general respiratory emergencies

Question 1

what is the MRC dyspnoea scale?

Answer 1

grade of breathlessness in relation to activities
stage 1: only breathless on strenous exercise
stage 2 : SOB when walking ir hurrying up a slight hill
stage 3: has to stop for a breath when walking at own pace
stage 4: stops for breathes after walking 100m
stage 5: too breathless to leave the house

Question 3

What are the 6 respiratory features to ask about in a respiratory history?

Answer 3

Dyspnea
Chest pain
Wheeze
Cough
Sputum
Haemoptysis
ALSO CHECK ABOUT FEVER AND WEIGHT LOSS

Question 4

what is stridor?

Answer 4

Inspiratory sound due to partial obstruction of the upper aiways

Within lumen: foreign body, tumour

Within wall: oedema from anaphylaxis, tumour

Extrinsic: goitre, lymphadenopathy

Question 5

What are some signs of respiratory distress?

Answer 5

Tachypnea
Nasal flaring
Tracheal tug (pulling of thyroid cartilage to sternum on inspiration)
Use of accessory muscles
Intercostal and subcostal recession
Pulsus paradoxus

Question 6

What should you send a sputum sample for and what do the following sputum colours indicate?

Black specks
Yellow/green
Pink frothy
Red
Clear

Answer 6

Send for gram stain, culture, cytology

Smoking
Infection
Pulmonary oedema
Haemoptysis (TB, malignancy, PE)
Saliva

Question 7

What are the causes of hypoxia (low PaO2)

Answer 7

Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch

Question 8

What are some causes of respiratory acidosis?

Answer 8

A
Alveolar hypoventilation e.g COPD
Hypoventilayion e.g neuromuscular disease

Question 9

WHat are the signs of anaphylaxis?

Answer 9

Pruitis
Urticaria
Angiooedema
Hoarseness progressing to stridor and bronchial obstruction
Wheeze and chest tightness from bronchospasm

Question 10

What is the emergency management for anaphylaxis?

Answer 10

Remove trigger
Maintain airway and 100% O2
- Lie flat and fluid resuscitation

• IM 0.5mg adrenaline
• IV chlorphenamine 10mg

Measure serum tryptase
Treat bronchospasm with NEB salbutamol
Treat laryngeal oedema with NEB adrenaline

Question 11

What are some signs of a COPD exacebation?

Answer 11

Increasing cough
Breathlessness
Wheeze
Change in sputum volume/colour

Fever
Raised WCC/CRP

Question 12

Q
What is the emergency management for an acute COPD exacerbation after sitting the patient upright?

Answer 12

ABCDE
- Oxygen therapy aiming for 88-92% sats with serial ABGs

• Salbutamol and ipratropium bromide NEBS
• 30mg PO prednisolone and ccontinue for 7 days
• Antibiotics if raised CRP/WCC or purulent sputum

CXR
Consider IV aminophylline
Consider NIV (BIPAP) if type 2 resp failure and pH 7.25-7/35
If pH<7.25 consider ITU referral

Question 13

what are some contraindications for NIV (biPAP)

Answer 13

Reduced GCS
Facial injury
Increased secretions
Vomiting

Question 14

what is a massive haemoptysis?

Answer 14

> 240mls in 24 hours

> 100mls/day over consecutive days

Question 15

how is massive haemoptysis managed?

Answer 15

ABCDE
- Lie patient on suspected side of lesion lateral decubitus

• Oral tranexamic acid IV for 5 days
• Stop NSAIDs, aspirin, anticoagulants

Abx if infection
Consider Vit K
- CT aortogram that can do bronchial artery embolisation

Question 16

what are some contraindications to treating a PE with thrombolysis

Answer 16

absolute:
haemorrhagic stroke, recent trauma/ surgery
bleeding disorder
aortic dissection

relative:
warfarin
pregnancy
infective endocarditis

Question 17

what are some complications with using thrombolysis for a massive PE?

Answer 17

bleeding
hypotension
intracranial haemorrhage/ stroke

Question 17

what are the border of the safety triangle?

Answer 17

Anterior border of lat dorsi
Lateral border of pec major
5th ICS in line with base of axilla

Question 18

When should we use high flow oxygen?

Answer 18

Cardiac arrest
Severe respiratory failure (Sats<85%) -Anyone acutely unwell
OTHERWISE USE CONTROLLED OXYGEN THERAPY

Question 18

What is the difference between lobar and broncho-pneumonia on chest x-ray?

Answer 18

Lobar is solid consolidation. Usually Strep.Pneumoniae
Broncho is patchy consolidation. Usually H.Influenzae, Pseudomonas, Moraxella

Question 19

What are some of the causes of acute respiratory distress syndrome?

Answer 19

Pneumonia
Inhalation
Shock
Multiple transfusions
Pancreatitis
Head injury
Malaria
Drugs e.g aspirin, heroin

Question 20

what is ARDS?

Answer 20

Acute lung injury causing lung damage and release of inflammatory mediators so increased capillary permeability and pulmonary oedema often followed by multiorgan failure

Question 21

What are some features of ARDS and what investigations should you do for this?

Answer 21

Symptoms: cyanosis, tachypnea, tachycardia, bilateral fine inspiratory crackles

Investigations: FBC, U+Es, amylase, clotting, CRP, blood cultures, ABG, CXR

Question 22

what do you see on CXR with a patient with ARDS?

Answer 22

Bilateral pulmonary infiltrates

Question 23

what is the criteria for ARDS?

Answer 23

Acute onset
CXR showing bilateral infiltrates
Lack of clinical congestive heart failure
Refractory hypoxaemia

Question 24

what causes type 1 and type 2 respiratory failure?

Answer 24

Type I: pneumonia, PE, pulmonary oedema, pulmonary fibrosis

Type II: COPD, OSA, sedative drugs, neuromuscular diease e.g GBS, myasthenia gravis

Question 25

what is Cor pulmonale and what causes it?

Answer 25

Right sided heart failure due to pulmonary HTN
causes: PE, COPD, bronchiectasis, pulmonary fibrosis, Mysathenia gravis

Question 26

What are the clinical features of Cor Pulmonale?

Answer 26

Dyspnea
Fatigue
Tachycardia
Raised JVP
RV heave
Hepatomegaly
Oedema

Question 27

How is Cor pulmonale treated?

Answer 27

Treat underlying cause
- Give 24% oxygen for respiratory failure if PaO2 <8. Consider LTOT for COPD

Treat cardiac failure with furosemide
Consider venesection if Hct>55%
Consider heart lung transplant if young