheral IV line and resus drugs available with senior docs from both ENT and Anaesthesia ready

42
Q

What is the mgmnt of epiglottitis?

A

1) ABC
2) Provide humidified O2
3) Airway maintenance with definitive surgical airway/intubation before further dx evaluation is done
4) Administration of antibiotics
- IV Ceftriaxone 2g or 100mg/kg and Clindamycin 600mg
5) Lateral neck X-ray if need be to see thumb sign

43
Q

What is the mgmnt of FB aspiration?

A

1) Series of 5 back blows and 5 chest thrusts in age 1
2) Direct inspection of hypopharynx via laryngoscope. Remove the FB with Magill Forceps if it’s accessible
3) If unsuccessful and pt deteriorating, perform intubation/surgical airway
4) Specialist team perform bronchoscopy or laryngoscopy.

44
Q

What are the impt invg to do in a typical case of SOB?

A 
Bloods:
-FBC(Hb, WBC)
-U/E/Cr
-ABG(look for resp failure and cause)
-CBG (metab acidosis) 
Radiology:
-CXR
Others: 
-ECG(in elderly esp)
-+Drug screen

Guide to Essentials in Emergency Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions