Resp Flashcards
ABG - normal pH
7.35 - 7.45
ABG - normal pCO2
4.5 - 6.0 kPa
ABG - normal pO2
10 - 14 kPa
Indications for NIV - in COPD
COPD with respiratory acidosis pH 7.25 - 7.35 (after starting nebs + steroids)
Initial settings for BiPAP in COPD - EPAP
4 - 5 cm H2O
Initial settings for BiPAP in COPD - IPAP
10 cm H2O
Initial settings for BiPAP in COPD - back up rate
15 breaths/min
Initial settings for BiPAP in COPD - back up insp:expiration ratio
1:3
Primary pneumothorax - rim < 2cm - not short of breath
Consider discharge
Primary pneumothorax - rim > 2cm or short of breath
Aspiration
Primary pneumothorax - rim still >2cm or still short of breath after attempting aspiration
Insert chest drain
Secondary pneumothorax - rim > 2cm and/or > 50 years old
Insert chest drain
Admit for 24+ hours
Secondary pneumothorax - patient < 50 years old, rim 1 - 2 cm
Attempt aspiration
Admit for 24+ hours
Secondary pneumothorax - rim still > 1 cm after attempting aspiration
Insert chest drain
Admit for 24+ hours
Secondary pneumothorax - patient < 50 years old, rim < 1 cm
Give oxygen
Admit for 24+ hours
Diving after secondary pneumothorax
Avoid permanently, unless had bilateral pleurectomy + normal lung Fx + CT post-operatively
Features of Lefgren’s syndrome (acute form of sarcoidosis)
BHL
Erythema nodosum
Fever
Polyarthralgia
Paraneoplastic ADH associated with which lung cancer
Small cell
Paraneoplastic ACTH associated with which lung cancer
Small cell
Lamber-Eaton paraneoplastic syndrome associated with which lung cancer
Small cell
Paraneoplastic PTH-rp associated with which lung cancer
Squamous cell
Paraneoplastic HPOA associated with which lung cancer
Squamous cell,
Adenocarcinoma
Paraneoplastic TSH associated with which lung cancer
Squamous cell
Paraneoplastic syndromes - Clubbing is associated with which lung cancer
Squamous cell
Paraneoplastic syndromes - Gynaecomastia is associated with which lung cancer
Adenocarcinoma
Causes of bronchiectasis
Post-infective Bronchial obstruction Cystic fibrosis, ciliary dyskinesias Immune deficiency ABPA Yellow nail syndrome
Post-infective causes of bronchiectasis
TB
Measles
Pertussis
Pneumonia
Immune deficiency causes of bronchiectasis
Selective IgA deficiency
Hypogammaglobulinaemia
Medication licensed for idiopathic pulmonary fibrosis
Pirfenidone,
Nintedanib
Pirfenidone MOA
Anti-fibrotic agent
Features of ABPA
Bronchoconstriction
Bronchiectasis
Eosinophilia
Life threatening asthma - PEFR
PEFR <33% best or predicted
Life threatening asthma - Oxygen sats
sats < 92%
Life threatening asthma - pCO2
‘Normal’ pCO2 (4.6 - 6.0 kPa)
Life threatening asthma - Examination
Silent chest,
Cyanosis,
Poor respiratory effort
Exhaustion, confusion, coma
Severe asthma - PEFR
PEFR 33 - 50% best or predicted
Severe asthma - Examination
Can’t complete sentences
Severe asthma - RR
RR >25/min
Severe asthma - HR
HR > 110 bpm
Life threatening asthma - Obs
Bradycardia
Dysrhythmia
Hypotension
Moderate asthma - PEFR
PEFR 50 - 75% best or predicted
Moderate asthma - Examination
Speech normal
Moderate asthma - RR
RR < 25/min
Moderate asthma - HR
HR < 110 bpm
COPD exaverbation - NIV unavailable/inappropriate
Doxapram
Doxapram MOA
Respiratory stimulant
COPD - still breathless on SABA/SAMA and LABA + ICS
Add LAMA
COPD - 1st line
SABA/SAMA prn
COPD - Still breathless on SABA/SAMA without asthmatic features/steroid responsiveness
SABA prn
LABA + LAMA regular
COPD - Still breathless on SABA/SAMA + asthmatic features/steroid responsiveness
SABA/SAMA prn
LABA + ICS regular
COPD -
SABA prn
LABA + LAMA regular
Still breathless
SABA prn
LABA + LAMA + ICS regular
COPD
SABA/SAMA prn
LABA + ICS regular
Still breathless
SABA prn
LABA + LAMA + ICS regular
Features of EGPA (Churg-Strauss)
Lung disease (late onset/worsening 'asthma') Renal disease (AKI) Eosinophilia pANCA Mononeuritis multiplex NO SINUSITIS (in exams)
Pulmonary hypertension group 1
I - Pulmonary arterial hypertension (PAH)
Pulmonary hypertension group 2
II - Pulmonary hypertension secondary to left heart disease
Pulmonary hypertension group 3
III - Pulmonary hypertension secondary to lung disease
Pulmonary hypertension group 4
IV - Pulmonary hypertension secondary to chronic thromboembolic disease
Pulmonary hypertension group 5
V - Pulmonary hypertension with unclear cause
Sarcoidosis - indications for steroids
Stage 2 or 3 disease + symptomatic
Hypercalcaemia
Eye/heart/neuro involvement
Restrictive spirometry - FEV1/FVC ratio
FEV1/FVC > 0.7
Obstructive spirometry - FEV1/FVC ratio
FEV1/FVC < 0.7
Cavitating upper lobe pneumonia in diabetic/alcoholic
Klebsiella