REsp Flashcards
Hospital acquired pneumonia - antibiotics to use
Ceftriaxone (low risk: HA from ward)
High risk: from ICU, ventilator etc (concern about pseudomonas)
Tazosin = piperacillin/tazobactram
Common causes of HA pneumonia
Gram neg: klebsiella, E coli, pseudomonas, bacteroides
MRSA
Common causes of community acquired pneumonia (typical)
Strep pneumonia (90% cases)
H influenzae
Moraxella
Staph aureus
Common causes of community acquired pneumonia (atypical)
Mycoplasma pneumonia
Chlamydia pneumoniae
Legionella
Pneumocystis Jiroveci
What is COPD characterised by?
airway inflammation and limitation that IS NOT FULLY reversible (asthma is fully reversible so is not COPD)
What medical conditions does COPD include? Define them
Emphysema - dilation and destruction of lung tissue distal to terminal bronchiole (alveolar wall destruction and overinflation)
Chronic bronchitis - persistent PRODUCTIVE cough for at least 3 consecutive months in at least 2 consecutive years (airway inflammation)
Risk factors/causes of COPD
Cigarette smoking Air pollution Occupational exposure Alpha1 antitrypsin deficiency Recurrent RTIs in childhood Genetics
What pattern would you see on respiratory function test with COPD?
Restrictive lung disease.
Forced expiratory ratio (FEV1/FVC) <70% indicating airflow obstruction.
FEV1 is reduced but FVC normal.
With no improvement with bronchodilator (ventolin).
Pathophysiology of emphysema
Noxious agent causes release of destructive cytokines and neutrophils, macrophages and CD8+ T cells which cause ongoing destruction of lung parenchyma - destruction of elastin and alveolar membranes -> reduced elastic coil - air trapping during expiration
Pathophysiology of chronic bronchitis
Noxious agent causes release of destructive cytokines and neutrophils, macrophages and CD8+ T cells which cause ongoing destruction of lung parenchyma and airway inflammation and remodelling
-> enlarged mucus secreting glands, goblet cell metaplasia, bronchial wall fibrosis, hyper secretion of mucus, inflammation
Clinical features of COPD
Chronic productive cough
Wheeze
SOB
HX smoking
What will you find on chest examination for COPD (Non-examination)
Auscultation - breath sounds reduced with prolonged expiratory phase, wheeze Percussion - normal/hyper-resonance Vocal resonance - normal or reduced Hyperinflation (barrel chest) Decr expansion
Classic CXR findings for COPD
hyperinflation (>6 ribs anterior ribs above diaphragm in mid-clavicular line)
Flat hemidiaphragms
Large central pulmonary arteries
Decr peripheral vascular markings
Management plan for COPD
CONFIRM diagnosis w pulmonary function tests
- smoking cessation
- influenza and pneumococcus vaccine (reduces risk of exacerbations)
- pulmonary rehab
- medications (depend on stage of disease)
- Long-term o2 therapy if chronic resp failure (Stage 4) - must be non-smokers
Pharmacological treatment of COPD
Stage 1: Short acting bronchodilators when needed
- Short acting beta 2 agonists (Salbutamol/Ventolin)
- SAMAR (ipratropium)
Stage 2: regular treatment with one or more long acting bronchodilators
- LABAs (Salmeterol/Serevent)
- LAMAR (Tiotropium/Spiriva)
Stage 3/4: Inhaled glucocorticosteroids if repeated exacerbations
Complications of COPD
CHRONIC BRONCHITIS COMPLICAITONS:
- SCC of lung resulting from squamous metaplasia
- Infective exacerbations
- Hypoxia -> pulmonary HTN -> cor pulmonale
EMPHESEMA COMPLCIATIONS
- Loss of diffusion capacity
- pneumothorax
- hypoxia -> pulmonary HTN -> cor pulmonale
Management of exacerbation of COPD
Give O2
Bronchodilators
Corticosteroids
Antibiotics
Mobilisation
Non-invasive ventilation - BiPap, VPAP
Why don’t you give high flow O2 with COPD?
Don’t give too much too quickly though, may be in chronic resp failure where their drive to breathe is low O2.
If you increase O2 then you decrease their drive to breathe which leads to hypercapnoea
Definition of bronchiectasis
Chronic infection of bronchi and bronchioles leads to permanent dilation of bronchi, as well as inflammatory changes in airway walls and neighbouring parenchyma
Pathophys of bronchiectasis
Recurrent inflammation of bronchial walls weakens walls
Fibrosis of surrounding parenchyma puts traction on and weakens walls, causes dilation
Symptoms of bronchiectasis
Signs
Cough
Copious purulent foul smelling sputum
intermittent haemoptysis
Signs:
- Clubbing
- Exp wheeze
- Coarse insp crepitations
Causes of bronchiectasis
Obstructive
- tumour
- foreign body
- thickened mucus (asthma)
Post-inflammation
- pneumonia
- Tb
- measles etc
Weakened defences
-CF
Common causes of lung abscesses
- Most commonly a complication of aspiration pneumonia (aspirated objects accompanied by bacteria -> inflammation secondary to inflammation -> localised consolidation)
- Pulmonary infarct
- malignancy
- Penetrating trauma
- Bronchial obstruction
Management of lung abscess
Empiracle antibiotics
If non-resolving, surgical intervention
+/- postural drainage
+/- chest physiotherapy