Resp Flashcards
in an anapylaxis allergic reaction what is immedietly doen?
remove trigger, maintain airway, 100% o2
IM adrenaline 1/1000 0.5mg (500 micrograms), repeat every 5 mins
what are the featuers of a mild asthma attack?
no features of severe asthma and PEFR>75%
what are teh features of a mdoerate asthma attack?
no features of severe asthma
PEFR >50-75%
what are the features os a severe asthma attack?
PEFR 33-50% of ebst or predicted
cannot complete sentences in one breath
resp rate >25/min
HR >110/min
what are teh features of a lfie threatening asthma attack?
PEFR <33% of best or predicted
sats <92% or ABG pO2 <8kPa
cyanosis, poor resp effort, near or fully silent chest
exhaustion, confusion ,hypotension, or arrythmias
normal pCO2
what is the main distinguishing feature fo a near fatal asthma attack?
raised pCO2!!!
what is doen for the management of an acute asthma attack?
- ABCDE
- aim fro SpO2 94-98% with O2, ABG is sats <92%
- 5mg neb salbutamol (can repeat after 15 mins)
- 40mg oral prednis STAT (IV hydrocort if PO not poss)
managment for a severe asthm aattack>
ABCDE
aim for SpO2 94-94% with O2, ABG if sats < 92%
neb ipatropium bromide 500 micrograms
consider back to back neb salbutamol
what is the managemnt of life threatening or near fatal asthma attack
urgent ITU or anaesthetist assessment
urgent portable CXR
IV aminophylline
consider IV salbutamol if neb route ineffective
what features point you towards an infective COPD exacerbation over non infective?
change in sputum colour/volume
- raised WBS +/- CRP
- fever
what is management of COPD exacerbation?
ABCDE
aim for SpO2 94-98% , if evidence of type II resp failure then aim SpO2 88-92%
NEBs - salbutamol and ipratropium
steroids - prednisolone 30mg STAT and OD for 7 days
ABX if raised CRP / WCC or purulent sputum
CXR
consider NIV if type II resp failure and pH 7.23-7.35
if pH <7.25 consider ITU
what are the main features of pneumonia?
consolidation on CXR
fever
prurulent sputum
raised WCC/CRP
wha t is the managemtn of a patient with pneumonia?
- ABCDE
- if any features of sepsis - NO DELAY in administering IV ABX and fluids
- otherwsie treat with ABX as per CURB-65 score, local pneumonia guidlines
Confusion
Urea >7
RR > or = 30/min
BP <90mmHg systolic or <60mmHg diastolic
> 65 yrs
what is the initial managament fo heamopytsis?
- ABCDE
- lie pt on side of suspected lesion
- oral transexamic acid ofr 5 days (IV)
- stop NSAIDs/aspirin/anticoags
- ABx is suspcted infection
- consider vit k
- CT aortogram
what are teh major signs of a tension pneumothorax?
hypotension
tachy
deviation of trachea away from side of pneumothorax
medistinal shift away from pneumothorax
hyper resonant on percussion
reduce sound on auscultation
what is the initial managment in a tension pneumothorax?
large bore IV cannula into 2nd ICS MCL
chestdrain into affected side
what are main synptoms in pt with a PE
heamoptysis
SOB
chest pain (pleuritic)
low CO followed by collapse (massive PE)
what is the initial managment for PE?
- A-E
- O2 if hypoxic
- analgesia if pain
- subcut LMWH whilst awaiting CTPA
- fully anticoagulated once confirmed diagnosied on CTPA
features of a massive PE?
hypotension/cardiac arrest
signs of R heart strain on CT/echo
pathophysiology of asthma?
asthma is a chronic inflammatory airway disease that is reversible
there is an increased airway responsiveness (narrowing due to increased muscel contraction, increase mucus production) to a variety of stimuli
- airway epithelial damage - shedding and subepithelial fibrosis, basement membrane thickening
- inflammatory reaction characterised by T lymphocytes and mast cells. inflmmatory mediators released include histamine, leukotrienes and prostaglandins
- cytokines amplify inflammatory repsonse
- increased number of mucus secreting goblet cells and smooth msucle hyperplasia and hypertrophy
- mucus plugging in fatal and severe asthma
what are teh main differentials fro a wheeze heard in a pt?
- acute asthma exacerbation
- bronchitis - viral or bacterial
criteria for safe asthma discharge?
PEFR>75%
- stop regular nebs fro 24 hrs prior to discharge
- inpatient asthma nurse review to assess inhaler technique and adherence
- at least 5 days oral prednis
- provide PEFR mete and written astham action plan
- GP follow up within 2 working days
- resp clinic follow up within 2 wks
name some asthma triggers
smoking
exercise
cold weather
allergens - pollens, dust mites, pets
URTI - mainly viral
drugs - aspirin, beta blockers
- pollution
occupation irritanst
food and drink
stress
what is the overview of management for severe asthma?
- use BTS stepwise managemnt guidelines
- assess and teach inhaler technique
- use self managment plans
- avoid trigger factors