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! ACC Separate Conditions > Pt w/ SOB > Flashcards

Pt w/ SOB Flashcards

1
Q

Acute asthma attack presentation

A

Acute SOB, wheeze, cough and cyanosis (if extreme)

PRECIPITANTS in hx: cold, exercise, allergens, smoke, infection

***the patient might not know they have asthma or they might come in with a dx and having tried to manage their own asthma at home and failed

**for the patient who does not know wheeze is an important sign

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2
Q

Grading of severity for acute asthma

A

MODERATE = PEFR 50-75% with none of below features
ACUTE SEVERE = 30-50% PEFR, RR >25, Tachycardia >100/min, Inability to complete a sentence
LIFE-THREATENING = 33 92, CHEST (33% PEFR, 92% Sats, Cyanosis, hypotension, exhaustion, silent chest, tachycardia)
NEAR FATAL = Raised PaCO2 or immediate requirement for ventilation

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3
Q

Investigations in acute asthma

A 
ABG (increased Co2 concerning, high bicarbonate suggests poorly controlled asthma over several days)
Sats 
CXR 
BLOODS: FBC (infection), U&E, CRP
ECG
PEFR
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4
Q

Immediate management for acute asthma

A 
Oxygen therapy 
Salbutamol nebulisers 5mg or terbutaline 10mg (up to every 15mins, space as appropriate)
Add ipratropium o.5mg 6-4hrly 
IV ACCESS
IV hydrocortisone 200mg 
Abx if evidence of infection
Hydration (IV fluid)
CALL SENIOR - theophylline, MgSO4 or IV salbutamol
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5
Q

Monitoring response to treatment - acute asthma

A

PEFRs regularly
Repeat ABGs 1-2hrly (consider arterial line or topical anaesthetic cream)
Monitor serum K+

***if poor response arrange admission to ICU

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6
Q

Acute COPD presentation

A

SOB, Wheeze, tachypnoea, accessory muscle use, cough (productive of infective sputum if infective exacerbation)

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7
Q

Acute COPD examination findings

A

Hyperinflation, hyper resonance, wheeze, cyanosis, right sided heart failure, hypercapnia symptoms (CO2 flap, trembling, bounding pulse, vasodilation)

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8
Q

Causes of acute COPD

A

Can either be infective or non-infective
INFECTIVE = H. influenzas or S. pneumonia
Hx factors will help determine (productive sputum, fever, malaise, anorexia)

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9
Q

Investigations for acute COPD

A 
FBC, U&E, CRP, ESR
Continuous observation 
CXR
ECG
ABG 
Septic screen (blood cultures, CXR, sputum culture)
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10
Q

Initial management of acute COPD

A

Oxygen to aim for sats 88-92% (ventures can be useful for this to make sure you’re not giving too much. Consider 28% venturi)
Salbutamol nebs 5mg
Ipratropium bromide
Oral steroid PRED 30-40mg PO or IV hydrocortisone 200mg
Abx if infective exacerbation suspected AMOXicillin 500mg-1g TDS or follow local protocols

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11
Q

Criteria for NIV in acute COPD

A

CPAP or BiPAP
Persisting respiratory acidosis after 1hr of medical management: (O2, salbutamol, ipratropium, prednisolone, and abx when indicated)

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12
Q

Pneumonia presentation

A

Symptoms of infection: temperature, malaise, anorexia, sweats, nausea
Resp symptoms: SOB, dyspnoea, cough (productive of purulent sputum), haemoptysis, pleuritic pain

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13
Q

Examination findings in pneumonia

A

Tachycardia, tachypnoea, crackles, hypotensive, febrile, confused

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14
Q

Causes of pneumonia

A

CAP - agents usually haemophilia influenzae or strep pneumonia (also mycoplasma, staph a)
HAP - classified as pneumonia >48hrs post admission - different profile of organism

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15
Q

Investigations for pneumonia

A

CXR
ABG
FBC, U&E CRP, ESR, glucose
Regular observations

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16
Q

Scoring pneumonia severity

A 
CURB-65 should be worked out for all 
Confusion - present as symptom 
Urea >7mmol/L
Resp rate >30
Blood pressure <90/<60 (either)
>65yo

***influences anti-microbial management

17
Q

Initial management of pneumonia

A

O2 - 15L NRBM aim for sats 94-98% (less for COPD patients)
IV fluids
Obtain blood cultures and sputum cultures
VTE prophylaxis
IV abx

18
Q

Anitmicrobial management of pneumonia

A

CAP

  • Mild = amoxicillin or clarithromycin
  • Moderate / severe = Co-amoxiclav + clarithromycin

HAP
- Tazocin

19
Q

Acute pulmonary oedema presentation

A

SEVERE DYSPNOEA (main sx)

  • coughing up frothy pink sputum, unable to talk
  • breathlessness is positional - sitting up helps as does tripoding
  • Sweaty, peripherally cool (incr CRT) and clammy (these all point towards a cardiogenic cause)
20
Q

Examination findings in acute pulmonary oedema

A

Unable to talk (breathless), tachypnoea, tachycardia, accessory muscle use
Wheeze
Fine inspiratory crepitations
3rd and 4th hearts sounds - gallop

21
Q

Causes of acute pulmonary oedema

A

Either cardiogenic or not
CARDIOGENIC (due to increase pulmonary blood pressure)
- arrhythmias, failure of prosthetic valve, VSD, cardiomyopathy, negative inotropic drugs, acute myocarditis
NON-CARDIOGENIC
ARDS
Decreased plasma oncotic pressure
Increased lymphatic pressure

22
Q

Investigations for acute pulmonary oedema

A 
Attach continuous cardiac monitoring 
Regular observations 
ECG 
Echo 
CXR
FBC, U&amp;E, LFTs, troponin
ABG
23
Q

Initial management of acute pulmonary oedema

A 
Sit patient upright, give O2 (15L NRBM)
Consider SL GTN 2x puffs 
IV furosemide 50mg 
Can manage pain with opioid 
Urinary catheter to monitor fluid output 
NIV
24
Q

Inhalation injury overview

A

usually of cleaning chemicals such as ammonia and chloride or SMOKE from fire
Dissolve in mucosal layer of alveoli and cause inflammatory response causing response symptoms

25
Q

PE

A

See chest pain pack

26
Q

Pneumothorax

A

See chest pain pack

27
Q

What criteria might make you consider admission in someone having an acute exacerbation of asthma?

A 
<18yo
Poor treatment adherence
Living alone
Psychogical problems 
Physical or learning disability
Previous asthma attack
Exacerbation despite adequate dose of oral corticosteroids before presentation
Presentation in afternoon or night 
Recent nocturnal symptoms 
Recent hospital admission
Pregnancy
28
Q

Summarise the treatment algorithm for an acute exacerbation of asthma

A

FOR EVERYONE
O2 if hypoxic
Nebulised salbutamol 5mg (to life-threatening or severe) - can repeat every 20-30mins or give continuously
40-50mg Prednisolone or 200mg IV hydrocortisone if severe

FOR LIFE-THREATENING OR SEVERE
Nebulised Ipratropium Bromide (500micrograms) - do not repeat within 4 hours

If unresponsive consider theophylline, and MgSO4

! ACC Separate Conditions (24 decks)

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