Respi week: Respiratory emergencies Flashcards
List indications for non-invasive ventilation
- acute exacerbation of COPD with respiratory acidosis
- respiratory failure secondary to obesity hypoventilation syndrome
- respiratory failure from underlying neuromuscular weakness (MND)
- weaning after invasive ventilation
What are NOT indications for non-invasive ventilation
- pneumonia
- severe asthma
- bronchiectasis
What would PE present with
- acute dyspnoea
- pleuritic chest pain
- cough
- haemoptysis
- raised JVP
- tachycardia (>100bpm), hypoxia, fever, DVT, tricuspid regurgitation
What does d-dimer test for
Used for diagnosis of thrombosis (e.g. for PE)
What does troponin test for
Raised if RV strain
Common causes of haemoptysis
- bronchial tumour
- bronchiectasis
- TB
- pneumonia
- PE
- bronchitis
Common causes of massive haemoptysis
- TB
- bronchiectasis
- lung abscess
- maligancy
What is the difference between primary and secondary pneumothorax
Primary: occurs in apparently normal lungs
Secondary: occurs in lungs with underlying disease
How does pneumothorax present during examination
- reduced expansion
- hyper-resonant percussion
- reduced breath sounds
Why is a tension pneumothorax potentially fatal
- Increased pressure in pleural cavity
- Compression of lungs/mediastinum
- Inhibited venous return
- Hypotension
- Cardiac arrest
How does tension pneumothorax present on examination
- acute respiratory distress
- hypotension
- raised JVP
- reduced air entry on affected side
- cardiac arrest
How does tension pneumothorax present in CXR
- tracheal deviation AWAY from pneumothorax
- reduced air entry on affected side
What group of people tend to have higher risk factor for spontaneous pneumothorax?
- tall
- fit
- male
What other conditions to test for in an unprovoked PE
- cancer
- thrombophilia
What is a respiratory-related cause of unresolved tachycardia
Pulmonary embolism
other vascular problems eg DVT also possible
Likely cause of pneumothorax in patient with COPD
Ruptured lung bullae, allowing air to escape into pleural space (rupture may be caused by coughing)
Risk factors for developing PE
- surgery
- pregnancy
- cancer
- decreased mobility eg flight
- previous DVT/ PE
- combined contraceptive
- thrombotic disorders
(not that being female is NOT a risk)
What investigations to do to diagnose PE
- d-dimer
- troponin
- ECHO (assess RV strain)
- ECG
- CXR
Causes of pleural effusion
- heart failure
- pneumonia
- PE
- lung cancer
- cirrhosis
- kidney disease
