Respiratory Flashcards
Management of COPD
- smoking cessation
- vaccine: flu and pneumococcal
- avoid places with polluted air and irritants
- optimize function: exercise, nutrition
- review comorbidities: CVS, anxiety, depression
- pulmonary rehab if symptomatic
Drugs for COPD
Bronchodilator
Long acting bronchodilator
ICS
Investigating pulmonary embolism
Risk stratify with Wells, and then PERC. if wells less than 4, do PERC. If PERC 0, no PE. If PERL more than 0, do d-dimer. D-dimer positive, imaging, negative do nothing. If wells 4 or more, imaging.
Imaging: CTPA or V/Q scan, echo if severely compromised. CXR TRO others.
ECG, ABG, U&E, FBC, clotting
Wells Score PE
3 Clinical s&s of PE
3 PE most likely diagnosis
1.5 Tachycardia
1.5 Immobilised 3 days or more or surgery within the past 4 weeks
1.5 Previous DVT/PE
1 Hemoptysis
1 Malignancy with treatment within 6 months or palliative
Managing PE in GP setting
O2 (once patient presents with SOB)
Send to hospital for CTPA or VQ scan, CXR, FBC, ESR/CRP, U&E, d-dimer, clotting, ABG
Managing PE in hospital
Anticoagulant: dalteparin, enoxaparin, warfarin after 3-4 days
O2 and morphine
Thrombolysis in some cases
Symptoms of PE
Acute SOB, pleuritic chest pain, cough, hemoptysis, syncope
hypotension, tachycardia, tachypnea, gallop rhythm, increased JVP, RV heave, pleural rub, cyanosis, swollen leg
Managing pneumonia in GP setting
Rest Fluids S.pneumoniae: amoxicillin 500g oral TDS for 5 days (must complete) Analgesia Lifestyle advice Prevention: avoid smoking, take influenza injection and pneumococcal, screening Provide brochure Arrange follow-up
Atypical pneumonia triad and management
Flu, headache, dry cough
Fever, malaise, minimal resp symptoms
Mycoplasma pneumonia management: doxycycline 200mg stat then 100mg daily for 14 days
Pharmaco (long-term) management of asthma based on new GINA guidelines
Step 1: Symptoms less than twice a month
- As-needed low-dose ICS-formoterol
Step 2: Symptoms twice a month or more, but less than daily
- Daily low dose ICS OR as-needed low-dose ICS-formoterol
Step 3: Shmptoms most days, or waking with asthma once a week or more
- Low-dose ICS-LABA daily
Step 4: Symptoms most days, or waking with asthma once a week or more, or low lung function
- Medium dose ICS-LABA
Step 5
- High-dose ICS-LABA
- refer for phenotypic assessment +/- add on therapy like tiotropium, anti-IgE, anti-IL5, anti-IL4R
Long-term management of asthma
Assess - symptom control and modifiable RF - comorbidities - inhaler technique and adherence - patient preferences and goals Adjust - treat modifiable RF and comorbidities - non-pharmaco strategies - asthma medications adjust Review Response - symptoms - exacerbation - SE - lung function - patient satisfaction
Tests to diagnose asthma
Spirometery
PEFR
- History of variable respiratory symptoms
- Evidence of variable expiratory airflow/limitation
- FEV1/FVC <75
- if after SABA it increases by more than 200 ml or >12% than prior
- average PEF variability is >10% (13 in kids)
- if increase by more than 12% or 200ml from baseline after 4 weeks of anti-inflammatory
Patho of asthma
- infiltration of mucosa by inflammatory cells and cellular elements
- airway hyperresponsiveness
- intermitttent airway narrowing
Acute bronchitis diagnosis and a management
X-ray if tachypnea, tachycardia, SOB
Mx:
B2 agonists if wheezing
Dextrometorphan
If bacterial (fever, increased sputum amount and sputum purulent) - amoxicillin/doxy
Chronic bronchitis definition
Chronic productive cough for at least 3 successive months in 2 successive years
