RESP TREATMETS Flashcards
pneumothorax
chest drain 4/5 intercostal space mid axillary line
tension pneumothorax
chest drain 2nd intercostal space mid clavicular line
16 gage cannula/large bore cannula
guided by US
reticular dysgenesis
bone marrow transplant
supportive Kostmann’s Syndrome
prophylactic antibiotics and anti fungals
definitive Kostmann’s Syndrome
Stem cell transplant and granulocyte colony stimulating factor (G-CSF)
supportive chronic granulomatous disease
prophylactic antibiotics and anti fungals
definitive chronic granulomatous disease
stem cell transplant
g-IFN therapy
phagocyte deficeincy
gene therapy
bone marrow transplant
SCID
hospitalised avoid infection (no vaccines, prophylactic antibiotics and anti fungals) agressive Tx of infection antibody replacement - IV Ig stem cell transplant
DiGeorge Syndrome
correct metabolic/cardiac problems
prophylactic antibiotics
early and aggressive Tx of infection
Ig replacement
B cell deficiency
aggressive Tx of infection
immunoglobulin replacement
stem cell transplant
anaphylaxis
adrenaline
allergy
immunotherapy (allergen administered SC injections)
T2 hypersensitivity
e.g. ABO blood reaction
immunosuppression
Plasmapheresis
T3 hypersensitivity
e.g. SLE, acute hypersensitivity pneumonitis, farmers/bird fanciers lung
avoidance
corticosteroids
immunosuppression
oxygen if acute
Sarcoidosis
NSAIDs
bed rest
corticosteroids e.g. oral prednisolone
immunosuppression e.g. methotrexate
Acute cellular or vascular rejection
immunosuppression
chronic allograft failure
minimise drug toxicity/hypertension/hyperlipidaemia
Flu
bed rest
fluids
paracetamol
Antivirals if risk of complications - Oseltamivir, Zanamivir
Atypical pneumonia
clarithromycin
tetracycline
legionella
erythromycin/clarithromycin
Fluoroquinolone e.g. levofloxacin
Pneumocystis Jiroveci
Co-trimoxazole
CAP HAP ASPIRATION PNEUMONIA EPIGLOTTITIS SUPRAGLOTTITIS COPD
look at antibiotic man deck
bronchiolitis
RSV - supportive Tx // Palivizumab - monoclonal AB not widely used
CF younger patients
Staph. Aureus/ Haemophilus Influenzae
flucloxacillin - Staph Aureus
ceftriaxone - haemophilus influenzae
CF older patients
Pseudomonas aeruginosa
Burkholderia Cepacia
Ciprofloxacin (oral)
Gentamicin (IV)
Tayzosin (IV)
Whooping cough
Erythromycin
clarithromycin
Bronchiectasis
Postural drainage
mild - cefaclor/ciprofloxacin/flucloxacillin (if SA)
persistent - ceftazidime
stop smoking, flu and pneumococcal vaccine
Bronchiectasis and chronic bronchial sepsis
prophylactic antibiotics
gentamicin neb
Pulsed IV ABs
alternating oral ABs
large PE
thrombolysis
small PE
LMWH
TB + HIV
RIPE for life
respiratory and non-respiratory TB
RIPE - 2 months
RI - 4 months
meningitis and CNS TB
RIPE 2 months
RI - 10 months
latent TB and about to undergo immunosuppression
RIPE 3 months prior
what is the first line treatment of asthma
intermittent asthma
SABA - reliever, PRN
what is the second line treatment of asthma
mild persistent asthma
ICS - 1st line preventer
what 4 drugs could be considered as 3rd line treatment of asthma
controllers
moderate persistent asthma
Theophylline (oral)
CysLT RA e.g. montelukast, oral OD
LABA/LAMA
Anti-IgE e.g. omalizumab/Anti-IL5
what is the 4th line treatment of asthma
severe persistent
oral steroid e.g. prednisolone
what is the asthma treatment pyramid
Some - SABA Interesting - ICS Ladies - LABA Can - CysLT RA Tame - Theophylline A - Anti-IgE Prince - Prednisolone
what is the treatment for acute asthma
OSHITMAN
O - Oxygen (atleast 60%)
S - SABA e.g. Salbutamol - high dose nebulised
H- Hydrocortisone IV or oral prednisolone
I - Ipratropium (SAMA) - nebulised
T- Theophylline /aminophylline/magnesium
M- Magnesium Sulfate
AN- ANaesthatist - ITU assisted mechanical intubated ventilation
Acute COPD
Salbutamol + ipratropium (neb high dose)
oral prednisolone
antibiotic if infective (amoxicillin)
oxygen
physio to help sputum expectoration
non-invasive ventilation to allow higher FiO2
ITU intubated assisted ventilation only if reversible component e.g. pneumonia
management of COPD
SAMA (mild) - e.g. ipratropium 4 times daily
LAMA - tiotropium once daily, aclidinium BD
ICS - frequent severe exam. e.g. beclametasone
LABA
PDE4 inhibitor e.g. roflumilast oral
Mucolytic e.g. carbocisteine oral
ABs for infective
alveolitis
systemic corticosteroids e.g. oral prednisolone
oral azathioprine - steroid sparing immunosuppressive
oxygen if hypoxia
treat pulmonary hypertension
idiopathic pulmonary fibrosis
(cryptogenic fibrosing alveolitis
anti-fibrinotic agents e.g. pirfenidone, nintedanib
mesothelioma
chemotherapy
non-small cell
surgery
radiotherapy
Gefitnib - tyrosine kinase inhibitor
what is the condition for lung cancer resection
must be atleast 2cm of disease free bronchi
what is the condition for radiotherapy
if target is < 5cm diameter
what are 3 types of endobronchial palliative treatments
stent insertion for stridor
photodynamic therapy
laser therapy
Radioactive pellets
small cell
chemo
croup (laryngotracheobronchitis)
oral steroids e.g. prednisolone
sleep apnoea
remove underlying cause - lose weight, reduce alcohol
CPAP
Asbestosis
symptomatic relief
Pneumoconiosis
remove exposure
CF
postural drainage and physiotherapy ABs salbutamol beclometasone pancreatic enzyme supplements vitamins high calorie diet
empyema
drainage
IV broad spectrum ABs
oral culture - specific
central sleep apnoea
NIPPV
treat underlying condition
respiratory stimulant
neonatal distress syndrome
ventilation and extra O2
artificial surfactant
to prevent - expectant mothers given steroids
Rhinitis
corticosteroids (beclometasone, prednisolone) Antihistamines SAMA - ipratropium Sodium Cromoglycate CysLT - montelukast
ARDS
ICU ventilation
treat underlying cause
prevention of transplant rejection
ciclosporin
most haemophilus influenza are sensitive to…
amoxicillin
pneumococci are treated with
amoxicillin
most pneumococci and h. influenza are sensitive to…
doxycycline
what does Co-amoxiclav cover
most H. influenza and coliforms
doxycycline covers atypicals except…
legionella
true/false Levofloxacin covers... MSSA H.influenza pneumococci coliforms legionella
true
what is the treatment of rhinitis
CAICM
corticosteroids anti-histamine ipratropium croons montelukast
