Respiratory

Question 1

What is anaphylaxis? and how is it split?

Answer 1

Anaphylaxis is an acute systemic hypersensitivity reaction with airway compromise.

classified:

• Immunogenic: IgE mediated
• Non-immunogenic: Mast cell degranulation with out antibodies

Question 2

what are the physiological effects of anaphylaxis? and the clinical features?

Answer 2

• Bronchospasm
• Capillary permeability
• Oedema

Clinical:

• stridor
• Angiooedema
• cyanosis
• Hypotension
• Urticaria

Question 3

How would you manage an anaphylactic patient?

Answer 3

Investigations:

• A->E
• Serum tryptase : be raised
• Post attack: skin prick testing , RAST test

Tx:
1- POSITION ( if airway, sit up , if circulation then lay them down)
2- Remove trigger if still present
3- Secure Airway + O2
4- Administer 0.5ug Adrenaline IM (1:1000)
5- Secure IV access
6- 10 mg chlorpheniramine (IV), 200mg hydrocortisone (IV)
7- Fluid bolus

After: specialist allergy service referral, Teach to self inject and stay away from allergens

Question 4

What are the symptoms of acute asthma and causes?

Answer 4

SOB, wheeze, cough and chest tightness

Causes: 1- Viral (rhinovirus) , 2- Bacterial (pneumonia )

Question 5

What are the investigations of acute asthma?

Answer 5

Investigations:
1- A-E approach

Bedside: PEFR, ECG, ABG, SaO2

Bloods: Full set

Imaging: CXR

Question 6

What are the severity categories of acute asthma?

Answer 6

PEF:
>50-75% - Moderate

33-50% - Severe ( RR>25, pulse> 110)

<33% - Life threatening (O2< 92%, silent chest)

Question 7

What is the management of acute asthma?

Answer 7

1- Sit patient
2-Oxygen (15L re-breather mask)
3-Neb salbutamol (4 hourly)
4- Steroids (IV hydrocortisone or Oral prednisolone [5-7 days ])

If no improvements:

1- neb ipratropium bromide
2- IV magnesium sulphate
3- IV aminophylline
4- Intubate / Ventilate - call ITU anaesthetics

Question 8

When can acute asthmatics go home?

Answer 8

After being monitored on a ward hourly up to 4 hours. peak flow >75% and SpO2 > 94%

inhaler technique, peak flow diary and trigger avoidance (smoke, allergens and NSAIDS/B-blockers) , ensure vaccinated

Safety net: Personalised Asthma Action Plan (PAAP) + inform GP within 24 hours of discharge

Question 9

What is COPD?

Answer 9

Chronic progressive lung disease= chronic bronchitis + emphysema

Question 10

What investigations would you carry out in acute exacerbation of COPD?

Answer 10

Bedside: ECG, ABG, sputum sample
Bloods: FBC, U&E, CRP
Imaging: CXR

Question 11

What management would you carry out in acute exacerbation of COPD?

Answer 11

1- Bronchodilator: Neb. salbutamol 5mg/4hr (STAT) + Neb Ipratropium bromide

2- O2 in low sats 
 (Depends if CO2 retainers or not) 
-CO2 retainers (O2 < 88%-92% venturi mask) 
-Non retainers(non-breather mask) 
-Start ABG 30 mins after 02 therapy 

3- Steroids: IV hydrocortisone or Oral prednisolone

4- Abx on trust guidelines

If no response: ICU

• IV aminophylline
• BiPAP (biphasic NIV)

Before discharge:

• Measure spirometry
• inhaler technique
• physio