Respiratory Flashcards
causes of COPD
smoking asbestos exposure coal mining asthma pollution chronic bronchitis
MRC dyspnoea scoring
1 = no breathlessness unless v strenuous activity 2 = SOB when hurrying on level / walking up hill 3 = walks more slowly, stops after 1 mile / 15 mins of walking 4 = stops after 100 yards / few mins of walking (on level ground) 5 = too SOB to leave house / SOB upon dressing
COPD treatments - mortality benefit
LTOT
smoking cessation
lung volume reduction
investigations for PE
Well’s score
D dimer +/-
CTPA
V/Q scan (can be performed if concern of radiation)
components involved in anaphylaxis
IgE
mast cells
basophils
histamine
treatment of anaphylaxis
remove trigger + maintain airway
IM adrenaline 500 MCG
IV hydrocortisone 200 mg
IV chlorphenamine 10 mg
mild asthma
PEFR > 75%
no sx of sev asthma
mod asthma
PEFR 50-75%
no sx of sev asthma
sev asthma
Any one of the following: PEFR 33-50% cannot complete full sentences RR > 25 HR > 110
life threatening asthma
Any one of the following:
PEFR < 33%
SpO2 <92% or ABG pO2 <8
cyanosis, poor respiratory effort, near / fully silent chest
exhaustion, confusion, hypotension, arrhythmias
normal pCO2
near fatal asthma
raised pCO2
acute asthma management
OSHITME Oxygen Salbutamol 5mg NEB (every 15 mins / back-to-back) Prednisolone 40mg PO Ipratropium bromide 500 MCG NEB Theophylline = aminophylline IV Magnesium sulfate Escalate care = refer to ITU / intubation
COPD exacerbation management
Oxygen: 88-94% SpO2 NEB salbutamol + ipratropium bromide Prednisolone 30 mg STAT PO + OD for 7 days Abx if CRP ^ / sputum +ve CXR consider IV aminophylline consider NIV (BiPAP) if T2RF / acidosis if pH < 2.5 ref to ITU
CURB-65 criteria
Confusion Urea > 7 RR > 29 BP systolic < 90 diastolic < 60 Age > 65
first line abx for COPD exacerbations
amoxicillin
massive haemoptysis definition
> 240 ml in 24 hours
OR
100 ml / day over consecutive days
massive heamoptysis management
lie pt on side of lesion (if known) oral / IV tranexamic acid for 5 days x NSAIDs, aspirin, anticoags Consider Abx Consider vit K CT aortogram - bronchial artery embolisation
tension pneumothorax presentations
hypotension
tachycardia
dev of trachea away from pneumothorax
dev of mediastinum away from pneumothorax
tension pneumothorax management
large bore IV annual into 2ng ICS
chest drain into affected side
? PE management
oxygen, fluid resuscitation if indicated
Well’s score
> 4 - CTPA
< 4 - D dimer
offer interim anticoagulation: apixaban (DOAC)
confirmed PE management
LMWH + dabigatran
massive PE features
hypotension / imminent cardiac arrest
evidence of right heart strain on CT / echo
massive PE management
consider thrombolysis with IV alteplase
absolute contraindications to thrombolysis
haemorrhage / ischaemia stroke < 6 months bleeding disorder GI bleed < 1 month aortic dissection CNS neoplasia recent trauma or surgery
complications of thrombolysis
IC haemorrhage / stroke reperfusion arrhythmias anaphylactic shock / allergic reaction systemic embolisation of thrombus bleeding hypotension
What is the pathophysiology of COPD?
mucus hypersecretion
ciliary dysfunction
emphysema
chronic inflammation
What comprises the COPD care bundle?
nebulisers steroids smoking cessation, diet advice pulmonary rehab bronchodilators antimuscarinics mucolytics LTOT lung volume reduction
When can LTOT be offered
recurrent SpO2 <7.2 kPa OR <8kPa + cor pulmonale
non CO2 retainers
non smokers
benefit > mobility loss associated
what is the pathophysiology behind asthma?
airway epithelial cell damage
^ goblet cell + SM cell hyperplasia
inflammatory reaction involving mast cells, eosinophils, T lymphocytes (histamine, cytokines, leukotrienes, prostaglandins)
mucus plugging
