Resp 1 Flashcards
Which abnormality presents with
Acidosis
Hypercapnia
Hypoxia
?
Type 2 Respiratory Failure
Which abnormality presents with
Hypoxia
Normocapnia
?
Type 1 Respiratory Failure
What can cause T1 Respiratory Failure?
Acute Asthma
Atalectasis (Lung Collapse)
Pulmonary Oedema
Pneumonia
Pneumothorax
PE
ARDS
What can cause T2 Respiratory Failure?
Acute Severe Asthma
COPD
Upper Airway Obstruction
Neuropathies - GBS, MND
Drugs (eg. Opiates)
What is the functional difference between the two types of Respiratory Failure?
In Type 1 RF, the lungs are still able to compensate for the hypoxia, by increasing ventilation. This leads to normocapnia, or hypocapnia.
How would you treat a case of Tension Pneumothorax?
Medical Emergency
Immediate wide bore cannula insertion at the 2nd Intercostal Space
Use an Orange or Grey needle.
How would you treat a symptomatic patient with a small Pneumothorax?
Needle Aspiration and O2
How would you treat an asymptomatic patient with a small Pneumothorax?
Reassure and discharge
What are the classical presenting features of a Pneumothorax?
Sudden-Onset
Unilateral, pleuritic chest pain
Dyspnoea
What are the main risk factors for Pneumothorax?
Male
Marfanoid habitus
Smoking
Tall
Skinny
What is the difference between Primary and Secondary Pneumothoraces?
Primary - Healthy young people without existing lung pathologies.
Secondary - Pre-existing Lung pathologies, or old long-term smokers.
How does a Tension Pneumothorax present?
Symptoms occur due to:
Lung Compression, causing:
- Severe Dyspnoea
- Tracheal Deviation away from the lesion
- Silent Chest, Hyperresonance
- Reduced expansion on the side of the lesion
Mediastinal Shift:
- Hypotension
- Tachycardia
What are the typical presenting features of a Pulmonary Embolism?
Pleuritic, unilateral Chest Pain
Hx of bed rest, recent surgery or long-haul travel
Hx of DVT (Leg tenderness/swelling)
Severe, acute dyspnoea
What is thr Well’s Scoring system?
Score used to assess the likelihood of a patient having a PE.
Assesses:
Previous Hx
Stasis
Cancer
Medical Opinion
PR
Haemoptysis
Evidence of DVT
How would you investigate a suspected Pulmonary Embolism?
Assess the patient’s Well’s Score
If 4 or above: CTPA
If less than 4: D-Dimer
What is the most common ECG finding in patients with a Pulmonary Embolism?
Sinus Tachycardia
What is a less common, but more classic ECG finding associated with Pulmonary Embolism?
S1Q3T3 - Indicative of RV strain
Prominent S wave in lead I
Presence of a Q wave in lead III
Inverted T wave in lead III
What are the main preventative measures used to prevent VTE during a hospital admission?
Anti-Embolic Stockings
Low molecular weight heparin
How would you manage a confirmed case of Pulmonary Embolism?
Haemodynamically Stable:
Respiratory Support
Anticoagulation (LMWH/Fondaparinux for 5 days, Warfarin for 3 months)
Haemodynamically Unstable:
Respiratory Support
1) Thrombolysis (IV Alteplase, Streptokinase, rt-PA)
2) Embolectomy
What should you do after starting a case of Pulmonary Embolism on first-line treatment?
Determine whether the PE was provoked (caused by obvious risk factors)
If not:
- Screen for Cancer (CT Abdo-Pelvis, Mammogram)
- Consider Antiphospholipid Testing
- Consider arranding Hereditary Thrombophilia testing if FHx
Define ARDS.
Acute Respiratory Distress Syndrome
Non-cardiogenic Pulmonary Oedema
What can cause a patient to develop ARDS?
Drugs
Barotrauma
Nearly Drowning
Severe burns
Sepsis
Pneumonia
Transfusion Reaction
How does ARDS develop?
ARDS develops due to a profound inflammatory response in the Lungs.
This leads to:
Diffuse Alveolar damage
The recruitment of Inflammatory Markers
Increased Vascular Permeability
Pulmonary Oedema
How does ARDS cause T1RF?
Alveolar Oedema increases pressure within the alveoli.
This causes collapse, which decreases the surface area available for gas exchange, and the distance between the capillary and alveoli.
This leads to hypoxia, and T1 resp failure.
How would you investigate a suspected case of ARDS?
ABG
CXR/CT
Echo
What would you see on the CXR of a patient with ARDS?
Similar to cardiogenic Pulmonary Oedema:
Alveolar Oedema (Bat Wing Opacities)
Kerley B Lines
Cardiomegaly
Dilated Upper Lobe Vessels
Pleural Effusion
