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Y6 Emergency Care > Resp emergencies > Flashcards

Resp emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is a pneumothorax

A

Presence of air in the pleural cavity (between the parietal and visceral pleuraa)

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2
Q

What are causes of pneumothorax

A
  • Spontaneous
  • Chronic lung disease (COPD, asthma, CF, lung fibrosis, sarcoidosis)
  • Infection (TB, pneumonia, lung abscess)
  • Trauma (inc iatrogenic)
  • Carcinoma
  • Connective tissue disease (marfans, ED)
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3
Q

What are the two types of pneumothorax

A

Primary (unknown cause)

Secondary (known cause - common in underlying lung disease, smoker >50)

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4
Q

What are symptoms and signs of pneumothorax

A

SOB
tachypnoea
tachycardia
cyanosis

reduced lung expansion
hyperresonance
decreased breath sounds

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5
Q

What are investigations for pneumothorax

A

Erect PA CXR

CT (gold standard)

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6
Q

What are signs in tension pneumothorax

A

severe resp distress

tracheal deviation to contralat side

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7
Q

what causes a tension pneumothorax

A

formation of a functional valve - lets air into pleural space but not out > mediastinal deviation to contralat side > risk of CARDIAC ARREST

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8
Q

How do you measure pneumothorax size

What is the limit size

A

From the lung margin to the chest wall

2cm

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9
Q

If primary pneumothorax: SOB and/or >2cm on CXR

A

Aspirate

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10
Q

What happens if aspiration for primary pneumothorax fails?

A

Insert chest drain + admit

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11
Q

what do you do if primary pneumothorax is small <2cm and no SOB?

A

reassure, analgesia if necessary, supplemental O2 therapy,

Consider discharge and outpatient review 2 weeks

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12
Q

what do you do for secondary pneumothorax >2cm

A

Chest drain

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13
Q

what do you for secondary pneumothorax <2cm

A

Aspirate. If not successful, chest drani

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14
Q

What is the first investigations you do for a suspected PE

A

CXR, ECG (sinus tachy), ABG (T1RF)

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15
Q

How do you use clincial probablity to assess best PE scoring system

A

low probability: use PERC

medium/high prob: use Well’s score

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16
Q

What does a 2 level Wells score tell you

A

> 4 points: CTPA (or VQ scan)

<=4 points: D dimer

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17
Q

What do you do if D dimer is low

A

safe to exclude PE

18
Q

what do you do if D dimer is high

A

immediate CTPA

19
Q

what do you do if CTPA is +ve

A

DOAC

20
Q

what do you do if CTPA is negative

A

leg USS (for query DVT)

21
Q

How do you manage haemodynamically stable PE

A

DOAC

  • provoked: 3 months
  • unprovoked: 6 months
22
Q

what do you do for PE if haemodynamically stable but DOAC is contraindicated

A

5 days LMWH > dabigatran

OR consider IVC filter

23
Q

What is ARDS

A

Acute and persistent lung inflammation with increased vascular permeability

24
Q

What are diagnostic criteria for ARDS

A

Acute onset lung injury
Blateral infiltrates consistent with pulmonary oedema
Resp failure (not explained by HF)
Decreased arterial PaO2/FiO2 ratio

25
Q

What is the commonest cause of ARDS

A

Sepsis

26
Q

What are key investigations for ARDS

A 
Sepsis 6 
Bloods 
CXR, EECG 
MSU 
Echo
27
Q

How do you manage ARDS

A
  1. Central venous access >inotropes
  2. Broad spectrum antibiotics, diuretics
  3. Oxygen

If non-shocked: sit upright
If shocked: colloid infusion

28
Q

Explain PEFR in different types of asthma

A

life threatening: <33%
Severe: 33-50
Moderate: 50-75

29
Q

When do you admit someone with moderate asthma?

A

never

30
Q

when do you admit someone with severe asthma

A

If no response to treatment in A&E

31
Q

What are other features of someone with severe asthma

A

cannot complete full sentences

High RR, high HR

32
Q

What are features of life threatening asthma

A 
CHEST 
Cyanosis 
Hypotension 
Exhaustion 
Silent chest 
Tachyarrithmia
33
Q

When do you admit life threatening asthma

A

ALWAYS

34
Q

What do you give for severe asthma exacerbation

A

High flow O
Salbutamol 5mg (back to back as req) - neb
Itratropium 0.5mg (every 4h) - neb

Pred (50mg PO) or hydrocortisone (100mg IV)

Senior support: IV mag sulphate, aminophylline, ITU+ intubation

35
Q

What Ix should you get for acute exacerbate of COPD

A 
Bloods, sputum pot
ABG 
Blood culture 
ECG 
CXR
36
Q

How do you manage COPD exacerbate

A

Oxygen therapy - 24% oxygen via Venturi mask (hypoxia kills quicker than hypercapnia)

Nebulisers (salbutamol, itratropium)
Prednisolone AND hydrocort

Abx (amoxicillin / co-amoxiclav, IV or PO)

37
Q

What is the most common abnormality on ECG with PE, and what other abnormalities can occur?

A

PE: sinus tachycardia (most common).

Otherwise RBBB, S1Q3T3

38
Q

What is the PE Well’s Score? summarise all points

A

EAT CHIP

Edema in legs and other S/S = 3 points
Alternative dx less likely than PE = 3 points
Tachycardia HR >100 = 1.5 points

Cancer = 1 point
Haemoptysis = 1 point
Immobilisation (for 3+ days) or surgery (<4 weeks ago) = 1.5 points
Prior DVT/PE = 1.5 points

39
Q

where is the triangle of safety

A

in axilla

superior border = base of axilla
Anterior border = lat edge of pec major
Posterior border = ant edge of lat dorsi
Inferior border = 5th ICS

40
Q

which causes of pneumthorax must you ALWAYS insert a chest drain for

A

if the cause is TRAUMA or MECHANICAL VENTILATION

ALWAYS insert a chest drain

Y6 Emergency Care (9 decks)

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