resp treatments Flashcards
asbestosis
symptom management
no treatment known to alter disease but corticosteroids are often prescribed
acute bronchitis
over the counter painkillers
antibiotics are often given (amoxicillin)
ARDS
admit to ITU, supportive care, treat underlying cause
Respiratory Support: Early ARDS - CPAP with 40-60% oxygen, later mechanical ventilation may be required
asthma
Step 1: SABA (salbutamol) as required + low dose ICS (beclometasone)
Step 2: + LABA (salmeterol)
↑ICS
Step 3: + 4th Drug: LTRA (montelukast), Methylxanthines (theophylline), LAMA (tiotropium), Sodium Cromoglicate in children
Step 4: + oral steroid (prednisolone)
Step 5: Consider trials of anti-IgE (Omalizumab)/IL-5 (Mepolizumab)/IL-4 (Dupilumab)
acute asthma
Acute O SHIT Man: Oxygen Salbutamol (neb) Hydrocortisone IV / oral prednisolone Ipratropium (neb) if PEF <75% Theophylline Magnesium Sulphate IV Anaesthetist
small cell carcinoma
chemotherapy and radiotherapy (SABR)
non-small cell carcinoma
surgery – lobectomy or pneumonectomy, radical radiotherapy, palliative chemotherapy, adenocarcinoma – EGFR mutations
bronchiectasis
Stop smoking, flu vaccine, pneumococcal vaccine
Airway clearance techniques and mucolytics
Antibiotics:
>3 exacerbations/year, preventative treatment:
low dose oral macrolides – clarithromycin 1x daily, azithromycin 3x a week
Persistent bacteria in bronchiectasis: oral macrolide (azithromycin), nebulised gentamycin, alternating oral Abs, pulsed IV Abs
Exacerbations
2 weeks of sensitive antibiotics
Bronchodilators
Corticosteroids
Surgery: for localised disease or to control severe haemoptysis
COPD
LABA/LAMA + SABA
LABA/LAMA/ICS – for frequent exacerbator with high eosinophilic counts (>300 cells)
acute COPD
iSOAP
Ipratropium (SAMA) – nebulised
Salbutamol (SABA) – nebulised
Oxygen 24-28%, keep SaO2 between 88-92% (if CO2 is normal target is 94-98%)
Amoxicillin if infection likely
(or doxycycline or clarithromycin)
Prednisolone – oral / hydrocortisone – IV
Aminophylline – IV (if no response)
cor pulmonale
Treat underlying cause
Treat respiratory failure – 24% oxygen in PaO2 <8kPa, monitor and slowly increase
Treat cardiac failure –diuretics (eg. furosemide), monitoring U&E
Consider venesection if haematocrit >55%
Consider heart-lung transplantation in young patients
cystic fibrosis
Physiotherapy (autogenic drainage, active cycle of breathing)
Antibiotics
Mucolytics
CREON (for absorbing energy due to exocrine failure)
Dietary input
Gastrograffin/Laxido for distal intestinal obstruction syndrome
Annual glucose monitoring
Out of hospital parenteral admission therapy
New gene therapies which target mutations
Lung Transplantation
empyema
Chest drainage
Broad spectrum IV antibiotics: amoxicillin and metronidazole
Targeted oral antibiotics for 5 weeks
epiglottis
Secure airway with ET tube and urgent IV antibiotics (vancomycin, clindamycin or ceftriaxone)
Hypersensitivity Pneumonitis
Acute: remove allergen and give O2 (35-60%), prednisolone
Chronic: allergen avoidance, long-term steroids (prednisolone)
idiopathic pulmonary fibrosis
Supportive Care: oxygen, pulmonary rehabilitation, opiates, palliative care input
Anti-fibrotic drugs (pirfenidone and nintedanib): slow disease progression
Oxygen if hypoxic
Pulmonary rehabilitation
Lung transplant (in young patients)
influenza
bed rest and paracetamol
Uncomplicated Influenza:
Symptomatic treatment
Antivirals for high risk patients
Complicated Influenza:
Antivirals Oseltamivir /Zanamivir
Antibiotics can also be given, as influenza can result in secondary bacterial infection
lung abscess
IV antibiotics
mesothelioma
Pemetrexed + cisplatin chemotherapy
obstructive sleep apnoea
Weight loss, avoidance of tobacco and alcohol, mandibular advancement device/surgery, CPAP during sleep, surgery
pertussis
clarithromycin
pleural effusion
Drainage (slow) for symptomatic effusions
Pleural tap
Long term pleural catheters (malignancy)
Pleurodesis with talc for recurrent effusions
Surgery for persistent collections and increasing pleural thickness
Palliative care including chemotherapy (pemetrexed/cisplatin combo) and radiotherapy
INR> 1.3 is a contraindicator for chest drain insertion (high INR means blood takes longer to clot)
Chest drainage is required in patients with a pH <7.2 – raises suspicion of pleural infection
pneumonia
Antibiotics
Community Acquired: amoxicillin / doxycycline
Hospital Acquired: amoxicillin + gentamycin
Aspiration: amoxicillin + metronidazole
Legionella: levofloxacin
Oxygen – SaO2 94-98% / 88-92%
Fluids
Bed Rest
pneumothorax
Primary:
<2cm and not SOB: Discharge and outpatient review
>2cm and/or SOB: HF O2, aspirate (16-18G needle)
discharge and review
Secondary:
>2cm or SOB: Chest Drain
1-2cm: Aspirate (16-18G needle)
admit for 24hour observation and review
tension pneumothorax
-needle decompression with a cannula through anterior second intercostal space in the mid-clavicular line on the side of the pneumothorax, then insert a chest drain and get a CXR
pulmonary embolism
Thrombolyse (tenecteplase) for massive PE
If haemolytically stable: LMWH (Fragmin) and warfarin – stop warfarin when INR is 2-3
Or DOAC (dabigatran) or factor X (rivaroxaban / apixaban)
Consider placement of IVC filter for recurrent PE
Prevention: heparin to all immobile patients
vitamin k antagonist should be given within 24 hours of diagnosis
respiratory distress syndrome
Keep warm, NCPAP to prevent atelectasis, intubation + ventilation to deliver artificial surfactant
type 1 respiratory failure
Treat underlying cause Give oxygen (24-60% by facemask Assisted ventilation (NIPVV) if PaO2 <8kPa despite 60% O2
type 2 respiratory failure
Treat underlying cause
Controlled oxygen therapy (start at 24% oxygen)
If this fails, consider intubation and ventilation
rhinitis
Glucocorticoids Anti-histamines Anti-cholinergic drugs Sodium Cromoglicate Cysteinyl Leukotriene Receptor Antagonists Vasoconstriction
sarcoidosis
Acute Sarcoidosis: bed rest, NSAIDs, steroids if a vital organ is affected
Indications for corticosteroids (prednisolone for 4-6 weeks):
parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement
sinusitis
Self-resolving but can require antibiotics Symptom relief: nasal decongestant vasoconstrictor (oxymetazoline), a nasal steroid or pseudo-ephedrine
tuberculosis
Active TB
Isoniazid & Rifampicin & Pyrazinamide & Ethambutol for 2 months
+ Isoniazid & Rifampicin for a further 4 months
Latent TB
Isoniazid & Rifampicin for 3 months
