lungs Flashcards
nebuliser vs inhaler
inhaler - hand held usually with a spcer
nebs- a machine that attached to a mask that turns liquid into a mist , usually in more sever condtions and in hospitals but some people can have nebs at home
COPD exacerbation what to give
- oxygen (need to check if they are a retainer or not because not all copd patients are retainers)
- bronchodilators (salbutomol/ipatrorpium)
- steroids
why is PE so hard to diagnose
can give a normal chest x ray
PERC SCORE
used to rule out PE definitvely
basically its if you really doubt a PE but you really want to make sure. as long as its zero, it means very low PE chance no need to do anythign. but if even one postive do a dimer
age >50
sats on room air <95
tachy >100
unilateral leg swelling
hempomptysos
hormone oestrogen use (not progesterone)
prior dvt or pe
what do you ALWAY ASK IN PATIENT IF SUSPECT PE
S.O.B
CHEST PAIN
INSPIRATORY PAIN
HEMOMPTYSIS!!!!
wells score interpatation
> 4 PE is likely order imaging
<4 PE is unlikely but do a d dimer to rule out
CI to ct Pa
contrast allergy
PERC VS WELLS
WELLS very high suspiciosn
PERC - very low
antibiotics given in pneumonia (just goofgle|)
usually would be amox but if allergic then move to macrolides like clarithromycin OR
doxycycline
Peak flow what is it and why
Vs spirometer
A device used to see how much air you can forcibly exhale from your lungs in 2 seconds
Take a deep breath in and then forcibly exhale for 2 seconds
We use it to diagnose asthma? but also to monitor as you do it regularly to see if getting better or worse
Spirometer is more reliable
More expensive
You generally do a peak flow first then spirometery confirms
What does an ABG show you and why would you perform it
Shows you if patient is hypoxic
Gives you lactation
Gives you bircarb and co2 levels
Perform it if a person looks clinically unwell or is respiratory conditions and also kidney conditions but also others like heart failure etc
ways to diagnose asthma
FeNo
eosiniphilia
spiromeery
meds you should be wary of in astham
BB
NSAIDS
Definition astha
acute inflammation of airways, that is reversible cause bronchial hyperreactivity with mucouse secretion
will you airways be the same after years of astham
no due to the chronic inflammation there will be remodeling
RF ASTHAM
ATOPY-exzema, rhnitis
FH
premature
Respiratory infections in infancy
Prematurity and low birth weight
Obesity
symptoms asthma
chets pain
dyspnea
wheezing
cough
why is asthma worse at night
beacsue you are sleeping on you rback so more tagantion but we dont know really the reason why
if you suspect asthma what would you start of with
FEno or eosiniphils level
then spriomteryr with revrsibility test
direct bronhcical challenge ~ not first line usually done when those above have not given a conclusive answer
note that all these tests can be falsley negative in paitents treated with inhaled CS
INVESTIGATIONS FOR ASTHMA ATTACK
ABG - to see hypoxia and co2 levels
x ray - want to see if any trigger for the attack or any complication such as pneumothorax
what should the co2 level be in asthma
low due to hyperventilation but if its high it means near fatal
management of asthma attack
salbuotmol nebulized if that does not work or its a sever attack you can addyo on to ipratropium (anitcholinergic)
Give prednisolone 40-50mg orally, or IV hydrocortisone if the patient is unable to swallow
Can consider IV magnesium sulphate and/or aminophylline if the patient is not responding to nebulisers
If the patient continues to deteriorate despite maximal therapy, they may require intubation and ventilation in an intensive care setting (for example in cases of severe hypoxia or exhaustion)
effect of adrenaline on airways
dilates
nomral technique for inhaler at home
take 1 puff every 30/60 secnds upo to 10 puffs if not better ambulance
Bad signs of asthma
bradycardia
bradypnea
hypotensive
hypercapnea
silent chest
normal sp02
94-98%
Remember, a ‘normal’ PaCO2 in an asthma exacerbation is not reassuring. A normal or raised PaCO2 is significantly concerning as this indicates that the patient is becoming tired and is failing to ventilate effectively. These patients need urgent discussion with a senior clinician and critical care.
doses of cs to give in astham
40/50 mg pred
iv hydrocortison - 100mg
Continue prednisolone 40-50mg daily for at least five days after the exacerbation or until recovery.
when would we consider giving mg so4
Consider giving a single dose of IV magnesium sulphate (1.2-2g infusion) to patients with:
Acute severe asthma who have not had a good initial response to inhaled bronchodilator therapy
Life-threatening or near-fatal asthma
Magnesium sulphate should only be used following consultation with a senior clinician.
when to give aminothyilline
should only be given by a senior clinician
in terms of giving fluids whats the limit
can give up to 4 times boluse (which adds up to 2000 in nomral patients of 1000 in heart failure/kidney failure
what are rhonchi examples
mucous in the airways, heard best centrally rather than peripherally as its usually the larger airways affected.
any condition with secretions in the lungs copd
bronchiactasis
pneumonia
CF
rhocnhi and coughing
can be cleared if cough as its mucous
monophonci vs polyphonic wheeze
one airway vs multiple airways (asthma /COPD)
veiscular breathing
normal
no pause between
inspiration longer than expiration and louder
expiration quieter (because its passive)
what transmits sounds better
solids and fluids increases transmission
are crackles affected by coughin
depends on the cause
e.g if due to secretions then if you cough it can clear the crackles or they improve! as youve mobilised the mucous
but if its edema - the fluid has no where to go
kussmaul breathing
associated with metabolic acidosis hence DKA,
BODY IS TRYING TO COMPENSATE BY REPSIRATORY ALKOSLOSIS TO BLOW OF THAT EXCESS CO2 BY A DEEP LABOURED BREATHING
PHYSIOLOGY OF BREATHING IN MEATBOLIC ACIDOSS
initially the body hyperventilates shallow and quick to get rid of the co2 but this cant be maintained and eventually breathing becomes slower and deeper. this is what we call kussmaul.
type 1 and type 2 resp failure
type 1 - just hypoxemia
pulmonary edema, pneumonia , ards
type 2 - hypoxia and hypercapnea
copd, asthma, neurological disorderees
ARDS everything about it
its due to a primary cause
leads to non cardigenic pulmonary edema
pt looks clinically unwell
causes
lungs , pneumonia,
systemic, sepsis, pancreatitis, DIC
usually managed in ICU
diagnosis - cxr,(edema) Abg (type 1), amylase - common cause
berlin criteriai
used to determine if ARDS
