Resp emergencies Flashcards
Treatment for anaphylaxis
A-E assessment (O2 with nebuliser, fluid resuscitation, airway adjunct if unconscious)
0.5mg IM adrenaline, repeat after 5 mins if persistent hypotension
10-20mg IV clorpheniramine
100-200mg IV hydrocortisone
Monitor for 24 hours as 2nd phase symptoms in biphasic anaphylaxis
Primary vs secondary pneumothorax
Primary no known cause
Secondary due to an underlying pathology e.g Marfan’s or asthma
What does distance of pneumothorax from hilar line indicate
> 2cm means large (>50% lung lost)
Different management pathway
Define massive haemoptysis
Life threatening volume of blood (anatomical dead space 150ml)
Causes of massive haemoptysis
Lung cancer Bronchiectasis Aspergilloma TB Iatrogenic Anticoagulation
How should you position patient in massive haemoptysis
Healthy lung up so lie on side with pathology
Deceive selective intubation
1 tube enters bronchi on side of bleed for suction
1 tube stays in trachea to ventilate
Antibiotics for different curb scores
0-1: amoxicillin
2: amoxicillin and clarithromycin/doxycycline
3: co-amoxiclav and doxycycline
CURB65 criteria
Confusion - AMT<8 Urea >7mmol Resp rate >30 Blood pressure <90 systolic or <60 diastolic >65
When should an asthma patient be admitted to ITU
Respiratory acidosis due to hypercapnia
Wells score for PE
3 points: DVT symptoms (pain and calf swelling at least), PE most likely diagnosis
1.5 points: immobilisation, tachycardia, history of DVT/PE
1 point: cancer or treatment within 6 moths, coughing blood
What is a low and high risk wells score and the difference in management
Low risk 4 or less: do d-dimer and CTPA if positive
High risk more than 4: do CTPA immediately
Definition of massive PE and management
Major PE with cardiovascular complications e.g persistent hypotension
Needs thrombolysis and anticoagulation treatment dose if stable
What is PESI
PE severity index … includes age in 1 point per year
<65 can be discharged
Stepwise treatment for pulmonary oedema
Oxygen IV diuretics Morphine GTN Continuous positive airway pressure Non invasive ventilation Infra-aortic balloon pumping Positive ionotropes
