Emergency Medicine - Respiratory

Question 1

Dyspnoa- Key differentials to rule out

Answer 1

Lungs
-PE, COPD, Asthma, Pneumonia, pneumothroax (Tripple P PAC))
Cardio
-HF, ACS, tamponade, valvular insufficiency

Panic attack
Kidney/liver failure
Anaemia
Pregnancy

Question 2

Causes of worsening heart failure

CHAMP

Answer 2

Coronary syndrome
Hypertensive crisis
Arrhythmia
Mechanical cause
Pulmonary embolism 

–> diet/medication compliance

Question 3

Signs of HF on Chest Xray

Answer 3

ABCDEs
A -Alveolar oedema
B - Kerly B lines
C - cardiomegaly 
D - Dilated upper lobe vessels
E - Plural effusion

Question 4

Type 1 vs type 2 resp failure

-causes

Answer 4

Type 1 (5P’s 2As)

• Acute asthma
• Pulmonary oedema, ARDS, pneumonia
• pulmonary fibrosis
• pneumothorax
• PE

Type 2 (broken breathing problems)
Brainstem (stroke, coma, toxins, drugs)
Spinal cord (trauma)
Neuromusculr (Muscular dystropy, myasthesia, gullian barre)
Chest wall movement reduced (flail ribs)
-also chronic COPD

-understanding of what this means

Question 5

CAP treatment
CURB score

HAP

Answer 5

CURB
0-1 - amox
1-2 - Amox + doxy
3-5 - Augmentin + azithro

HAP - piptaz - complicated
normal - Augmentin

CURB65
confusion 
uremia
RR
BP 
65

Question 6

COPD acute treatment

Answer 6

ABCs
Nebs - Salbutamol, Ipratorpium
Hydrocortisone
Antibiotics

Niventilation

Question 7

Asthma acute Management

ABCs, and investigations

Answer 7

ABCs
Airway
SAMPLE history

Breathing 
Vitals - O2, RR
Assess - work of breathing, resp exam (auscultate lungs, trachea, percuss)
Do - Peak flow, xray, give O2
(rule out other causes)

Circulation
Vitals - HR, BP
Assess - Cap refill, heart sounds, legs.
Do - IV access + bloods

Disability - GCS, glucose
Exposure - temp, other exams

Investigations
-ABG/VBG, Bloods, Peak flow, ECG, Xray

Treatment
Oxygen, Salbutamol Neb, Ipratropium, Corticosteroids
Mg Sulfate
Adrenaline

Constantly reassess and monitor (vitals, peak flow, work of breathing)

Abx - if infection
Med review/use

Question 8

Signs of increased work of breathing

Answer 8

Accessory muscle use
Nasal flaring
Cant speak full Sentences
Tripod position

02 saturation
RR increased

Question 9

Red flags of Asthma

Answer 9

PEFR <30% 
Oxygen sats <92%
Inability to talk 
Silent chest
Cyanosis
Poor resp effort, exhausted
Hypotension, bradycardia