Emergency Management

Question 1

How is the emergency respiratory patient approached?

Answer 1

Start on Oxygen
Give them time
Empirical therapy- evaluate response to treatment

Question 2

Where can dyspnoea be localised to?

Answer 2

Upper airway- increased inspiratory effort
Small airway- increased exploratory effort
Pulmonary parenchyma increased/mixed
Pleural space- short choppy
Chest wall and diaphragm- irregular/slow

Question 3

What is paradoxical movement and what does it indicate?

Answer 3

When chest goes out, abdomen goes in

Indicates severity but not pathognomonic

Question 4

At what pa02 is cyanosis seen?

Answer 4

20-40paO2 (normally 100)

Question 5

What is the target pulse oximetry reading and why?

Answer 5

Aim to keep readings over 95 to avoid desaturation

Question 6

How is upper airway disease managed?

Answer 6

Sedation
Cooling
Anaesthesia
Tracheostomy

Question 7

How is lower airway disease managed?

Answer 7

Medical management

Dexamethasone and terbutaline

Question 8

How is pleural space disease managed? And when is it suspected?

Answer 8

Suspected when the chest sounds dull
Thoracocentesis
Chest drain placement- Trocar chest tube or Seldinger over the needle

Question 9

How is parenchyma disease diagnosed how is it managed?

Answer 9

Radiography is required for final diagnosis

Empirical therapy can be used diagnostically ie cardiogenic problems will improve markedly within 1 hour of furosemide

Question 10

When is tracheotomy required?

Answer 10

1. Unable to secure airway (at least try smaller ET tube)
2. No improvement after sedation
3. Moving to a referral centre on a hot day

Question 11

What can be assessed using ultrasound in respiratory distress?

Answer 11

TFAST
Look for fluid
LA:Ao should be less than 1.5 in the right short axis view at the level of the aortic valve