Resp 2 Flashcards
when does Light’s criteria apply?
pleural fluid
25-35 g/L
Light’s criteria - pleural effusion
Exudative
Pleural fluid LDH > 2/3 of the upper limit of the serum LDH
pleural fluid LDH / serum LDH >0.6
Pleural protein / serum LDH >0.5
Ix pleural effusion?
PA CXR
USS
contrast CT
pleural aspiration
21G needle
50ml syringe
pH, protein, LDH, cytology and microbiology
Exudative causes of pleural effusion?
inflammation
> protein is leaking from tissues into pleura
Infection
Pneumonia / TB
Inflammatory
> RA
Malignancy
Mesothelioma
Lung cancer
Transudative causes of Pleural effusion?
congestive cardiac failure
HYPO albumin
hypothyroid
Meigs
Meigs?
Pleural effusion
Ascites
benign ovarian tumour
escalating life threatening asthma
Urgent intubation and ventilation
superior vena cava syndrome
intraluminal mass or compression
when to attempt chest drain compared to needle aspiration? in pneumothorax?
needle
> symptom relief
big enough rim
Chest drain
> high risk features
» haemodynamic instab
» hypoxia
» bilateral
» underlying lung disease
» 50 years of age
montelukast MOA?
leukotriene receptor antagonist
blocks action of leukotrienes
what doe leukotrienes do?
narrowing and swelling of the airways in the lungs
= wheezing
SOB
chest tightness
cough
fostair is?
formoterol and beclometasone
LABA and ICS
severity of COPD is classified by?
FEV1
<30% is very severe
<49% Severe
<79% Moderate
<80% Mild
sarcoidosis mx
NSAIDs
steroid treatment : oral prednisolone
> lung disease
> uveitis
> hypercalcaemia
> neuro / cardiac involvement
Sudden deterioration with ventilation suggests
tension pneumothorax
what is an empyema formation
pus in a cavity
klebsiella
gram - pneumonia
alcholics and diabetics
upper lobe
Obstructive sleep apnoea can cause
HTN
compensated resp acidosis
COPD second line
if on sama what to do
and no atopy
stop SAMA
> replace with SABA
start LABA
LAMA
how to manage a tension pneumothorax?
decompress immediately with needle
Perform needle thoracostomy
decompress the pleural space and restore normal respiratory function
commonest cause of anterior mediastinum mass?
teratoma
terrible lymphadenopathy
thymic mass
thyroid mass
what is 1 pack year?
20 cigs per day for 1 year
chest drain swinging
RISES in inspiration
falls in expiration
chest drain is into the pleural space of the patient
> connect to a bottle
responds to thoracic pressures
safe triangle chest drain
> mid axillary line of 5th intercostal space
edge of latissimus dorsi
lateral border of pectoralis major
line superior to level of nipple
apex below the axilla
example of a LAMA
sama?
tiotropium
> spiriva
Ipratropium bromide
atrovent
sama and saba combo
combivent
LTOT indications in COPD
cyanosis
polycythaemia
raised JVP
<30% FEV1
o2 sats of 92%
peripheral oedema
when is oral theophylline used in COPD?
when all else fails
aspiration pneumonia from HAP - how to differentiate?
classically RLL
> right main brainstem is LARGE and STRAIGHT
what is lung volume reduction surgery?
removal of poorly ventilated but perfused areas of lung
so blood can be redistributed
Late stage alpha 1 antitrypsin deficency management?
lung volume reduction surgery
Before starting Azithromycin why is it important to do an ECG?
rule out prolonged QT interval and baseline liver function tests
diagnosis of mesothelioma?
histology and thoracoscopy
indication for corticosteroid use in sarcoidosis?
hypercalcaemia
parenchymal lung disease
uveitis
neuro / cardio involvement
Asthma adults diagnosis?
symptoms
spirometry
FENO
bronchodilator reversibility
bronchodilator reversibilty?
> 12% FEV1 increase and 200ml
> 10% of predicted normal
peak expiratory flow reversibility changes in asthma diagnostic
2 weeks
> 20%
1st line in children asthma
5-16
FeNO
>35 ppb
CRP and WCC in infection
acute phase reactant
CRP is more laggy
WC is more reflective
Mx of atelectasis?
chest physiotherapy and mobilisation and breathing exercise
what is atelectasis?
basal alveolar collapse
airway obstructed by bronchial secretions
>dyspnoea
>hypoxaemia 72 hours post op
hypoventilation would lead to?
respiratory depression can cause hypoventilation
Resp acidosis
accumulation of CO2
decrease in blood pH
Lung Cancer Mx
SCLC
chemo mainstay
adjuvant radiotherapy
kartageneres syndrome
PCD
dextrocardia - complete situs invertus
chronic sinusitis
bronchiectasis
cancers with raised platelets?
lung
endometrial
gastri
oesophageal
colorectal
il6 stimulate platelet
what is the contraindication to chest drain insertion and bleeding?
INR >1.3
cannonball mets on a CXR
CT abdomen
as it is most commonly caused by RCC
acute asthma BTS guidelines for ABG use?
o2 sats <92%
managing a Pleural effusion
Imaging
PA chest xray
USS> successful pleural aspiration
contrast CT ; underlying cause
pleural fluid findings
low glucose
amylase
blood staining
low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
Lung cancer referral
CXR findings suggestive of lung cancer
> 40 and over w unexplained haemoptysis
