Respiratory Flashcards
What is asthma
Chronic inflammation of airways secondary to T1 hypersensitivity
reversible bronchospasm - obstructs airway
Asthma risk factors
Atopy maternal smoking, RSV infection low birth weight X breast fed allergens exposure air pollution hygiene hypothesis
IgE mediated atopic conditions
Atopic dermatitis - eczema
Allergic rhinitis - hay fever
Asthma symptoms
cough (worse at night)
dyspnea
wheeze
chest tightness
Asthma signs
Expiratory wheeze
reduced PEFR
FEV1/FVC <70%
Asthma management
- SABA - salbutamol
- Inhaled corticosteroids
- Leukotriene receptor antagonists - montelukast
- LABA - salmeterol
Acute asthma?
worsening dyspnoea, wheeze, cough
not responding to SABA
can be triggered by infection
Moderate acute asthma
PEFR 50-75%
normal speech
RR <25
HR <110
Severe acute asthma
PEFR 33-50
can’t complete sentences
RR >25
HR >110
Life threatening acute asthma
PEFR <33 O2 <92% silent chest, cyanosis bad resp effort Bradycardia dysrhythmia hypotension exhausted confusion coma
near fatal acute asthma
PCO2 raised!
need mechanical ventilation
Acute asthma management
- O2 - 15L, non rebreathe
- 94-98% sats
- salbutamol neb 5mg
- ipratropium neb 0.5mg
- hydrocortisone IV 100mg
OR 40mg prednisolone oral
Acute severe/life threatening asthma management
- magnesium sulfate IV 20mg
- aminophylline, maybe IV salbutamol
- invasive ventilation
COPD
chronic obstructive pulmonary disorder
chronic bronchitis, emphysema
COPD causes
smoking
alpha 1 antitrypsin deficiency
cadmium, coal, cotton, cement, grain
COPD symptoms
cough - productive
dyspnea
wheeze
RH failure - peripheral oedema
COPD CXR
hyperinflation
bullae (mimic pneumothorax)
flat hemidiaphragm
exclude lung cancer
COPD post-bronchodilator therapy
FEV1/FVC ratio <0.7 and also FEV1 - mild >80% - mod 50-70 - severe 30-49 - v severe <30
COPD management
- SABA/SAMA
- if they have asthmatic features - LABA/ICS
- If not LABA or LAMA
COPD triple therapy
if still exacerbations
LAMA, LABA, ICS
too many COPD exacerbations?
oral prophylactic AB therapy
azithromycin prophylaxis
requirements for starting oral prophylaxis antibiotic therapy
need to quit cigs
CT exclude atypical infection/TB
LFTs, ECG needed to exclude QT prolongation (azi can make it longer)
chronic productive cough w COPD?
mucolytics
Carbocysteine
long term O2 therapy
15hrs a day if severe airflow abs cyanosis polycythameia peripheral oedema raised JVP O2 <92% measure w 2 ABGs
COPD exacerbation?
increased, dyspnea, cough, wheeze
increased sputum
hypoxic
acute confusion
COPD exacerbation organisms
H influenza
H rhinovirus
S pneumoniae
M catarrhalis
COPD exacerbation management?
24% O2 Venturi mask 88-92%
Nebuliser salbutamol 5mg/4hr
Ipratropium 0.5mg/6hr
30mg prednisolone 5 days
And hydrocortisone???
oral ABS if sputum purulent/signs of pneumonia
- amoxicillin, clarithromycin, doxycycline
what is pleural effusion, symptoms
excess fluid between pleura membrane
- dyspnea
- pleuritic chest pain
- non-productive cough
pleural effusion transudate
<30g/L protein Heart failure Hypoalbuminaemia - liver disease, nephrotic metastases hypothyroidism meigs ew?
pleural effusion exudate
>30g/L infection, pneumonia, TB, abcess RA, SLE lung cancer PE dressers yellow nail
pleural effusion signs
trachea AWAY
stony dull
less air entry, bronchial breathing
reduced expansion/resonance
pleural effusion X-ray
Blunt costophrenic angles
Dense shadow –> meniscus
Mediastinal shift away
Coin lesion/cardiomegaly
pleural effusion US
guides aspiration, detects fluid
pleural effusion CT
underlying causes
pleural effusion aspiration
percuss border, 1/2 spaces below lignocaine 21g needle send for inspection allow to drain?
pleural effusion fluid analysis raised amylase, low pH
pancreatitis, oesophageal perforation
pleural effusion fluid analysis low glucose, low ph, high protein
RA, TB, SLE
pleural effusion fluid analysis blood staining
mesothelioma, PE, TB
pneumothorax, symptoms
air in pleural space collapse? - sudden - dyspnea - pleuritic chest pain - sweating - tachycardia, tachypnea
tension pneumothorax, signs
one-way valve - air can't escape respiratory distress cardiac arrest mediastinal compression increased JVP increased HR, low BP
causes of primary pneumothorax
young, thin men
smokers
causes of secondary pneumothorax
COPD asthma CF lung cancer pneumonia marfans, EDS, pulmonary fibrosis, sarcoidosis
trauma pneumothorax
penetrating
blunt, rib fractures
pneumothorax signs
reduced expansion, breath sounds, VR
resonant percussion
tension pneumothorax management
resus
no CXR
large bore 2nd ICS mid clavicular
ICD
primary pneumothorax management
<2cm/no SOB –> discharge?
larger –> aspirate, if fails chest drain
stop smoking!!!
secondary pneumothorax management
> 50, >2cm, SOB
chest drain
if not attempt aspiration first
sarcoidosis, who?
multisystem
non-caveating granulomas
young, African, females
Acute sarcoidosis presentation
erythema nodosum bilateral lymphadenopathy fever - swinging polyarthralgia weight loss fatigue HSM
sarcoidosis other features
SOB, chest pain polyneuropathy renal stones pit dysfunction uveitis restrictive cardiomyopathy pericardial effusion cholestatic LFTS lupus pernio
sarcoidosis blood results
hypercalcaemia
increased ESR, Ig, LFTs, ACE
sarcoidosis investigations
bloods
tuberculin neg in 2/3
spirometry - restrictive
biopsy - lung, LN, liver
sarcoidosis management
asymptomatic - nothing acute - bed rest, nsaids chronic - 40mg red 4-6 wks - immunosuppression - methotrexate, ciclosporin ...
BHL differentials
sarcoidosis
TB, mycoplasma
lymphoma, carcinoma
interstitial disease
type 1 resp failure
hypoxaemic PaO2 <8 PaCO2 <6 V/Q mismatch damage to lung tissue prevents oxygenation, diffusion failure
type 2 resp failure
hypercapnic PaO2 <8 PaCO2 >6 may have V/Q mismatch alveolar ventilation unable to excrete CO2
type 1 resp failure causes
Pneumothorax, PE, pulmonary hypertension , atelectasis,
COPD, asthma, bronchiectasis
pulmonary fibrosis, oedema,
type 2 resp failure causes
chest wall, muscle weakness CNS depression severe asthma obesity hypothyroid
hypoxia acute effects
dyspnea, tachypnea agitation confusion cyanosis tachyarrhythmias
chronic hypoxia effects
polycythemia
pulmonary hypertension
cor pulmonale
hypercapnia effects
headache flushing peripheral vasodilation/warm bounding pulse flap confusion, coma
asthma - spirometry
FEV1 reduced
FEV1/FVC <70%
obstructive pattern
increased 12% w beta agonist
asthma investigations
spirometry
diurnal variation
atopy
FeNO (>40ppb positive)
Pulmonary embolism?
Blood clot in lungs!
- pleuritic chest pain
- dyspnea
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