REspi failure

Question 1

asthma pharm rx

Answer 1

1. inhaled SABA
2. low dose ICS
3. LABA or med dose ICS
4. LABA + med dose ICS
5. LABA + high dose ICS
6. • oral corticosteroids
7. specialist e.g omalizumab

Question 2

acute on chronic respi failure: PO2 targets

Answer 2

not exceeding 60-65mmHg

60 corresponds to SaO2 of 90%

but in acidotic patients, HbO dissco curve shift to right thus for any given pO2, Hb sats are lower

Question 3

best parameter for monitor alveolar ventilation

Answer 3

pCO2

if repeat ABGs required, put arterial line

Question 4

first line neb

dose

repeat

timing to max effect

Answer 4

5mg (1mg) salbutamol with 1ml N saline

up to 3 doses

taking 15 mins each

Question 5

COPD: salbutamol neb inadequate, 2nd line neb

and dose

timing

Answer 5

ipatropium bromide 250-500microgs every 4-6 hours

Question 6

COPD other rx

Answer 6

1. 14 days oral steroids
2. abx
3. CPAP and Bipap, intubation
4. mucolytics
5. chest physio

Question 7

nebs still not working, 3 techniques

Answer 7

1. undiluted
2. cont
3. parenteral salbutamol (rare, try steroids first)
   4.

Question 8

respi cause of raise JVP

Answer 8

hypoxic pul vasoconstriction

Question 9

3 explanation for increase in pCO2 on the administration of O2

Answer 9

1. Haldane effect: oxygenated Hb lose affinity for CO2, release into plasma
2. VQ mismatch due to hypoxic vasoconstriction
3. oxygenation lead to more bicarb dissociating into CO2 and H+